Health services effects of a reduced routine programme for antenatal care. An area-based study

Abstract

Objective: To assess the consequences of a reduction of the routine programme for surveillance of normal pregnancy.

Study design: An area-based study of a total pregnant population comparing utilization of care the years before and after a new routine antenatal programme was introduced, a reduction of three to four midwife visits during the second half of pregnancy. All women from the catchment area who gave birth in 1990 (n=2008) and 1992 (n=1874) and had attended antenatal care in the area during the second half of their pregnancy, were analyzed for use of prenatal primary and secondary care, obstetric interventions, pregnancy outcome and perinatal outcome.

Result: Compliance to the programme improved, resulting in a reduction of only 1.8 visits per pregnancy. Extra visits initiated by staff increased slightly, but extra contacts initiated by the mother remained very few. There were no significant differences in maternal outcome or obstetric interventions and the rates of prematurity, low birthweight, low Apgar score and the need for neonatal interventions were equal both years.

Conclusion: This reduction of three to four scheduled visits in the traditional antenatal care programme can be done without increasing demands for extra visits, need for specialist consultations or emergencies or less favourable outcome.