Combining the perspectives of midwives and doctors improves risk assessment in early pregnancy

Abstract

Background: Traditionally, risk identification in early pregnancy in Swedish antenatal care [ANC] is performed by the midwife at booking, and confirmed by the doctor at a routine visit in early pregnancy, but this extra visit has been questioned. This study compared the risk assessment by the two professions.

Methods: In a cluster randomised trial, a planning conference, where midwives reported new mothers to a doctor, replaced the routine consultation with the doctor. Ten ANC-clinics with the new program (942 mothers) were compared to 10 clinics with standard care (758 mothers). Risk factors were registered independently by midwives and doctors. Degree of agreement in risk identification between midwives and doctors was estimated by the kappa coefficient.

Results: The degree of agreement in risk registration was good for previous pregnancy complications (kappa = 0.62; CI: 0.55-0.68), and recommendations for the doctor's consultation (kappa = 0.67; CI: 0.62-0.72); fair for social problems (kappa = 0.29; CI: 0.03-0.55), and poor for registration of symptoms and problems in index pregnancy (kappa = 0.09; CI: 0.03-0.21) and psychosocial aspects, such as anxiety (kappa = 0.09; CI: 0.03-0.21). Significantly more risk factors were registered in the study group.

Conclusions: Replacing the routine consultation with the doctor early in pregnancy with a planning conference had no negative impact on risk identification. The results support that the different perspectives of the two professions in combination are important for the safety of surveillance and the psychosocial support expected from antenatal care.