SUPPORT Summaries
Evidence of the effects of health system interventions
for low- and middle-income countries
Evidence of the effects of health system interventions
for low- and middle-income countries
August, 2016 - SUPPORT Summary of a systematic review | print this article | download PDF
Improvements in antenatal care have included changes to traditional practices in order to improve womens’ experiences of antenatal care and the clinical outcomes of maternity care. One such change has been giving women their own clinical case notes to carry throughout their pregnancy in order to enable women to participate in the decision making regarding their healthcare, and to improve the availability of the records when needed.
Key messages
-may lead to an increase in assisted deliveries;
-may lead to a slight increase in epidural analgesia;
-may lead to little or no difference in miscarriages, stillbirths or neonatal deaths, breastfeeding initiation, or smoking cessation;
-probably feel more in control and involved in decision making about their care, and want to carry their notes again in subsequent pregnancies;
-may be slightly more satisfied with antenatal care;
-may lead to little or no difference in availability of complete antenatal records at the time of delivery or loss of case notes.
-Access to and utilisation of antenatal care.
-Literacy rates of women and care providers.
People making decisions concerning improvements to antenatal and maternal care.
Brown HC, Smith HJ. Giving women their own case notes to carry during pregnancy. Cochrane Database of Systematic Reviews 2004. Issue 2. Art. No.:CD002856
A summary of studies addressing a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise the relevant research, and to collect and analyse data from the included studies.
SUPPORT – was an international project to support the use of policy relevant reviews and trials to inform decisions about maternal and child health in low- and middle-income countries, funded by the European Commission (FP6) and the Canadian Institutes of Health Research.
In seeking better ways to deliver antenatal care, giving women their own clinical case notes to carry during pregnancy has several potential benefits. It is perceived as empowering women and could facilitate greater participation in clinical care decisions. When women move from one facility to another, it could also ensure that the records are available and that all healthcare providers write in one record, potentially reducing clinical error and improving continuity of care. It has also been hypothesised that women who take responsibility for their own case notes will exhibit other improved health behaviours such as reduced smoking, improved breastfeeding and a reduced need for analgesia in labour. Although this is already practised in high, middle and low income settings, evidence of its effectiveness is not widely available.
This summary is based on a systematic review assessing the effects of giving women their own case notes to carry during pregnancy in studies conducted in high-income countries. An updated version of this review found one additional randomized trial, which did not change the conclusions of the review (See related literature). This summary has not yet been updated to incorporate the additional trial.
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Review objectives: To evaluate the effects of women carrying their own case notes during pregnancy. |
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| Types of | What the review authors searched for | What the review authors found |
|---|---|---|
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Study designs & interventions |
Randomized trials of interventions in which pregnant women were given their own case notes to carry during pregnancy. |
Three trials in which pregnant women were given their complete antenatal records to carry and control groups were given a coop card (short summary card with no clinical progress information). |
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Participants |
Pregnant women. |
Pregnant women recruited at their first antenatal booking visit. |
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Settings |
Antenatal care services. |
Antenatal care services within the public health sector in the UK (2) and Australia (1). |
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Outcomes |
Primary: maternal satisfaction and control, administrative efficiency. Secondary: partner involvement, health related behaviours, clinical outcomes. |
Primary: maternal satisfaction and control (3), admnistrative efficiency information (2). Secondary: Breastfeeding initiation (1), smoking cessation (2), and clinical outcomes (1). |
| Date of most recent search: March 2011 | ||
| Limitations: This is a well-conducted systematic review with only minor limitations. An updated version of this review found one additional randomized trial, which did not change the conclusions of the review (See related literature). This summary has not yet been updated to incorporate the additional trial. | ||
Brown HC, Smith HJ. Giving women their own case notes to carry during pregnancy. Cochrane Database of Systematic Reviews 2004. Issue 2. Art. No.:CD002856
High: This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different† is low.
Moderate: This research provides a good indication of the likely effect. The likelihood that effect will be substantially different† is moderate.
Low: This research provides some indication of the likely effect. Howevver, the likelihood that it will be substantially different† is high.
Very low: This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different† is very high.
* This is sometimes referred to as 'quality of evidence' or 'confidence in the estimate'.
† Substantially different = a large enough difference that it might affect a decision.
See last page for more information.
Three trials in high-income countries assessed the effects of women carrying their own case notes compared to women carrying a coop card (a short summary card with no clinical progress information).
1) Behavioural and clinical outcomes
None of the studies assessed partner involvement directly. Two studies assessed smoking cessation, one assessed breastfeeding initiation, and one assessed clinical outcomes (such as assisted deliveries, use of epidural analgesia, miscarriages, stillbirths, and neonatal deaths). Data for smoking cessation was not provided, and its effect was reported in the narrative of the review. The studies found that giving women their case notes to carry:
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Behavioural and clinical outcomes |
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People: Pregnant women. |
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| Outcomes |
Absolute effect* |
Relative effect (95% CI) |
Certainty of the evidence (GRADE) |
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Without women carrying notes |
With women carrying notes |
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Assisted delivery |
16 per 100 |
29 per 100 |
RR 1.83 (1.08 to 3.12) |
Low |
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Difference: 13 more assisted deliveries per 100 pregnant women. (Margin of error: 1 to 33 more). |
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Epidural analgesia |
27 per 100 |
38 per 100 |
RR 1.43 (0.96 to 2.13) |
Low |
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Difference: 11 more epidural analgesia per 100 pregnant women. (Margin of error: 1 fewer to 30 more). |
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Miscarriage |
6 per 100 |
8 per 100 |
RR 1.19 (0.45 to 3.16) |
Low |
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Difference: 2 more miscarriages per 100 pregnant women. (Margin of error: 3 fewer to 14 more). |
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Stillborn or Neonatal death |
2 per 100 |
2 per 100 |
RR 1.04 (0.15 to 7.24) |
Low |
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Difference: no stillborn or neonatal deaths per 100 pregnant women. (Margin of error: 2 fewer to 11 more). |
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Breastfeeding initiation |
77 per 105 (77.1%) |
79 per 98 (78.6%) |
RR 1.02 (0.88 to 1.18) |
Low |
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Difference: 2 more breastfeeding initiations per 100 pregnant women. (Margin of error: 9 fewer to 14 more). |
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| Margin of error = Confidence interval (95% CI) RR: Risk ratio GRADE: GRADE Working Group grades of evidence (see above and last page). | ||||||
| * The risk WITHOUT the intervention is based on pregnant women not carrying their clinical case notes. The corresponding risk WITH the intervention (and the 95% confidence interval for the difference) is based on the overall relative effect (and its 95% confidence interval). |
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2) Other outcomes
Two trials reported on women’s feeling in control and involvement in decision making, one reported on satisfaction with antenatal care received, and all three reported on the proportion of women who wanted to carry their own case notes in a subsequent pregnancy. Evidence from the trials showed that women carrying their own case notes:
| Findings | Interpretation* |
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| APPLICABILITY | |
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| EQUITY | |
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| ECONOMIC CONSIDERATIONS | |
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| MONITORING & EVALUATION | |
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| *Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low-income countries. For additional details about how these judgements were made see: http://www.supportsummaries.org/methods | |
Related literature
Updated version of this review: Brown HC, Smith HJ, Mori R, Noma H. Giving women their own case notes to carry during pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD002856. DOI: 10.1002/14651858.CD002856.pub3.
Elbourne D, Richardson M, Chalmers I, Waterhouse I, Holt E. The Newbury Maternity Care Study: a randomised controlled trial to assess a policy of women holding their own obstetric records. British Journal of Obstetrics and Gynaecology 1987; 94:612-9.
Homer CSE, Davis GK, Everitt LS. The introduction of a woman health record into a hospital antenatal clinic: the bring your own records study. Australian and New Zealand Journal of Obstetrics and Gynaecology 1999; 39(1): 54-7.
Lovell A, Zander LI, James CE, Foot S, Swan Av, Reynolds A. The St Thomas’s Hospital maternity case notes study: a randomised controlled trial to assess the effects of giving expectant mothers their own maternity case notes. Paediatrics and Perinatal Epidemiology 1987; 1:57-66.
This summary was prepared by
Lilian D Dudley, South African Cochrane Centre, Medical Research Council, South Africa and Charles Shey Wiysonge, Centre for Evidence-based Health Care, Stellenbosch University, & Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
Conflict of interest
None declared. For details, see: www.supportsummaries.org/coi
Acknowledgements
This summary has been peer reviewed by: Heather Brown, Mario Festin, Lelia Duley, Esperança Sevene, Alda do Rosário Elias Mariano, Julie Cliff, and Hanna Bergman
This review should be cited as
Brown HC, Smith HJ. Giving women their own case notes to carry during pregnancy. Cochrane Database of Systematic Reviews 2004. Issue 2. Art. No.: CD002856.
The summary should be cited as
Dudley LD, Wiysonge CS. Does giving women their own case notes to carry in pregnancy improve maternal care? A SUPPORT Summary of a systematic review. August 2016. www.supportsummaries.org
Keywords
evidence-informed health policy, evidence-based, systematic review, health systems research, health care, low and middle-income countries, developing countries, primary health care, maternal care, antenatal care, pregnancy care, antenatal records, antenatal case notes.
