Maternity care in general practice

This content relates to the following topics:

Part of Inquiry into the quality of general practice in England

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?

During the inquiry, we asked for your opinions on this care dimension. You can read the comments submitted below. You can also read the response to this paper from the Royal College of Midwives

Related content

Comments

Geoffrey Rivett

Organisation
Homerton Foundation Trust
Comment date
04 August 2010
A valuable document. I am incorporating it in my NHS history www.nhshistory.net and want to reference it. At present I can hyperlink to the report but my experience is that links to KF documents often fail as the documents are sooner or later removed from the website. Do you give such reports doi numbers and ensure permanent availability?
Regards

Geoffrey Rivett

Katie Mantell

Position
Head of New Media,
Organisation
The King's Fund
Comment date
04 August 2010
Geoffrey, thanks for your comment, and for referencing the document. We don’t give our reports DOI numbers at the moment. However, we won’t be removing the document from the website. Do contact the web team directly at website@kingsfund.org.uk if you have problems locating previous documents and we’ll be happy to help. Regards, Katie

Mark Deverill

Position
Senior Lect. Health Economics,
Organisation
Newcastle University
Comment date
05 August 2010
see our recent paper that suggests women prefer antenatal care from midwives

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)

Ed Wallace

Position
Clinical Lead,
Organisation
GNEF teaching CHP Fife
Comment date
05 August 2010
Timely discussion. I think that we underestimate the importance of the relationship between GPs and pregnant women. e.g. Research has shown that anxiety can increase the risk of adverse outcomes in pregnancy and that a good relationship with Midwife and GP can reduce anxiety levels and reduce complications

Dr. Margaret M…

Position
Chief Executive Officer,
Organisation
Action on Pre-eclampsia
Comment date
05 August 2010
At last recognition that antenatal and postnatal care is of such importance, it is crucial that GPs are actively involved. Not only is it important tht GPs update themselves on the latest NICE guidelines and current knowledge, but also that they seek to actively connect with the midwives and obstetricans also involved. Better handover and information sharing systems would give the necessary level of care and reassurance to pregnant women - my organisation runs day seminars and workshops on community care for the most dangerous and common diseases of pregnancy - hypertensive diseases of pregnancy - and yet we struggle to get a single GP to attend. There are new NICE guidelines out this year and Action on Pre-eclampsia has a seminar on their implementation in London in December and GPs would be very welcome.

Belinda Phipps

Position
Chief Executive,
Organisation
NCT
Comment date
05 August 2010
This report comes at a time when maternity services are under close scrutiny and though it makes some useful suggestions, the preferred model of care would be to continue to provide choice of carer and to actively promote midwife-led care to women.

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.

Rhonda Crockett

Position
3rd yr student midwife,
Organisation
NHS
Comment date
05 August 2010
Pregnant women with no other "medical issue" or obstetric risks should have care provided by a midwife If shared care is then necessary then referral by the midwife to the Obstetric consultants would be all that would be appropriate. Then with the women plan the care she would like. With Children's centres in the community, women are able to have their care by the midwives, the experts in Normal childbirth, away from "sick" people in waiting rooms. I would like to see Midwife prescribers, so that women do not have to then see their GP when a low HB, or Candida infection or when other common pregnancy ailment occurs.
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 .

Clare

Comment date
05 August 2010
As a mother of 2 boys one only 5 months, I personally prefer midwife led care - my expereince and that of friends is that not all GP are well informed and this can lead to mixed messages, confusion and stress - also extra appointments are also not welcome. That said if there are any medical issues that may impact on birth and preganacy GP's input can very useful but I think this should be exception rather than the rule

Janet Patience

Position
Midwife,
Comment date
04 August 2010
The basic premise of this document as outlined in the introduction is "This paper asks whether there still is a role for GPs in maternity care." and it is therefore a flawed document.
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.

Maureen Treadwekk

Position
BTA Committee,
Organisation
BTA
Comment date
04 August 2010
This document is absolutely excellent – particularly its incisive final conclusions. “The GP should be part of an effective team in which the roles, responsibilities and lines of communication are clear. Collaboration, co-operation, communication and competence are key.” So many of the tragic cases that our organisation encounters result from poor teamwork, poor communication and lack of skills and knowledge. This is costly primarily in human terms but also because the NHS is wasting huge amounts in litigation. Childbirth is often a straightforward event but complications are extremely common; women are having bigger babies later in life, there is more IVF and more obesity. Most women might hope for an uncomplicated pregnancy birth but they also want health care professionals to be alert to potential problems including those that may be unrelated to pregnancy. Midwives are trained to deal with uncomplicated births in healthy women – indeed their focus is often described as ‘promoting normality’. Whilst this may be safe in most cases, perhaps there needs to be more caution and more focus on promoting best outcomes. Many women have an excellent relationship with their GP and, providing they have choice, should not be prevented from receiving shared care from a health care professional they trust, who may know a great deal about them and could make a valuable contribution to their care.