Important Components of Antenatal Care: Midwives'and Obstetricians'Views
Authors: Haertsch Maggie , Campbell Elizabeth , Sanson‐Fisher Rob 
Published: February 2008

EDITORIAL COMMENT: We accepted this paper for publication because it is appropriate for the ‘Guidelines for Antenatal Care ‘issued by the National Health and Medical Research Council in 1988 to be reconsidered at least every 5–10 years. In Victoria the Consultative Council on Obstetric and Paediatric Mortality and Morbidity publishes ‘Standards of Antenatal Care’ in its annual report which is distributed to all practising obstetricians and midwives in Victoria. These recommendations are adapted from the bulletins prepared by the National Health and Medical Research Council and are reviewed each year when the report is prepared. The Royal College of Obstetricians and Gynaecologists also has circulated recommendations for antenatal testing to all its fellows, members and diplomates and this journal had carried editorial comment on the subject. It is difficult, perhaps impossible, to reach consensus even on the relatively simple matter of the routine tests to be performed during pregnancy. There are powerful advocates for various tests and each expert body seems able to provide data that establish the cost‐effectiveness of the test(s) they recommend. This applies to ultrasonography for recognition of fetal malformations, including Down syndrome (10–12 week test for nuchal translucency), triple plasma testing for Down syndrome, and a screening test for gestational diabetes. When one considers the multitudinous testing of very small premature infants, sometimes such that replacement blood transfusion is necessary, it seems to the editor of this journal, that a test of fetoplacental function at 30–34 weeks' gestation should be performed in all women, since this may prevent mortality/ morbidity in normally developed mature infants who are likely to require a minimum of care if delivered at the appropriate time. Routine serological testing for syphilis is one test that has commanded editorial comment in most journals and always has been considered to be necessary. Testing for vaginal Group B haemolytic streptococcal infection has also been discussed extensively, but other routine tests have excited less comment. The other items mentioned in this paper such as health promotion, and psychosocial and organizational components of antenatal care are more difficult to quantify but are also important. Let the debate continue, but in the meantime each obstetrics hospital staff should have an agreed protocol for antenatal testing and audit of its performance by its individual medical/nursing practitioners. In the case of private patients where tests are performed in laboratories other than those of the hospital for confinement, it is the duty of the practitioner to ensure that a copy of the test result is available for inclusion in the woman's hospital record (and perhaps in the antenatal record held by her) so that the results are available to allow appropriate care at delivery, not to mention accurate and complete coding in the hospital record for purposes of patient care and research.

Summary: This study sought the views of midwives and obstetricians about what they considered to be important aspects of routine antenatal care. Midwives and obstetricians were randomly selected from the NSW membership lists of the Australian College of Midwives and The Royal Australian College of Obstetricians and Gynaecologists, respectively. Seventy‐eight percent of midwives (n=196) and 52% of obstetricians (n=114) completed a questionnaire which itemised components of routine care derived from the National Health and Medical Research Council's Guidelines for Antenatal Care. Participants were asked to rate each of the 77 components on a 4‐point scale as either: very important; desirable but not essential; not necessary; or, don't know. Twenty‐four (31%) of the components were rated as very important by at least 90% of midwives and 19 (22%) were rated as very important by at least 90% of obstetricians. ‘Recording details of previous pregnancy complications' was the component most commonly rated as being very important by bodi groups. On 37 (48%) of the components there was a significant difference between midwives and obstetricians in terms of whether or not they rated the component as very important (p<0.01). There were considerable differences between midwives' and obstetricians' views about the important components of routine antenatal care and a substantial proportion of both groups did not consider many of the components listed in the guidelines to be essential in routine care. The findings suggest that a revision of the current antenatal care guidelines is necessary.