Support and reassurance in antenatal care: a randomised controlled trial of a telephone support intervention with and without uterine artery Doppler screeening for low risk nulliparous women

Abstract

Background: The number of routine antenatal visits provided to low risk nulliparous women, has been reduced as recommended (NCCWCH 2008) . It was recognised that this change in care may result in women being less satisfied with care and having poorer psychosocial outcomes. The guidelines identified the need for further research to investigate alternative methods of providing women with information and support during pregnancy. Objectives: To investigate whether the provision of proactive telephone support with and without uterine artery Doppler screening (UADS) would reduce the total number of antenatal visits required and affect the psychological outcomes measured. Methods: The study used a mixed methods approach. 840 low risk nulliparous women were recruited to a three arm randomised controlled trial. Women in the control group received standard care, those in the Telephone intervention group (T), received a telephone call from a midwife at 28, 33 and 36 weeks and women in the telephone and Doppler group (T+D) received the telephone support intervention and uterine artery Doppler screening at 20 gestation. The primary outcome measure was the total number of antenatal visits received. Semi structured interviews were undertaken with 45 women to investigate their views of the interventions and the antenatal care they received. Results: The median number of unscheduled (n=2.0), scheduled visits (n=7.0) and mean number of total visits (n=8.8) were similar in the three groups. Additional support was not associated with differences in clinical outcomes, levels of anxiety, social support or satisfaction with care. Perceptions of antenatal care were affected by women’s perceptions of their pregnancy, the structure of care and the way the care was delivered by their midwife. Conclusion: Further research is required to investigate alternative methods of providing women with support during pregnancy, in particular the utilisation of new technologies.