Giving women their own case notes to carry during pregnancy

 

Abstract

Background

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

Objectives

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

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2011).

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 with 95% confidence intervals.

Main results

Three trials were included (n = 675 women). Women carrying their own notes were more likely to feel in control (risk ratio (RR) 1.56, 95% confidence interval (CI) 1.18 to 2.06). Women's satisfaction: one trial reported more women in the case notes group (66/95) were satisfied with their care than the control group (58/102) (RR 1.22, 95% CI 0.99 to 1.52); two trials reported no difference in women's satisfaction (one trial provided no data and one trial used a 17 point satisfaction scale). More women in the case notes group wanted to carry their own notes in a subsequent pregnancy (RR 1.79, 95% CI 1.43 to 2.24). 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 (RR 0.38, 95% CI 0.04 to 3.84). There was no difference for health related behaviours (cigarette smoking and breastfeeding), analgesia needs during labour, miscarriage, stillbirth and neonatal deaths. More women in the case notes group had operative deliveries (RR 1.83, 95% CI 1.08 to 3.12).

Authors' conclusions

The three 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 satisfaction during pregnancy, 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 hold their antenatal records in another pregnancy. There is insufficient evidence on health related behaviours (smoking and breastfeeding) and clinical outcomes. It is important to emphasise that this review shows a lack of evidence of benefit rather than evidence of no benefit.

 

Plain language summary

Giving women their own case notes to carry during pregnancy

Women carrying their own case notes improves their sense of control and satisfaction 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 three trials, involving 675 women, suggests that there are both potential benefits (increased availability of antenatal records during hospital attendance, increased maternal control and satisfaction during pregnancy) 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 and clinical outcomes.

 

摘要

背景

給孕婦隨身攜帶的病歷紀錄(媽媽手冊)

在很多國家會給孕婦媽媽手冊來增加他們的自我支配感和照顧滿意度。

目標

評估給孕婦媽媽手冊的效果。

搜尋策略

我們搜尋了the Cochrane Pregnancy and Childbirth Group's Trials Register (搜尋到2007年6月)。

選擇標準

關於有否給媽媽手冊的隨機對照實驗。

資料收集與分析

兩位評論作者獨立審查符合定義相關文獻的品質。由一位作者將文獻中資料以標準格式取出(再由另一位作者複查)。我們採用95%信任區間(95%CI)的相對機率(RI)來評估預期效果。

主要結論

包含三個實驗共675位女性。擁有媽媽手冊的孕婦較有自我支配感(relative risk (RR) 1.56, 95% confidence interval (CI) 1.18 to 2.06)。關於孕婦的滿足感方面:一個實驗顯示擁有媽媽手冊的孕婦(66/95)比對照組(58/102)有較高的照顧滿意度(RR 1.22, 95% CI 0.99 to 1.52);另兩組實驗則無明顯差別(一組沒有提供資料，另一組則採用17分的滿意度量表)。擁有媽媽手冊的這組在下次懷孕時有較高比例會要求再擁有媽媽手冊(RR 1.79, 95% CI 1.43 to 2.24)。兩組實驗合併統計(n = 347)媽媽手冊遺失或留在家中忘記帶出的機率並不高(RR 0.38, 95% CI 0.04 to 3.84)。在健康相關的行為方面(吸菸和哺乳)、無痛分娩比例、流產、死產和新生兒死亡率方面則無明顯差別。擁有媽媽手冊的孕婦卻有較高比例接受剖腹生產(RR 1.83, 95% CI 1.08 to 3.12)。

作者結論

這三組實驗規模太小並且非每個實驗對於各方面預後皆有報告。結果似乎顯示優缺點並列(較高的孕期支配感和滿意度、住院時有較正確的產前紀錄，但卻有較高的剖腹產率)。然而很重要的一點，所有的實驗都顯示擁有媽媽手冊的組別於下次懷孕時會有較高的比例希望能再擁有媽媽手冊。沒有足夠的證據顯示對於健康相關的行為方面(吸菸和哺乳)和臨床預後有影響。最後必須強調的是這篇整理只是顯示出缺乏有益證據而非證明沒有任何益處。

翻譯人

本摘要由周產期醫學會(Taiwan Society of Perinatology)王鐸聲翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

孕婦擁有媽媽手冊可以增加孕婦本身的支配感、滿足感以及產前紀錄的正確性，然而在其他方面的效果仍缺乏足夠證據。某些醫療系統已會提供孕婦自行保管的媽媽手冊並於每次產檢時帶來。這篇整理似乎顯示發放媽媽手冊優缺點並列(優:增加住院時產前紀錄的正確性、較高的孕期支配感和滿意度，缺:較高的剖腹產率)。所有的實驗都顯示擁有媽媽手冊的組別於下次懷孕時會有較高的比例希望能再擁有媽媽手冊。然而沒有足夠的證據可以證明發媽媽手冊與否和健康相關的行為方面(吸菸或哺乳)或臨床預後有相關。