The Royal College of Obstetrics and Gynaecology want to know what you lot think about...

It is a little peculiar the greater majority of Gynaes being male but the clinics are set up to have a female nurse present at all times.

I think I have met one obstetrician after I had an early pg scan and I can't say I was overly taken with her.

In answer to question 1. I've seen a gynae for both abnormal smear results and for subfertility. In total I have seen 3 different gynaes in 4 different locations over 10 years. Each have had very different bedside manners. The last one who I saw for both problems I think was the best. He had a local clinic and one at his base hospital(hence 4 locations)

Due to the reasons for seeing a gynae my GPs were very good refering me.

Ime it can take far too long to see a specialist in pregnancy. I have an underactive thyroid (which was the possible cause of some of my miscarriages - untested despite recurrent mc but that's another story) and in pregnancy early review by an endocrinologist is crucial. I was almost in the second trimester by the time I got to see one. Similarly, I was referred to an obs in my second pg, due to hypothyroidism and recurrent mc, but again was well into second trimester. The obs told me that if he had seen me earlier he would have put me on Aspirin but that there was now no point.

I think the UK system is great - I had a consultant led service in both my pregnancies because thats what I wanted (NHS ) and she was fab. Midwife during my twin delivery , however was rubbish and I nearly lost a baby because of her.
Consultants should be facillitated to work and train part time to enable more parents to be Ob & Gyn specialists

'the role of the specialist doctor remains them same throughout his/her career, unlike many other professions where the challenges do not stop at the specialist level.'

Why? That's a bit wierd doncha think? It isn't as if it CAN'T. There is lots of research to be done, being done, particularly in the field of natural birth, the roles of the hormones during labour and pregancy on the health of the mother and baby, the developing field of natural c/sections etc.

How can you simply stop learning new exciting things? Why can't you also contribute to other's learning and research etc.?

1. I think the carrying around of your own pregnancy notes is archaic. I have a couple of other conditions that complicated pregnancy and often move between specialities. I'm in Scotland where there are computerised records and the other doctors use these very efficiently when working together. Had my GI doctor had access to the Ob/Gyn notes I would have avoided quite a serious complication. The Ob/Gyn have no reason to keep themselves separate, perhaps understandable for midwife led care but not for women where pregnancy and other conditions could together cause problems.

1. I don't think this is true, not from the doctors I know and I struggle to think of many jobs with more variety and career development. The encouragement to attend conferences and complete research work alongside, perhaps, or brief sabbaticals in other departments to keep up to date with the complex patients, and the treatment or surgery they have had. People are high risk for a number of reasons but most can be broadly categorised and ob/gyn should have at least one expert per category in the department.

Agree with PestoPenguin about professionals working through their own experiences. I did a BF peer support course recently and we spent a good chunk of time going over our own experiences so that it is not what we focus on when we support mothers. Of course doctors and midwives should do the same.

Re referral, my only experience of something that needs to change is automatic cons review after a premature birth- my DS was born early after a midwife led pregnancy so I didn't have a consultant, I would have fallen through the gap if I had not insisted on being seen and a helpful nurse sorted an appointment for me. I needed to understand the risks for future pregnancies.

I was not in London .

I had a traumatic first birth. My 6 week check was with my GP who made light of various issues I was having. I agree, that after difficult births and OB/GYN would be more appropriate. However, after my 2 intervention-free births with minimal tearing and no stitches there was no need for me to have any physical checks at all with anyone. Indeed, the GP only asked about the babies.

1. Have only once met an obstetrician, when referred to hospital for a scan for suspected (actual) miscarriage. There must be lots in the results of your miscarriage survey about consultation settings especially and this question generally.

2. I find this surprising, I thought doctors were quite hot on CPD. They take quite a while to become a consultant, with constant learning and professional exams along the way. I know it could be early thirties but can be longer, if they have time off for children or don't get every promotion first time. Perhaps they are so used to the pressure of assessment that it all seems a bit more relaxed (normal to anyone else) after that. Surely they are constantly keeping up with developments though - pretty worrying if not.

Don't they already have the opportunity to take academic sabbaticals to write, lead research, do PhDs etc? Couldn't they become more specialised and share their particular expertise with other consultants - does this not happen between hospitals already? If they feel they're arriving at consultant posts too early and not adequately challenged, maybe they need to extend the training period and broaden the training?

In so many other professions people do attain a level of competence then sit at the same 'senior practitioner' level for the rest of their lives, I don't see this as unusual but the ongoing challenge comes from the continually changing context and opportunities that keeps things different day to day and year on year. Otherwise, in most jobs, you leave behind your specialism and become a manager.

I would like to see an integral part of the Obstetricians training to be e requirement to attend, purely as an observer, at least 4 successful homebirths. Or at the very least births that involves no interventions at all. I think this might help redress and rebalance any view they may develop that birth is always a risk to be actively managed. We're really quite well designed on the whole. It should not be permissible to practice as an Obs without meeting this criteria.

Also agree that they should do the 6-8 week postbirth check.

If obstetricians have children themselves then they should be offered the opportunity to debrief their own birth experiences (whether as mothers or fathers) so that they do not bring their own baggage into consultations with patients. I agree it may aid their empathy, but again, may skew their views based on their own small personal experience. The same is a risk with midwives (hear the one born every minute midwives telling mums in labour about their own labours ).

I think there is a huge tolerance of gynaecological and post birth problems amonst GPs and this leads to great difficulty in accessing a consultant or any kind of specialist care. A post partum infection nearly killed me and the GP's attitude at the beginning was that it wasn't important enough for him to make a home visit (I wasn't able to get to the surgery due to other problems caused by the birth). After my second child I had a tear in a very painful place which meant that I couldn't wee...the emergency GP I saw was unconcerned and told me to put vaseline on it. That night I was admitted with an infection and a bladder so over stretched I had to have a catheter for 3 weeks. My very ragged fanjo probably warrants a look over by a specialist but again, the GP isn't interested. Better training for GPs on womens care post birth would help enormously as that is the point of access - and it would be good to be able to self refer for some issues.

As in ask for themselves.

MrsM that seems a generalisation and not necessarily a good one. Research showed that female Ob consultants were more likely to ask for a CS than the general population.

Not sure if this falls into the remit of either question, but I suspect in the field of Obs and Gynae, and also Paediatrics, there is more demand for female doctors, and probably more interest from female doctors in going into these areas - certainly my dd currently would like to be either one of these two doctors - and so I think the encouragement of 'female-friendly' job setting is important - with possibilities for job-sharing, flexible hours etc.

Oh and one thing I was shocked about in the UK is that a GP does the 6 week postnatal check. I had that with an ob/gyn and based purely on my postnatal thread and friends' experiences I think the care I received was hands down the best nor just in terms of physical thoroughness but in the way I felt it was all taken seriously rather than a cursory check over by a generalist.

I would slightly disagree with bonsoir. In general yes there is too much intervention but French ob/gyns can be better versed in normal pregnancy and birth and they are a lot better about postnatal perineal health/issues e.g. free sessions to get your pelvic floor back). My named OB (although I was under MWs mostly) was very into natural active birth, pro breech VB etc - which is admittedly a rarity - but I like that ob/gyns aren't reserved for complications. So a possible avenue for progression there as a PP said...

Career progression is tough without knowing much about what the current status quo is but aside from management, research and teaching there isn't really anything in other progressions. I would encourage international exchanges to learn about best practice not just in Europe but in more traditional birthing cultures. I suppose that they specialise in an area of interest already?

From my mother's experience I think access should be much easier for non-pregnant women with gynae concerns. Total self-referral is something I do like here in France. Also drawing on her experience services could be better organised and doctors should be able to have more autonomy to lead on cases rather than being very restricted by a service where all doctors are seen as interchangeable. Here more than in any area they can't be easily and sensitively substituted and that must be recognised.

1. Re setting of consultations - Have had the misfortune to have to attend several coloscopy appointments in the last couple of years. They are held at the maternity hospital - there is nowhere I would less rather be than surrounded by happy pregnant women or those with new babies when attending for a coloscopy. The women (and husbands as well usually) waiting for the coloscopy appointments have to sit in a special area of the room - not separate enough to provide any privacy from those there for antinatal appointments, but separate enough to feel self-conscious that everyone knows what you are there for.

They send you a leaflet beforehand that says they may decide to do treatment at the same time as the coloscopy, so you should avoid sex, have someone with you to drive you home, etc. This has caused me loads of unnecessary stress each time - I was single two years ago and had noone to take with me. My (now) partner works 50 miles away, not easy to take time off. And all completely unnecessary because I turned out not to need the treatment each time. They do this I presume to make things easier for them, but it causes a lot of stress to people who didn't in fact need to have anyone with them. The latest time I made a clear decision upfront to refuse treatment on the day if offered, and insist on rescheduling, and found the whole thing much less stressful.

I would prefer to be seen at an ordinary outpatient clinic, to sit in the same part of the room as everyone else (or a completely separate room) and not to be told I need someone with me for what in fact turns out to be pretty similar to a smear test each time.

2. Afraid my own career path is too far away from medicine to really be able to comment