The Royal College of Midwives' response to the role of GPs in maternity care research paper

The Royal College of Midwives (RCM) is the trade union and professional organisation that represents the vast majority of practising midwives in the UK. It is the only such organisation run by midwives and for midwives. The RCM is the voice of midwifery, providing excellence in representation, professional leadership, education and influence for and on behalf of midwives. We actively support and campaign for improvements to maternity services and provide professional leadership for one of the most established of all clinical disciplines.

The RCM broadly supports The King's Fund report findings on the role of GPs in maternity care. The RCM agrees that there is a role for GPs in maternity care. The extent of the role of GPs should be dictated by a woman's choice and by her specific needs.

Midwives are the trained professionals in normal birth. The RCM believes that care should be provided by the right professional for the right person in the right place at the right time. For maternity care this will usually mean a midwife. However there will be occasions when care is best provided by another professional. There is substantial investment in training midwives to be the experts in birth. Given the current pressures on government spending and efficiency savings needed in the health sector, it is therefore sensible to use midwives to provide the bulk of maternity care.

The RCM strongly supports choice of maternity care for all women. It should be emphasised in the report that women should be able to exercise choice when deciding on their maternity care. As highlighted in this report, most women will see their GP first when they discover that they are pregnant, though we would suggest that this varies, for example in some areas where community midwives are based in GP surgeries, receptionists refer women directly to midwives. This means they are often the first source of information, advice and referral for a woman. GPs therefore need to ensure that they are appropriately trained to provide this initial support. It is also important that GPs provide impartial advice and do not act as the gate keepers to maternity services.

Strategic policy should support choice. This includes allowing GP practices to share routine antenatal care with community midwives if this is what a woman chooses. This would help to develop on-going relationships with pregnant women and their families and enable GPs to maintain their skills. This can only happen if skills are acquired in training and maintained in practice, through continuing education. The involvement of GPs will require GPs to maintain competence in providing maternity care as well as collaborating and communicating with all other members of the maternity team to ensure the care is centred on the woman and her needs. It is also important to note that not all GPs will choose to provide maternity care. This appears to be particularly the case when there is no financial compensation for the provision of maternity care.

Communication between GPs and midwives is critical. The RCM is pleased that the report highlighted the need for two-way communication. Anecdotally we know that GP practices that still offer midwifery services generally have good communication between the GPs and the midwives. However, where the midwifery practice is outside of the GP practice, communication is often minimal or non-existent. There has been some concern expressed that having a GP as an active member of a community midwifery team would not be likely to work.

The concern has also been raised that the reduction in postnatal visits in some areas may lead to more women seeking advice from their GP when a midwife is not available. Few GPs have up-to-date knowledge on important aspects of postnatal care, for example current breastfeeding guidance and advice. This could potentially lead to women receiving conflicting advice.

Many of the concerns that have come up as a result of this report are largely a result of historical behaviours and a lack of trust between professionals. There is a distrust that everyone will behave sensibly and purely in the interests of the woman. In order to provide the best care for pregnant women, all professionals must work together, communicate effectively and respect the roles of all members of the maternity team.