Five hundred and ninety-three women formed the cohort of women eligible to return completed questionnaires and 562 of these completed them (92% of those who agreed to participate).
Attitudes to pregnancy
Mean scores for the whole sample were 11.3 on the ‘pregnancy as a normal event’ scale and 11.2 on the ‘pregnancy as a risky event’ scale. There was no difference between scores for nulliparous or parous women on either scale (‘pregnancy as a normal event’P= 0.98; ‘pregnancy as a risky event’P= 0.85).
‘The way you look after yourself in pregnancy’(i.e. internal control) was felt to have greatest influence by both nulliparous and parous women, with mean scores of 4.7 for nulliparous women and 4.6 for parous women (P= 0.27). Antenatal care (i.e. external control) was viewed as the next most important influence. Nulliparous women felt that this would have a greater influence on their pregnancy outcome than parous women, mean scores 3.4 and 3.0, respectively (P= 0.0001). Chance or fate was deemed to be less important with mean scores of 2.2 and 2.4, respectively, for nulliparous and parous women (P= 0.38). ‘God’ was viewed as having least influence, with mean scores 1.5 and 1.4, respectively (P= 0.43).
The question about planning the pregnancy allowed four responses: hoping to become pregnant as soon as possible; hoping to become pregnant, but not as soon as they did; not hoping to become pregnant; and unsure how they felt. The results are shown in Table 1. More parous women (66.3%) than nulliparous (56.2%) had been hoping to become pregnant as ‘soon as possible’. More nulliparous women (70 [30%]), than parous, (54 [17.8%]) reported that they were ‘hoping to become pregnant, but not as soon as they did’. There were more parous women than nulliparous not sure or hoping not to become pregnant (χ2= 11.1, df 3, P= 0.01).
Table 1. Planning of pregnancies. Were you hoping to become pregnant? Values are given as n or n (%).
|Yes, as soon as possible||131 (56.2)||201 (66.3)||332 (61.9)|
|Not just yet||70 (30.0)||54 (17.8)||124 (23.1)|
|No||23 (9.9)||34 (11.2)||57 (10.6)|
|Unsure||9 (3.9)||14 (4.6)||23 (4.3)|
Out of a maximum of 5, scores on the different items for what women wanted to get out of their antenatal care were as follows: ‘wanting reassurance’(4.8); ‘an opportunity to talk about worries’(4.4); ‘an opportunity to ask questions’(4.4). There were no differences between nulliparous and parous women. However, ‘time to talk about labour and the birth’ was rated more important by nulliparous than by parous women (mean scores 4.3 and 3.8, P < 0.001).
When asked what pattern of care they had hoped they would receive (traditional or flexible), 267 (47.5%) reported that they did not have a preference. Nulliparous women were less likely to express a preference than parous women (55% not having a preference vs 46% of parous women; P < 0.01). Unfortunately, the study design did not allow this question to be asked before women were actually randomised, and Table 2 shows that there is a strong influence (among those who expressed a preference) of women stating a preference for their allocated group. Of the 268 women who did express a preference, 164 (61%) preferred traditional care. There was no significant difference (at the 1% level) between the numbers of nulliparous and parous women preferring traditional care (56% of nulliparous women expressing a preference, compared with 69% of parous women, P= 0.03).
Table 2. Preference for care type. Which group did you hope to join? Values are given as n or n (%).
|Traditional care||115 (72.8)||49 (44.5)||164|
|Flexible care||43 (27.2)||61 (55.5)||104|
|χ2= 21.7; df 1; P < 0.001.|| || || |
Among women who expressed a preference, those who had been planning to become pregnant were more likely to prefer traditional care than women whose pregnancy was unplanned (67% compared with 48%, P= 0.006).
Apart from parity and whether the pregnancy was planned, other factors examined (e.g. age, educational attainment, feelings concerning the previous pregnancy, attitudes to pregnancy as a normal or a risky event and locus of control) were not associated with differences in women's preferences for a particular pattern of care.
A small number of women, both nulliparous and parous in both groups, commented spontaneously on a lack of care and information in early pregnancy and felt that this was an aspect of antenatal care in need of improvement.
Table 3 shows how well women thought their general practitioners knew them as individuals. The data showed a predictable effect that women feel better known the longer they have been registered with a general practitioner. The proportion reporting that they felt they were well known was 11.2% if registered for less than two years, compared with 25% if registered for more than 10 years. Parous women did not report feeling better known than nulliparous women (Table 3). How well they felt known by their general practitioner did not influence their preference for a particular pattern of care.
Table 3. Relationship with general practitioner. How well do you think your general practitioner knows you? Values are given as n or n (%).
|Not at all||39 (17.1)||46 (15.2)||85|
|Know a little about me||144 (63.2)||186 (61.4)||330|
|They know me well||45 (19.7)||71 (23.4)||116|
As stated above, women were randomised to flexible or traditional groups before completing the first questionnaire. In order to ensure that allocation had not influenced questionnaire responses, a stratified analysis was carried out, comparing the responses given by the two groups. Apart from the effect on preference for type of care, the stratified analysis showed no differences between the traditional and flexible groups in terms of attitudes to pregnancy, locus of control, planning of pregnancy and expectations of care.