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?

babbilicious- I have just read what your midwife said about missing appointments! Illegal??

Sorry, but that is surely a load of crap, and suggests your midwife had a bit of a power complex!

i have had to cancel midwife appointments with my hospital midwife- due to the fact even making the earliest appointment possible, it is always over 2 hours before i get seen. Not everyone has on tap child care, or is having their first baby. And twice they said checking my urine wasn't necessary- cue inevitable uti, and kidney infection.

This is in contrast with making an appointment with my gp- half hour wait max, can still get my urine and bp checked, and sort out prescriptions at the same time etc. The midwives aren't interested in making sure my depression is under control, for example. Had bugger all with getting attention- it was about getting basic treatment, without taking half a day to do it! (My gp has seen me throughout my last 2 pregnancies, and now this one as well). And i've never seen the same midwife twice, so hardly continuity of care!

Don't get me wrong- in my first two pregnancies my shared gp/midwife care was great. This time round, after a 4 year gap, it seems to have changed totally and not for the better.

I wonder if she meant that legally your employer can't refuse to let you havetime off for ante natal care (within reason)?

Threatening you with Social services- bloody hell!!!

Sorry- that was ranty! (32 weeks and very hormonal today)

Honestly, I think this political obsession with placing everything under the sun within the GP remit is all about cost-cutting and not at all about improving care.

I will agree that I wish some GPs were more up to date with their Obs/Gynae knowledge - my OH, a GP, is more aware of all this than the majority purely because of the problems we have faced as a couple (multiple miscarriage, endometriosis, IUGR and premature labour and birth).

Furthermore, how on earth are GPs meant to find the time to adequately fulfill these many and disparate roles within the ten minute window of an appointment and without letting any other elements of patient care slip? OH and I have been keeping track of proposed changes to the GP role in the last year (whether DOH or think-tank in origin), which have included the following:

• leading obese patients on brisk walks around local parks during lunchbreaks in order to encourage exercise. Never mind that it is lunchbreaks in which the home visits are invariably done ...
• enquiring as to whether patient is addicted to gambling at routine visit e.g. for ear infection
• treating most patients by phone to minimise their carbon footprint
• commissioning most local healthcare services
• offering climate change advice to their patients
• resuming out-of-hours services even if they do not wish to
• prescribing fewer antibiotics and giving fewer sick notes (oops, I mean 'well notes') whilst simultaneously increasing patient satisfaction ratings

Ah, not to mention the fact that according to the Daily Wail / Express they are greedy, self-seeking good-for-nothings whom you ought to sue if they do not grant one's every request for the latest miracle cure.

If it keeps going down this road I'll be urging OH to consider a family move to Australia before the DOH tell him he has to start running local embroidery classes or something ..

As with everything, I'd say "it depends - on the GP and on the midwife".

My midwife was brilliant!

And I wouldn't have wanted my GP to be involved with my pregnancy, thanks. (Though 'involved' isn't really applicable to anything in his case, if I may say that without sounding derogatory!) He's a nice chap but my midwife was just what I needed when I was pregnant.

I'd like to say

Sorry aabout above my silly laptop! I was going to say I think its very important that GPs are more involved with pregnancy.

At 4 months I had severe pain in my back/legs/hips andd could barely walk. I saw a midwife (as I was told all care was given by the midwives) who said I had spd. I saw a physio and got cruthes and that was it, no other help. I had to finish work very early as I was in so much pain. If only I had gone to see my GP....

The spd was supposed to go after the birth. 3 months afterward I had no respite and following advice from other spd sufferers I saw a chiroprctor (all of which cost over £300). The pain was still there 6 months postnatal so I went to the GP. 1 blood test later I was referred to a rheumatologist, had an mri and have been diagnosed with ankylosing spondylitis - a degenerative arthritic condition which has caused irreversible spinal damage and the disease is autoimmune so will not go away. Apparently the best hope is to diagnose it early - no chance of that now.

I think there needs to be a balance between midwives and GPs and personally think they should be attached to the GP surgery and work as a 'whole' team. If that doesn't happen, midwives should not diagnose things, especially where it could be other things, however experienced they are, they should always refer to a doctor.