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

[RowanMumsnet]

...well, a few things really

RCOG (which has helped MN out a lot with, among other things, our Miscarriage Campaign) is currently consulting on the topic of 'Tomorrow's Specialist'. They want to 'define the changing role of tomorrow's specialist within a team, which focuses on high quality women's healthcare, through innovative and rewarding ways of working, embracing training, lifelong learning and professional challenge.' (You can see more about the consultation here.)

I've been asked to go along to an evidence session on Friday and reflect Mumsnetters' views on the following:

1. Access to obstetric and gynaecology services: referral routes, doctors' roles, setting of consultations.
2. Career progression and development: 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. What do you think makes a career exciting, and how can those elements be incorporated into the specialist doctor's career plan?

Speaking as someone who's never so much as met a obstetrician or gynaecologist, it's fair to say I'm feeling a little underpowered on this one. So I'd be tremendously grateful if any of you - as either service users or professionals in related fields - could let me know your views.

Thanks
MNHQ

I would like to know whether they see expansion in the nurse specialist role in colposcopy with the changing disease profile we will see in cervical disease in the post HPV vaccination world.
How do they view the role of the gynaecologist/colposcopist changing in the next 5-10 years and what're their views on the possiblity of specialist cervical disease centres as the incidence of cervical cancer falls?

I don't know much about gynaecology, rather more about obstetrics. My first comment is that the role of obstetric consultants has to be considered in context with training grades and also the role of the midwife. The RCOG, understandably, wants greater consultant cover and I agree that this is desirable, but not if it undermines midwife autonomy and resourcing.

I don't see the current model of access to obstetricians as problematic. I saw one once in my pregnancy - when I asked to - and then again when I was in with my emergency caesarean. I was very happy to have midwife-led care and equally happy that when I needed an obstetrician I was able to easy access one.

I'm slightly perplexed by question (2) - I would have thought the role of the consultant does not remain static, but continues to develop either into clinical leadership roles, or management roles, or into sub-specialist fields. No obstetrician I have ever met (and I used to work in maternity care) has ever complained of being bored - many other things, but not that!

One little comment, though - there are lots of specialist midwife roles e.g. working with drug dependency, or high risk labour. I've not, though, come across an obstetrician who specialises in normal birth. I know their function is to focus on the high risk end, generally, but I'm really interested in how we can bring together the benefits of modern medicine with the benefits of a commitment to natural/gentle birth. For example, Prof Steer at Charlotte's was doing some interesting work on 'gentle' caesareans, working with specialist midwives (don't know if this is still happening, I no longer work in the field). This was exploring ways of bringing Leboyeresque techniques (low lighting, hush, immediate skin to skin) into elective caesareans. SO worthwhile, and how I wish my CS had been more like that! I'd love to see more obstetricians taking an interest in this kind of approach.

Thanks so much, BelaLug0si and Devora

Any more for any more?

I just love the English system the way it is . I live in France where there is far too much intervention in women's gynaecological and obstetric health. I returned to England to give birth and never so much as set eyes on an obstetrician - I just saw (really lovely) MWs.

Re Q2 IMO opinion this is a very valid comment on 'treading water' roles for all doctors whether in a hospital setting or as GP. There are few other careers where you reach the pinnacle at around 30. It seems not many consultants then move around so the risk of group think becomes a problem.

To spice things up. I would remove the current consultant awards system where peers say you're worth extra money and then you get it in perpetuity (if I've got that right). I would keep the money though for rewards but on an annual basis for exceptional performance or bursaries for higher level studying.

I would actively encourage sabbaticals for work for charities and even in the commercial world; for exposure to other 'corporate' cultures and working practices.

To underscore my point: Read the link and see how doctors are having to be paid for each email sent to move them away from letters to using email - think that would happen in any other workplace?

www.guardian.co.uk/healthcare-network/2012/mar/06/whittington-health-yi-mien-koh?CMP=twt_gu

I only have an opinion to question 1)
imo the access to a gyn services apart from pregnancy related can be a nightmare. ignorant gp's tend to fob women off, even if the pain/bleeding is nearly unbearable. if you the are finally referred, waiting times to see specialists are often very long, by then the many women have been to a&e due to complications. doesn't feel dignified at all.

Does the role of the specialist Dr really remain the same throughout their career?

All the Obs and Gynae Drs I know (and I know a lot) seem to be constantly going on courses, revising for exams, improving their skills. They're keen to reach consultant level so to all they can to have a wide and indepth range of skills. I suppose that once they reach consultant level there's a risk they might stop being so motivated. Though most of the consultants I know are keen to be involved in research.

As for access, that's difficult. I've struggled in the past to be referred when I did need a referral. But that's down to the GP. I don't see what alternative there is. You could trial self referral and bypass the GPs but then I'm sure GPs are also good at weeding out the ones who don't need referring. But I've found you need to be quite assertive to get a referral. Last year I wanted a referral for a different gynae problem - went to see the GP who tried to put me off saying well why don't we try xyz (pilla and coil mainly) and tried to be quite assertive about it. I just point blank refused and said I wanted a gynae referral and I would discuss it further with a Gynae consultant.

The main thing I think needs addressing is the worrying, increasing numbers of Registrars who seem clueless and incompetent. I don't know if this is related to the fact that junior Drs work less hours per week now than in years gone by but it can be scary at times. I've known Regs who are barely able to interpret a CTG and are too scared to make a decision. These aren't junior Regs, they're the person in charge on labour ward (we don't have in hospital consultant cover at weekends/nights). Of course there's plenty of good ones as well. So maybe its not a training issue but more of a failing to fail (when an SHO) issue.

1. Access to obstetric and gynaecology services: referral routes, doctors' roles, setting of consultations.

-Access, unless direct privately paying can be hard to get, personally I don't think that simply seeing an obstetrician or gynaecologist is enough to deal with most issues requiring their services
Usually a specialist team is best
Considering this I feel it is useful to have specialist nurses who have a role in coordinating services, often a lot of issues around reproductive health will need the impute of counselling, dietician, endocrinologist and so on

2. Career progression and development: 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. What do you think makes a career exciting, and how can those elements be incorporated into the specialist doctor's career plan?

• I think they should learn to work with others, it is impossible to know everything in such complex issues, learning from and working with others should not be seen as a threat to professional integrity but as a tool to further develop and expand knowledge

I'm not sure how relevant they are to the questions asked, but it would be great if you could emphasise what has been said above about normal birth and the apparent lack of experience of most doctors in normal hands-off physiological birth (i.e. birth without intervention, not just vaginal delivery, and specifically not with mum supine). I appreciate their role is specifically where things move away from normal, but even medical students have to witness births, yet how many actually get to see genuinely normal birth? For doctors often the problems and tricky bits might be more interesting, but it's really important for them to understand the norm too, otherwise their viewpoint can become skewed.

More training is also needed, especially in doctors more junior than consultant level in obstetrics, in informed consent and engaging patients in decision-making about their pregnancy. Stories abound on here of mums who feel pressurised into particular courses of action during pregnancy or labour, and often it strikes of a paternalistic attitude. One good example is when discussing induction with women who have gone past their due date. How many are really made aware that they have options and choices? Often (and I'm not just talking about induction) whatever is the hospital's policy is presented as the only option. I think sometimes the long-term impact of women's experiences is marginalised because 'all that matters is a healthy baby'. Women talk about their bad birth experiences decades after they happen. If they feel genuinely involved in decision-making they are likely to feel more positive afterwards, even where things are far from ideal.

MrsMicawber when you are pregnant, yes. but not if you just have problems with abdominal pain or bleeding.

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

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.

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.

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.

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.

As in ask for themselves.

Thanks so much for all of these, I feel significantly less stupid about it now.

Do please keep it coming.

MNHQ x

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.

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 ).