GP involvement in the care of pregnant women has declined significantly over the past 30 years and midwives are now the main health care providers for 'low risk' pregnancies. The role of GPs in maternity care could disappear completely, unless valid future responsibilities can be defined and clarified.
Related document: The role of GPs in maternity care - what does the future hold?
What did we explore?
To inform its work, the Inquiry panel commissioned a discussion paper to examine what good-quality maternity care looks like and the implications for general practice. The role of GPs in maternity care – what does the future hold? assesses the current state of general practice involvement in maternity care, what GPs can do to stimulate and maintain care quality, and how care quality can be measured. The paper's authors are Alex Smith, former Health Policy Researcher, The King's Fund, and Judy Shakespeare, GP.
What have we learnt about maternity care?
Key issues raised for debate include:
- The implications for a woman's general health care, both physical and psychological, if GPs are not involved in maternity care.
- The role of general practice in meeting the stated preferences of pregnant women for continuity of care and post-natal support.
- The potential for GPs to provide co-ordination and advocacy for women who have complicated medical histories in addition to being pregnant.
What's your view?
Antenatal care for first time mothers: a discrete choice experiment of women's views on alternative packages of care , 12 April 2010
M. Deverill, E. Lancsar, V.B.A. Snaith, S.C. Robson
European Journal of Obstetrics & Gynecology and Reproductive Biology July 2010 (Vol. 151, Issue 1, Pages 33-37)
The current problems in maternity care are caused not by the principle of less GP involvement but rather by the lack of supportive systems to make the role of the lead carer, midwife or consultant obstetrician, easier and seamless. A partnership needs to emerge between the health professionals involved in the care of pregnant women, when they are well and when they are unwell.
Birth is a normal, physiological process and the majority of women who are healthy, with a straightforward pregnancy, do not require medical involvement either at general practitioner or hospital consultant level. A social model of care is therefore preferable which is why midwife-led care should be offered to all women. Some women will benefit from the involvement of a GP or require specialist help from dieticians, substance abuse services or social services and some will want to maintain their relationship with their GP. However, many women find getting to know a midwife they can trust and who will be with them thought their pregnancy and birth is vital.
Pregnant women in England currently have a choice to receive their care from their GP or a midwife. The midwife will explain this choice to them when they book their first visit.
GP knowledge on maternity issues has fallen behind current evidence and a considerable amount of retraining will be required to enable them to fulfill their role in pregnancy in relation to the health of the woman and the baby who have medical needs. Even more training would be required if GPs are expected to deal with the pregnancy and birth and the post partum period, as a midwife would.
In the current, cost conscious climate, the most effective solution would be for a pregnant woman to book in with a midwife, for the midwife to have her medical records on her first visit, and the midwife then informing the GP of the pregnancy of one of their patients. Where there are pre-existing medical problems, the woman should be referred by the midwife to the appropriate service, which may be the GP or may be other services.
Should the women have other medical/ill health issues, not connected to pregnancy arise, then the GP is the right person to see. And the appropriate referrals to the Obstetric team when necessary.
I would also like to see the 6 week postnatal check for mother and baby, also within the midwife's domain.
I wonder if this issue is really about the "funding" for GP shared care. Perhaps this money should go into the provision of more midwives who can then provide a case loading model of care and continuity for all women. Have enough midwives to honor the commitment to home births and Midwifery led birth centres.
As just starting out in this career, I have hopes for the future and it isn't going backwards .
There is no evidence to suggest that todays GP's can contribute to improved maternity care and indeed their involvement in such care can only detract from their ability to provide care for their other patients. In a time of financial contraints to suggest the reintroduction of a generalist practitioner into a specialist care model is unrealistic.
Such overt, politically motivated research is unworthy of consideration.