ABSTRACTObjective: The aim of the study was to determine the effect of the woman held antenatal record card (PNC2) on the continuity of maternity care received when presenting to the acute rural setting for clinical assessment. Design: Qualitative, open‐ended questionnaires. Setting: Rural New South Wales public hospital. Subjects: Maternity consumers, 50 women who were inpatients receiving antenatal or postnatal care between August and October 1998. A stratified sample of healthcare professionals employed by the service, 12 midwives and 13 general practitioners. Main outcome measure: The self reported use of the antenatal card and the viewed effects of the card on the continuity of healthcare received. Results: The study identified a significant difference between the responding professionals (93%) positive perception of the effect of the PNC2 on the women's pregnancy continuum of care and the maternity consumer (36%), who felt it bore little impact on their care. The study findings suggested a lack of compliance and standardisation in usage of the antenatal card negated any flow on effects for the women. Conclusions: The intended purposes of the PNC2 were compromised in this rural setting. The study recommends that stakeholders in rural maternity care be accountable for examining the benefits and barriers of their antenatal practices, that the rural community's expectations of ‘continuity of maternity care’ are sought and that there should be a review of the available models of rural antenatal care. What is already known: The woman held antenatal record has been reported to be an effective approach for enabling consumers to participate in their maternity care, whilst also address the concerns of continuity, safety and information sharing. This form of medical record has been strongly supported by the National Health and Medical Research Council and NSW Health as a professional and consumer friendly strategy. The usage or the effects of the antenatal record in rural New South Wales settings have yet to be widely evaluated. What this study adds: The study's questionnaire responses identified that the antenatal record may have met the needs of rural health professionals, however, the maternity care consumers were unaware of these benefits. The study suggests that the antenatal record was operationalised at the discretion and for the convenience of the rural health care professional. Identifying rural communities perceptions of continuity of care and the need to explore models of care that promote continuity in rural areas, where significant findings of the study.