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?

Where I live we have shared care.
Often I could not get a midwife appointment at the scheduled weeks and could always see my GP, which suited me.
Whilst midwives are specialists in pregnancy and babies, I still trust what a GP says over what the midwife says. Midwives are not trained as nurses so there are many things they simply are not trained to do. I see their area of expertise as being in delivering babies, which doctors also do as part of their training.

bootymum my use of the term 'handmaiden' was in response to the OP saying

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!

I remember being a hand maiden in my nursing days and being a handmaiden in my early midwife days. Thank fully that is no longer the case for either profession (mainly).

There can be a general confusion that nurses and midwives are the same and I was trying to emphasise that they are 2 separate professions entirely.

I don't want to be referred to as a nurse when I am a midwife. I am sure you would feel the same.

excitychick doctors do not deliver babies in their training to become GPs. If lucky they may get the chance to deliver a couple under the guidance of a midwife. For maternity care, midwives have far greater knowledge that GPs.

The GP surgery where we were living when DD1 was born was useless.

The one guy was definitely an addict. The other was an idiot and a sleaze, possibly an alcoholic, too. The HV was a poncey, snobby ass bitch who had no business in the job and I hope she is no longer being unleashed on an unsuspecting public. They had a terrific locum, but she left - gees, I wonder why?

The one where I had DD2 was brilliant! It was linked directly with the university and very up-to-date on everything.

It just depends where you are, I guess.

stripeyknickersspottysocks , I can think of many nurses who have had sole responsibility for parts of my health care - you certainly don't only see nurses when you are 'ill'!

As far as midwives go, do you leap straight to Band 6 on qualification? (genuinely interested).

Snowmash - some places you go straight onto Band 6 but its more usual to spend a year on Band 5 and afetr your first year you go up to Band 6.

I can certainly think of some nurses who have that extra esponsibility such as Practise nurses, McMillan, etc. But I'd have thought that there are also a lot of nurses who on wards doing drugs rounds, obs and care pathways. I had to spend 4 weeks on a general ward when training, now I admit 4 weeks isn't a long time but thats all I saw the nurses on that ward doing.

I know some of the midwives I work with who have done the 18month conversion course from nursing have said when NQ how the responsibility of being a m/w is more than that of a nurse.

My NHS mw was absolutely rubbish last time I was pg, and I ended up very ill. Her answer to a very serious case of SPD was to 'take two paracetemol' (I ended up hospitalised). She also forgot repeatedly to do referrals and messed up all the paperwork over and over again, and then was economical with the truth about this.

In the end, my MP had to intervene so I got proper medical care, and I shuttled between a private mw paid for by health insurance, a consultant and my GP, which all worked a lot better. I wouldn't see the NHS mw again for love nor money.

Should add that general nurses who haven't specialised look after patients with a wide variety of illnesses and needs so I wouldn't expect them to be able to have as much input as a m/w can when a m/w only has obstetrics to focus on. Not unless they've specialised.

I don't meant that to sounds like I'm dismissing the work that they do, just that its a different job.

I do wish some GPs were encouraged to do more pg and birth related stuff, and do domiciliary obstetrics, as this would be well received by a lot of mums as an alternative to crappy mws.

I think I'd be tempted to say that the NHS planned/needed demographic is different for nursing than for midwifery. But then again, I was one of the people who would suggest that professions were equal but different during inter-professional learning (which is why I was curious about midwife banding, as I was never in a group with one).

Perhaps the band 6 reflect generic aspects such as lone working and access to supervision/support?

Looking at friends from the various AHPs, some have made band 6 within 6 months, and others are happy on band 5...but it is the generic aspects rather than basic levels of clinical competence that change, as in some professions specific areas of work tend to be 1-1/have little chance of the supervision a band 5 should have access to.

i don't see why i would want to see a doctor about a pregnancy related matter - midwives quite simply know more about it.

in fact i think if it were possible to extend MW care further into post natal care that would be better - as after the birth people find themselves going to GPS for birth-related problems the GP is not a specialist in.

also, midwives handle a much higher-risk area of medicine than GPs - the level of knowledge possessed by a fully trained mw must necessarily be detailed, specialised ad up-to-date. 23.$

but about five million people have already said that on this thread....

In my own (anecdotal) experience, the only time I saw a GP throughout my 3 pregnancies was with my 2nd at 34 weeks. She told me the baby was head down and engaged.

It wasn't. My daughter was breach, had been since at least 28 weeks and the experienced midwife picked it up at 38 weeks.

I then had a successful EVC and my daughter was born without intervention, BUT, if I had continued to see the GP I could potentially have ended up in labour with a breach birth.

I, for one, am glad that GP's keep their distance from ante-natal care.

I think it could potentially put unfair pressure on female GPs.

I'm sure I'm not alone in preferring a female for intimate procedures such as the 6 week check, sweeps, breastfeeding problems etc. A male midwife would be ok, but a male GP with little experience of pregnancy and birth would be someone I'd prefer not to have to see.

OP: I haven't read the thread but I wanted to tell you that I 100% agree with you.

I was diagnosed with hashimoto's thyroiditis just before my first pregnancy and so was labelled "high risk" and told I had to have consultant led care. I didn't argue as it was my first pregnancy. The care should really have been called "junior doctor led care" and on each visit I had to see midwife / endo and obsetrician. Over the course of the pregnancy I saw only 2 endos but it was a different midwife and obstetrician each time, and each appointment took hours.
I managed to get signed back into midwife lead care for the last 6 weeks but it was stll a different midwife each time, and they were always running really late so was not great either.

In my second pregnancy I thought there must be a better way. I discussed the care I'd had in my first pregnancy with my lovely (male) GP and he agreed he'd see me for as many appointments as possible. He was very lovely - monitored my thyroid and everything else and in that pregnancy I went to the hospital twice for the scans and midwife once for a sweep right at the end.

In my third pregnancy it was a different GP but I still saw her as often as possible. Again turned down the consultant lead care, and again midwifes were totally useless eg not following up on blood tests, running super late, different person every time.

OP: In a totally ideal situation I'd see a midwife, but it would be the same one each time to build up relationship, based in the GP surgery, and there would be a GP, esperienced in pregnancy on standby at each clinic to pick up on things (another poster mentioned SPD) that might be problematic. I think the shared care model works well for people like me with minor medical issues (like hashimoto's) that don't actually need specialist input but are too medical for nurses.

BTW my dad is a retired GP and I wouldn't want to see him for ante-natal appointments but my gran (now dead) was a GP specialising in homebirths and midwifery (retired aged 70 in 1990) and I would have loved to have seen her. She delivered 3 generations of the same family.

to the poster re: the breech point - my friend's midwife told her the baby was head down, actually it was GP that spotted it was breech!

The only time I saw a GP for a antenatal checkup it was embarrassing for us both how little she knew about what to do.

Another vote for just seeing midwives during pregnancy. They are the experts on normal pregnancies and can refer to specialist obstetricians if the pregnancy is abnormal.

GPs are for general medical diagnoses/prescriptions. I really can't see what the benefit would be from seeing a GP during pregnancy.

I am now 26wks with dc3 and at no point in any of my pregnancies have I wished I was seeing a doctor and not a midwife (although often wished I was seeing a different midwife!!).

Ime you build up a relationship with the gps in your practice when you have a child/children and take them in umpteen times with various childhood illnesses.

I think you should be able to see the same caregiver throughout.
I saw midwife twice then was told I had to see consultants, due to my age.
I had to go every 3 weeks throughout although not in the last 3 weeks? when i actually wanted to go.
I didnt therefore build up a relationship with my midwife like all my friends and colleagues did. If they had a question or issue they used to pop and see their midwife or ring them I had no support.
The consultant said I had to see my Gp at one point during the pregnancy. I therefore made the appointment when i got there he asked why I had gone? I said apparantly it is standard procedure? so he check blood pressure etc.
I felt very much on my own throughout my much wanted pregnancy and felt as if I was managing the whole thing.

"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?"

What a very defensive statement. You seem very insecure.

I still live in the world of "the doctor prescribes the treatment and the nurse carries it out"

GarlicChicken I'd be very interested in roughly your generation as it seems very outdated. To the extent that I'm not sure how seriously to take it

OK, this is why I don't want a GP having anything to do with my antenatal care:

None of the ones I had contact with during my first pregnancy seemed to have the first clue about pregnancy and childbirth. I attended one surgery with a ?UTI at about 24/40 to be asked "Can I listen in to your baby?" He then proceeded to fail to distinguish between the maternal and fetal HB, confidently announcing that MY pulse (at 70bpm) was the baby's heartbeat. It was the nurse practitioner that put him right. He then threw the doppler down, saying "Well ,I can't find your baby's heartbeat, but I am sure it's fine.".

I kid you not.

When I'm pregnant, I'd like to see someone specialising in that area. That means a mw or obstetrician. Not a GP.

stripeyknickers I think you have made quite a lot of generalisations about nurses.

i go to a gp if i'm unwell - pregnancy is not an illness!
i had very normal, natural pregnancies and labours and had homebirths because i had no medical complications and did not want doctors having anything to do with my care unless absolutely necessary.
i recently moved and was told by my new surgery i had to see a gp for a pregnancy test before i could see a midwife - rediculous! wasted my time and theirs, i didn't need to see a gp to tell me something i was well aware of.
in cases such as mine where there are no complications i don't see why a gp needs to get involved with the midwives i have seen do such a fantastic job. i have never felt so confident and happy with nhs care as i was when pregnant because the only health professionals involved were midwives.
i can see how there may be cases where a gp has knowledge of a mum-to-be's history that could influence the womans early pregnancy care and options but that doesn't mean they need to get involved, it just means information needs to be shared appropriately and the midwife needs to carefully ensure she has taken a full history of any relevant information.

I had shared care, which meant 2 of my antenatal appts were with my GP.

Who contracted out all antenatal care to a different bunch of midwives, feeling that MWs were better placed to do routine care, which makes sense but defeats any point of sharing care with your 'usual GP' as your GP isn't seeing you.

I tried making this point to the hospital MWs but they said they weren't allowed to book those appts with them for me.

I can only speak from my own experience and that has been that with each of my 3 pregnancies (3 different midwives, 2 GPs, 2 consultants) I have been lucky enough to have shared care.

The midwives have each been alright I guess, but were rather flippant, did not seem motivated to answer any of my questions, and were fairly low on up to date knowledge too to be honest (2 of them were just about to retire, but the new, younger one was also rather disinterested). Much of what they did say to me seemed like common sense to me anyway- but it was the lack of care which struck me about each of them. Ate lots of my cakes though, as they had never had time to stop for lunch and had worked right through so were always apreciative of tea and cake.

The GPs and consultants however, who I had to see reasonably regularly too due to other health problems which could mean pregnancy risks, were fantastic. Always telling me very clearly what was going on, no wooly meaningless waffle, reassuring me that extra visits were no trouble if I should want them (I didn't, but nice to know). Ringing me to check I had got results ok, double checking health implications with connected specialists and generally going the extra mile.

I think anything that you do all the time (especially under workload pressure) can make you rather anaesthetised to aspects of it, you become blase about things which are a big deal to the person experiencing them. I'm sure I was just unlucky with my midwives, ime community midwives are the best of the bunch as at least they are a little bit friendly, don't even get me started on the midwives on the wards.

"ignorant", "arrogant" ow!ow!ow! Well it serves me right! Never post when you've had a couple of glasses of wine!
Mears.. yipes.. fair comment. I apologise.
But seriously though, I am shocked at the feelings towards GPs. What has happened? Never mind. I've learned my lesson and will put my "opinions" back into retirement. Least said, soonest mended.

Very elegant of you to apologise to our beloved mears, LGC. Don't retire your opinions; just beware of the fuelling effects of a couple of glasses

Seriously, I'm sure nobody wants to GP-bash. And you could just as easily fill a thread with people complaining about midwives, or health visitors (and we often have). But the strength of feeling on this thread could maybe give you food for thought about how women experience GPs' involvement in maternity care...

Thankyou What has happened? That is a good question. Difficulty in accessing your own GP can be a real problem. Can I say though, I know my own GPs very well and care that my father gets is excellent. He has Alzheimers and is looked after at home by my mother. I am sure because GP time is mot utilised seeing normal pregnant women, my GPs have the time to see patients who truly need them