Why see a doctor when pregnant?

[mears]

How many pregnant mums out there have seen the midife to confirm pregnancy instead of the doctor? Do women realise that he midwife has the expertise in normal care?
The midwife is the appropriately trained person to look after a woman with normal pregnancy, yet the vast majority of women expect to see a doctor. It is proposed that this should change if it has not changed already in some areas. Women should be able to go directly to the midwife for her care. Ofcourse she could still see her GP or consultant obstetrician if she wanted to, but she shouldn't HAVE to.
The midwife would refer her to the consultant should any problems arise during the pregnancy.
Has anybody got experience of this type of care?
What do you think about it?

I had midwife-led care through both of my pregnancies - made an appointment to see her when I was roughly ten weeks both times. I didn't see a doctor at all in either pregnancy apart from my horrible forceps delivery with dd1.

I have to say I was tempted to see a consultant with dd2 as I had had such a rough delivery last time, but didn't in the end and had no need to.

I was very pleased to have midwife only care and I certainly only want midwives around when I am giving birth - and I'm afraid they would HAVE to be women as well, didn't want a man anywhere in the vicinity (grudging exception made for dp )

I like the idea of being able to directly refer myself to the midwife, though obvious with all my medical crap I've always started with my GP because medicine dosages have needed changing etc.

I have to say that as I was not as ill the first time round I only ever saw a midwife, I always assumed that I would see a doctor if there was a complication. And it suited me fine that time.

All the hospitals where I live though offer shared care to low risk pregnancies. Most of the appointments are done by the GP, with the hospital ones only at the beginning and end. I guess its to lighten the load of the hospitals.

Does your hospital have shared care mears?

i only ever saw a doctor to confirm pregnancy and to "release" me from hospital. i wouldnt have even gone then if i knew

Unfortunately it does pie, but all the recommendations around now state that the midwife should be the lead professional for normal women. The GPs have resisted that because it means they would no longer get paid for the antenatal care that a lot of the don't deliver! However, the new GP contract will sort that out.

It has always puzzled me that you have to see the GP to confirm the pregnancy and where I live, you also have one antenatal appointment with the GP along the way. As the first appointment simply consists of saying to the GP "I'm pregnant" and him saying "Ok, you need to go and see the Midwife", it seems utterly pointless.

Mears, I would prefer not to have shared care, I'm having it this time, and the medical side handled by the Obsetric medicine clinic, as I find that my GP is so much more rushed than the midwife is.

Mears, I think it sounds sensible, going direct to a midwife instead of a dr. I was v. irritated this time to be told that I had to see the doctor at my surgery prior to meeting a midwife. I was then told I had to see the GP again at 20 weeks. The first appt was ridiculous - Me: "I'm pregnant so can I see a midwife please?" GP: "I'm not a midwife" Me: "I Know but I've been told I have to see you first. NOW can I make a booking appointment with the midwife please?" GP "Yes. Goodbye. Next!" What a complete waste of everyone's time!

Then, despite knowing I wanted an appointment for 4 weeks time, I had to call on the day I wanted the GP appointment. When I called she wasn't in, the next day she was fully booked 20 minutes after the phone lines opened and so eventually, after another 2 calls, I saw her the following week. I did moan about their crap appointment system (all to do with govt stats about being able to see a dr on the day you call, hm so that's effective and efficient for everyone isn't it?) and just about managed not to tell the snotty receptionist that if they didn't find me an appt actually I would go straight to the midwives and bypass the doctor altogether. I suspect it was something to do with the way GPs are paid for pregnant women isn't it? Total pants so far in Devon, I have to say. My GP in London made it clear that she needed me to sign various bits of paper so she got paid, but in retrospect all she did was come and check ds at home the day after he was born and talk to me about my birth plan once during the whole pregnancy so I'd have been better off going direct to the hospital midwives, who were fantastic and delivered ds at home.

bells, posts crossed, but yes, absolutely, re GP appts!

In my first pregnancy (in the UK) I went to my GP when I did my pregnancy test ... mainly to find out what to do next. My GP was anti-midwives (by his own admission) and so I saw him for the the whole of my pregnancy ... I think I saw a midwife for my blood tests but that was it.
I never quite worked out why I saw my GP and not a midwife ... I wasn't ill and he was never ever going to deliver me ... When I was in hospital giving birth the midwives all rolled their eyes when they found out who my GP was ... he was notorious for not letting his patients see midwives ... I think what bugs me is that he never gave me an option ...
With this pregnancy I am in New Zealand and it is a different story all together ....
All maternity care is free on Public Health ... as in the UK ...
When you get pregnant you get to choose an LMC (Lead Maternity Carer) ... it is up to you ....
You can have a) your GP ... b) an independent midwife (that you find yourself ... you can ring as many as you like to find the one that suits you) ... c) a hospital team (basically whoever is on duty when you have your appointments) ... or d) A Specialist Obstetrician.
Options c) and d) are really for problem pregnancies unless you have lots of money then you go for a private Specialist Obstetrician.
It is such a good system. The LMC that you choose is responsible for your care antenatally and for 6 weeks post natally.
I have gone for an independent midwife who is prepared to take me on (I have a risk of c/s due to having had one already and some midwives don't like that as it has implications on their payment from the govt if you don't go into labour) ... and I haven't even been to my GP to tell her that I am pregnant, let alone have my pregnancy confirmed.
I like the idea seeing one person throughout ... like the idea of that person (all being well) delivering my baby. She will come to my home for all my antenatal and postnatal appointments and when I go into labour will come to my house to check on my progress before I go to hospital.
Just a brilliant system I think and it is about time that something similar was done in the UK.
We are pregnant ... not ill (with some exceptions of course) and so why see a doctor??
Good thread Mears ...

Our practice is a bit like www's - I had to go to GP - announce "I'm pregnant" - they refer you to midwife, and the next time you see GP is at 6 week post-natal check. Would make sense to go straight to midwife, but I guess this gets on to your notes if you see a GP first.

Forgot to add that should there be any problems the m/w will refer you to a Specialist (or a Consultant as they call them in the UK) ...

I had to see a doc to say I was pregnant, have a check at I think 20 weeks, and then got a hospital visit afterwards. Most of which was pretty pointless...

Since I had an IVF pregnancy I guess it had already been confirmed by a doc when I was discharged to the 'normal' system to book in. I intended to see the GP first (simply because I wanted to tell her in person about the pg, as she had referred me back for treatment) but when I couldn't make an appointment with her for weeks, I decided just to see the midwife instead. No-one at the practice made any objection, and I wonder how much of the 'seeing the dr to confirm pregnancy' is something that women do automatically, because they assume they have to?

So far in this pregnancy I haven't seen a doctor at all, and don't intend to unless a complication arises. LAst time I didn't feel they added anything at all!!

(Oh, and there are some practices like Ghosty's in the UK - my first pregnancy was with a midwifery practice, part of King's Hospital, which was attached to my GP's surgery - you did have to check in first with the GP, but then got pretty well independent-style care on the NHS with lots of continuity and contact with the same one or two people - totally optional whether you went for home or hospital, could decide at any point in labour. It was after that that I opted for a home birth for dd2, simply to get a bit more continuity and - at the time - with the intention of staying at home as long as poss before heading for the drugs!

My pregnancy care was split GP / midwife, i.e. I saw the GP for one appointment and the midwife for the next. The GP surgery had a particular doctor who covered ante-natal care, and so wasn't my normal GP. When I visited my GP I always had to provide a urine sample, but never did for my midwife visit as they considered it a waste of time. The midwife visit was a lot more helpful, generally.

I saw my GP to say I was pregnant. He made a few ntes, confirmed dates and arranged for a nuchal scan and then told me when to make my booking in appointment with the midwife. After that, I think I generally saw the midwife, GP after the main scan and then for alternate appointments after about week 30 and all these were at the GP surgery. Only went to the hospital for GTT, scans and labour.

Mears - good question! I am supposed to alternate appts between midwife and GP but I would prefer just to see the midwife - the GP is pretty useless and the midwife a source of knowledge and kindness!! If I have a problem or a worry I call the midwife unit - not my GP

Sounds good to me. With ds I experience the domino system. I felt it worked really well for me - I had alternate appointments with the gp and midwives. Although my GP surgery is great, I agree that it would be a much better use of resources for the midwives to lead the care of pg women. I thought that you had to see your GP first of all in order to confirm your pregnancy and also to refer you to the hospital/midwife team of your choice? My midwives were fab and I am really hoping I will be put under the care of that team again this time.

Soupdragon - my experience was similar to yours....

I'm not in UK & don't see a midwife at all

I'm also alternate. I see a midwife from the group that's I'm assigned to, at my doctor's sugery, then next time I see my own doctor. My doctor is great and has a very relaxed attittude so this suits me fine. She has kids of her own and as a working mum herself, she understands that it is difficult for me to make appoinments during the day, and find time to excercise etc. My midwifes are also very helpful and reassuring, but they can't persribe Gaviscom!!

how do you get to see the midwife? can you phone the local hospital? I had a really bad experience last time I was in the UK and in the end in desperation of getting any medical care at all I flew back home I'm pregnant again and really want to give birth in the UK this time but can I just refer myself to the midwives? Last time it had to go via the GP and he was always either busy or just 'lost' the letters of referal he swore he'd written. It's really early days but I'm keen to go for a vbac so I feel I'll need all the midwife support I can get.

1st time round I saw my GP and he referred me to my midwife who I saw for the rest of my pregnancy. She said to go and see the GP at around 34 wks so he would "earn the money they get for every pregnancy". I saw another GP in the practise who was horrified that he would have to do my checkup, he really didn't want to come too close to my bump!

This time I called the midwife directly and she booked me in, arranged scans etc. At 20 wks she suggested I saw the GP because there's no procedure to let them know about your pregnancy, and also you have to sign a form so they get there money (for your care, presumably). The GP was slightly surprised to see me and more surprised that I had managed to get scans etc without his help. He wants to see me again around 34 wks just to "remind him that I'm pregnant".

bunnyrabbit has a point, I get through the gaviscon like there is no tomorrow, but to benefit from my free prescriptions for life I have to see a doctor just for this.

I would have thought that if more care became m/w only they would have to become something akin to nurse practictioners so that they can prescribe some really basic stuff. Otherwise the doctor comes back into the equation when for things like gaviscon they aren't really needed.

I've never seen a GP for any of my pg although I had to see the consultant at 20 weeks for the first 2. Complete waste of time. Had 30 min drive to hospital, 1 hr wait and then just a quick prod and told everything seemed OK, go and book a 42 week appt. Not impressed. Far more faith in my MW. Releived when MW said I didn't need to see a consultant this time. I feel that a MW has far more experience than a GP when it comes to pg women and it always amazes me when women say they've had to see their GP instead. Why? I mean don't they have enough other stuff to do.