Midwifery-led antenatal care models: Mapping a systematic review to an evidence-based quality framework to identify key components & characteristics of care
Start date: 18 June 2017
Place of Publication: The Hague, the Netherlands
Background: Implementing effective antenatal care is a key global policy goal. Certain antenatal care models, including midwifery continuity of care, have demonstrated improved outcomes, but the underlying causal mechanisms are poorly understood, limiting their replication. The Lancet Series on Midwifery’s Quality Maternal and Newborn Care (QMNC) framework identifies key aspects of quality care, offering the opportunity to identify systematically those effective care delivery characteristics that may be generalizable across a range of settings.
Purpose/Objective: To map the characteristics of antenatal care models tested in Randomised Controlled Trials (RCTs) to the QMNC framework, thus facilitating the identification of characteristics of effective care and promoting the replication of the most effective characteristics.
Method: Systematic review of RCTs of midwifery-led antenatal care models. Mapping and evaluation of models’ characteristics to the QMNC framework. Paired team members independently extracted data and conducted quality assessment using the QMNC framework and standard RCT criteria.
Key Findings: From 13,050 citations we identified 17 RCTs of midwifery-led antenatal care models from Australia, the United Kingdom, China, Sweden, Ireland, Mexico and Canada. QMNC framework scores ranged from 9 to 25 (possible range 0-32); most models reported fewer than half the characteristics associated with quality maternity care. Description of care model characteristics was frequently lacking; intervention arms were better reported than control arms, but still lacked detail. Organisation of care was the best-described component. Underlying values and philosophy of care were poorly reported.
Discussion: The QMNC framework facilitates assessment of care model characteristics. It is vital to understand not only what is done but why it is done, by whom, and how this differs from standard care packages. By applying the QMNC framework we have established a foundation for future reports of intervention studies so that individual model characteristics can be evaluated, and the impact of any differences appraised.
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