Giving women their own case notes to carry during pregnancy

Overall, the quality of the evidence was graded as low to moderate. The updated search identified one cluster-randomised trial, which was included.

Women carrying their own case notes improves their sense of control and the availability of antenatal records, but insufficient evidence of additional effects.

In some healthcare systems women are given their own case notes to look after and bring to each antenatal visit. This review of four trials, involving 1176 women, suggests that there are both potential benefits (increased availability of antenatal records during hospital attendance, and increased maternal control) and harms (more operative deliveries). All the trials reported that more women in the case notes group would prefer to hold their antenatal records in another pregnancy, but there was not enough evidence to determine the effect of women carrying their own case notes on health behaviours such as smoking and breastfeeding, women's satisfaction, and clinical outcomes.

Authors' conclusions: 

The four trials are small, and not all of them reported on all outcomes. The results suggest that there are both potential benefits (increased maternal control and increased availability of antenatal records during hospital attendance) and harms (more operative deliveries). Importantly, all of the trials report that more women in the case notes group would prefer to carry their antenatal records in another pregnancy. There is insufficient evidence on health-related behaviours (smoking and breastfeeding), women's satisfaction, and clinical outcomes. It is important to emphasise that this review shows a lack of evidence of benefit rather than evidence of no benefit.

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Background: 

In many countries women are given their own case notes to carry during pregnancy to increase their sense of control over, and satisfaction with, their care.

Objectives: 

To evaluate the effects of giving women their own case notes to carry during pregnancy.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2015) and reference lists of retrieved studies.

Selection criteria: 

Randomised controlled trials of women given their own case notes to carry during pregnancy.

Data collection and analysis: 

Two review authors independently applied the inclusion criteria and assessed study quality. One review author extracted data from the included studies using a standard form (checked by second review author). We assessed estimates of effect using risk ratio (RR) with 95% confidence intervals (CI). The quality of the evidence was assessed using the GRADE approach.

Main results: 

Four trials were included (n = 1176 women). Overall, the quality of the evidence was graded as low to moderate mainly due to the nature of the intervention not allowing blinding. The updated search identified one cluster-randomised trial, which was included.

Women carrying their own notes were more likely to feel in control (two trials, RR 1.56, 95% CI 1.18 to 2.06; 450 women; moderate quality evidence), although there is no evidence of difference in women's satisfaction (two trials, average RR 1.09, 95% CI 0.92 to 1.29); 698 women; low quality evidence). More women in the case notes group wanted to carry their own notes in a subsequent pregnancy (three trials, RR 1.79, 95% CI 1.57 to 2.03; 552 women; low quality evidence). Overall, the pooled estimate of the two trials (n = 347) that reported on the risk of notes lost or left at home was not significant (average RR 0.38, 95% CI 0.04 to 3.84). There was no evidence of difference for health-related behaviours (cigarette smoking and breastfeeding (moderate quality evidence)), analgesia needs during labour (low quality evidence), maternal depression, miscarriage, stillbirth and neonatal deaths (moderate quality evidence). More women in the case notes group had operative deliveries (one trial, RR 1.83, 95% CI 1.08 to 3.12; 212 women), and caesarean sections (one trial, average RR 1.51, 95% CI 1.10 to 2.08; 501 women; moderate quality evidence).

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