GPs should have a bigger role in antenatal care

[LikeGarlicChicken]

Better confess straight off, I'm a retired GP. I couldn't agree more with this statement by The King's Fund. But the Gen.Sec. of the Royal College of Midwives says of GPs "....they must be able to demonstrate an up to date knowledge of the field...". Well Hello, Excuse me, who's the doctor here? I know I'm a bit reactionary and I still live in the world of "the doctor prescribes the treatment and the nurse carries it out", but really! The problem with midwives, from the beginning of time is that they have always thought of themselves as doctors in all but name. But it ain't so.
Yes I'm being a bit provocative here, but I always shared antenatal care with the midwife and I think this should always be the case. What does everyone think?

I prefer things as they are. The GP, yes, is a doctor, but had fingers in many pies.

The midwife does nothing but babies and pregnant women.

So no, I would not want the GP having a greater role in antenatal care.

In many places, it's hard enough getting in to see a GP at all, now they want to add even more people trying to get appointments with them?

The midwife comes out to see you, even whilst pregnant. No way many GPs can do this.

I'm glad the old school of 'I'm the doctor, you're the nurse' is dying out, because really, it's a team, which each one being a vital link in the chain. And a chain is only as strong as it's weakest length.

They do shared care in my area so I saw the GP for some of my antenatal appointments (we are lucky to still have the good old fashioned family doctor). In some ways this is really good as you get to know your GP better, and they you, before you have the baby and become regulars. But I did find that my GP was not up to date on some current practice. For example she listened for the heartbeat at 16 weeks - she did warn me not to worry if she couldn't find it, but she couldn't and I did and ended up on the day case ward the following weekend to have them listen again.

I did feel I had more confidence seeing the community MW, especially since I had a lot of concerns following my first pregnancy and delivery. I was supposed to see the GP for my 38 week appointment but elected to see the MW instead as I felt it was more appropriate at that late stage. But on balance I think giving at least the option of shared care would be a good thing. That does rather depend on the relationship one has with the GP though, and whether you can even see the same one twice. As I said we are very lucky that the same GP looks after us all as a family and knows us all really well as a result.

I didn't see the GP at all during my second pregnancy. Which was fine by me!

I'd rather see a midwife - who deals with pregnant women all day every day - than a General Practitioner.

Not sure what your problem is with the concept of having an up-to-date knowledge of obstretics and gynaecology/pregnancy and childbirth is?

I like things the way they are too.

One of the arguments for having greater involvement from the GP is that they already know the woman and her medical history. IME that hasn't been the case. I rarely need to see a GP (jinxed it now!) and when I do it's a different one nearly every time. OTOH the MW recognised me this time around because she remembered seeing me during a previous pregnancy, even though it was several years ago.

Personally I also feel more at ease talking to a MW than I do with a GP.

Yes, right, I'm getting the message here .
Expat.... Yes, good points, the team thing is important and it worked well in my case as long as it was a two way thing. But I wouldn't argue against what you say.
Gaelic.. Yes I like what you say, and am pleased you have a good GP
Cat...mmm yes OK, but I'm a bit

I agree with coppertop. I rarely see the GP and if I do then it's one of 3 in a practice so none of them know me especially well. I saw the same midwife for most of my antenatal appointments (in the same surgery) and also after ds was born.

Don't get me wrong, I like all my GPs and did see one of them for the last antenatal appointment and the 6 week check after birth, but the one time I asked my GP about baby care it was at the 6 week check about breastfeeding and he just said "I don't know anything about that, better ask the midwife".

Midwives deal with most cases/situations but there is already consultant obstetrician care where necessary, and they are specialists whereas GPs are by definition generalists. So I'd prefer the system to stay as it is.

Ninth "Not sure what your problem is with the concept of having an up-to-date knowledge of obstretics and gynaecology/pregnancy and childbirth is?" Really no problem at all, I feel the GP should have that, no question.
Copper I think you have hit the nail on the head. Perhaps I am living in the past but I feel that a GP should know his patients, they should see the same doc each time and meeting throughout pregnancy should lead to an establishment of trust which carries on into future care of the child. It may be that this can no longer happen but I am sad if this is so. I accept your opinions though .

I go to my GP for only two reasons -

if I feel I need a prescription for drugs (antibiotics, strong painkillers etc)

or

for a referral to a specialist.

I am never going to be pregnant again but if I was I wouldn't want to be seen by a GP - I'd want a specialist, ie a midwife.

I and many others have had too many negative experiences with doctors to jeopardise my future emotional or physical health - just read the posts on here for reference op.

As a midwife I am trained exclusively to look after women and their babies throughout the childbirth period. I don't need a GP to tell me what to do. When I detect a problem with a pregnant woman, I want to refer her to a specialist (obstetrician), not a generalist. Unfortunately LikeGarlicChicken, GPs no longer 'know' their families and some certainly do not appear to keep themselves updated. Times have changed dramatically. In my experience, GPs were happy to opt out of the maternity services when they could. You also made the fundamental mistake of using the word nurse. I am not a nurse (doctor's handmaiden of old). I am a registered midwife accountable for my own practice.

I'm not been funny but a lot of GPs don't know their arse from their elbow when it comes to pregnancy. As a m/w I have just seen the end of another rotation of SHOs, yesterday was their last day of a 4 month placement. That is all the practical, hands on experience they get on the VTS programme before qualifying as a GP.

Only last week I had to tell one of them that they couldn't prescribe diclofenac to a pregnant woman. They start their 4 months often not knowing how to insert a speculum, have to ask me when doing one "is that a cervix", have to ask "whats dopplers". I despair of them at times.

There was a lady near to me recently who went to her GP when 7 months pg with headaches and spots in her eyes, etc. Was given paracetamol, told to drink plenty and rest. First we knew about her was when she arrived on labour ward fitting. It wasn't a happy outcome.

You may still live in the world of hte Dr prescribes and the nurse carries it out but I'm not a nurse. I'm an accountable, autonomous professional who has done 3 years of training. If a woman's low risk she has no need for a GP and if she isn't low risk then she certainly doesn't a GP but someone more specialised.

I had shared midwife and GP care for my first child and solely midwife care for my second child.

With my first baby I had a lovely GP. I was glad he was involved in my care. A pregnant woman is more than a bump. A GP can look after any physical conditions or mental health of a pregnant lady might have. Don't see that being up to date is a problem. GPs have to be up to date in every area of medicine.

Unfortunately this lovely GP retired and moved to cornwell five years ago. I was sad when he retired. My new GP is very young and naive about the world. He has had no obstetic training.

With my second child I just had midwifey led care and a very limited number of appointments. I was expected to see the GP if I had any problems between appointments. I had really nasty SPD and struggled to walk at 29 weeks. My stupid GP made it clear that midwifey care was not his area and that there was no need to refer me to a physio or the pain clinic as the problem would resolve itself in 11 weeks time.

Midwives have different skills to GPs. There is no way that I have a GP deliver a baby or help with breastfeeding. Midwives are experts in the normal. Giving birth is as normal (admitally nowhere near as pleasent) as having sex. Its not a medical proceedure. Doctors are for when things go wrong.

I had my second baby born at home and I think its a pity that my GP refused to the newborn check.

I think GPs generally get an unfairly hard time as they are surely victims of the current state of the NHS. They must find the current system a complete nightmare to work with. I can't imagine having to deal with 5 minute consultations back to back with maybe 2 minutes in between to appraise myself of the patients' medical histories, most of whom I have never seen before. Surely GPs themselves would welcome a return to the arrangement where a patient always saw their own doctor and they could build up a relationship of trust and familiarity?

I whole heartedly agree. I'm a junior doc and would NEVER want to be seen by a GP for my antenatal care. A midwife is trained to deal with low risk pregnancies and ime has a lot more time for the patient than the GP does.

That said I think it is inexcusable for ANY doctor if ANY speciality to not pick up on imminent eclampsia. (but then I trained abroad )

A midwife isn't a nurse! I'm glad someone as arrogant and ignorant is retired, I wouldn't want someone with that attitude treating me or my family.

Many GPs don't even have a proper knowledge of the reproductive process and it's failings. I wouldn't trust a GP to be the main provider of my ante-natal care, when would they ever have the time for a start.

I like the idea of GPs enhancing their contribution to the maternity care team. I think some GPs would do this very well - but they're probably the ones who already are, who are trusted by their patients who prefer to have their routine antenatal care with them (as they can).

Mostly, GPs are too busy, too rushed, too generalist... There's nothing wrong with my GP, but honestly I would have hated to have had my routine antenatal care with her. For me, it's midwifery care every time, with referral to an obstetrician as/when needed.

Just to admit that although I remained under midwife care during my pregnancy I did attend the EPAU with right iliac fossa pain at 9 weeks and the labour ward at 25 and 30 weekswith Braxton-Hicks. So not really a 'relaxed' pregnant woman

I'm a gp and love the bit of shared care that I do. I make sure patients have continuity by arranging their next gp appointment with me before they leave. I do the postnatal checks too and get referrals from the hv re pnd as I'm the gp mental health lead in our practice. I have done an obstetrics attachment and would check for a heartbeat at 16 weeks. With a good quality Doppler you can detect it much earlier - found my dd2's heartbeat at 9 weeks. I have never had formal training re bf but am bf my second (as I type in fact) and have read a lot. I do help mums with bf but sadly by the 6 week check it is often too late. I get very frustrated when mums I have seen while pg who were keen to bf come at 6 week telling me why they are ff and they have clearly had no educated support at all. I don't see nurses or mws as my hand maiden but know I have something to offer both ante and post natally.

I've never seen a GP, either, during all three of my pregnancies.

I like my GP, but really, they don't have time for this.

As I said, in many areas, it's hard enough to get an appointment at all.

mollycuddles - I understood that the particular problem at 16 weeks is that the heartbeat is often masked by the position of the placenta? Hence current MW practice (at least in our area) is not to listen lest it not be possible to detect it.

with my first pregnancy i had shared cared with a gp, the gp was FANTASTIC and i saw her when pregnant with my second child as well, she came and did a home visit after ds2 was born so i didnt have to go to the surgery unfortunately she changed surgeries

we have since moved and i have had another two babies with only midwife care, which has been fine, the gps i have seen when pregnant made it quite clear that they didnt want to be seeing me and refused to do the newborn checks if i had a home birth and infact said that i wouldnt be allowed one as they didnt like them!

now preg with no 5 and i am supposed to be having extra support and care from the gp's as i had post natal psychosis after my last baby (which they missed completely despite me going to them numerous times saying i wasnt well) and they are being crap, have seen them twice and they arent interested at all, so its a good job i am feeling well and have a lovely cpn who i can call anytime i need to

midwife is also lovely, one i have had before but she is VERY busy, so appointments can feel rushed etc.

if i could have a gp like the one in my first two pregnancies i would be happy, but sadly i have never found another gp like her the ones at the surgery i am currently at are really not helpful at all and i dont want to have ante natal care from them but am 'supposed' to because of my pnp after ds4, however they seem clueless and uninterested.