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 see an integral part of the Obstetricians training to be e requirement to attend, purely as an observer, at least 4 successful homebirths. Or at the very least births that involves no interventions at all. I think this might help redress and rebalance any view they may develop that birth is always a risk to be actively managed. We're really quite well designed on the whole. It should not be permissible to practice as an Obs without meeting this criteria.

Also agree that they should do the 6-8 week postbirth check.

1. Have only once met an obstetrician, when referred to hospital for a scan for suspected (actual) miscarriage. There must be lots in the results of your miscarriage survey about consultation settings especially and this question generally.

2. I find this surprising, I thought doctors were quite hot on CPD. They take quite a while to become a consultant, with constant learning and professional exams along the way. I know it could be early thirties but can be longer, if they have time off for children or don't get every promotion first time. Perhaps they are so used to the pressure of assessment that it all seems a bit more relaxed (normal to anyone else) after that. Surely they are constantly keeping up with developments though - pretty worrying if not.

Don't they already have the opportunity to take academic sabbaticals to write, lead research, do PhDs etc? Couldn't they become more specialised and share their particular expertise with other consultants - does this not happen between hospitals already? If they feel they're arriving at consultant posts too early and not adequately challenged, maybe they need to extend the training period and broaden the training?

In so many other professions people do attain a level of competence then sit at the same 'senior practitioner' level for the rest of their lives, I don't see this as unusual but the ongoing challenge comes from the continually changing context and opportunities that keeps things different day to day and year on year. Otherwise, in most jobs, you leave behind your specialism and become a manager.

I had a traumatic first birth. My 6 week check was with my GP who made light of various issues I was having. I agree, that after difficult births and OB/GYN would be more appropriate. However, after my 2 intervention-free births with minimal tearing and no stitches there was no need for me to have any physical checks at all with anyone. Indeed, the GP only asked about the babies.

I was not in London .

Agree with PestoPenguin about professionals working through their own experiences. I did a BF peer support course recently and we spent a good chunk of time going over our own experiences so that it is not what we focus on when we support mothers. Of course doctors and midwives should do the same.

Re referral, my only experience of something that needs to change is automatic cons review after a premature birth- my DS was born early after a midwife led pregnancy so I didn't have a consultant, I would have fallen through the gap if I had not insisted on being seen and a helpful nurse sorted an appointment for me. I needed to understand the risks for future pregnancies.

1. I think the carrying around of your own pregnancy notes is archaic. I have a couple of other conditions that complicated pregnancy and often move between specialities. I'm in Scotland where there are computerised records and the other doctors use these very efficiently when working together. Had my GI doctor had access to the Ob/Gyn notes I would have avoided quite a serious complication. The Ob/Gyn have no reason to keep themselves separate, perhaps understandable for midwife led care but not for women where pregnancy and other conditions could together cause problems.

1. I don't think this is true, not from the doctors I know and I struggle to think of many jobs with more variety and career development. The encouragement to attend conferences and complete research work alongside, perhaps, or brief sabbaticals in other departments to keep up to date with the complex patients, and the treatment or surgery they have had. People are high risk for a number of reasons but most can be broadly categorised and ob/gyn should have at least one expert per category in the department.

'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.'

Why? That's a bit wierd doncha think? It isn't as if it CAN'T. There is lots of research to be done, being done, particularly in the field of natural birth, the roles of the hormones during labour and pregancy on the health of the mother and baby, the developing field of natural c/sections etc.

How can you simply stop learning new exciting things? Why can't you also contribute to other's learning and research etc.?

I think the UK system is great - I had a consultant led service in both my pregnancies because thats what I wanted (NHS ) and she was fab. Midwife during my twin delivery , however was rubbish and I nearly lost a baby because of her.
Consultants should be facillitated to work and train part time to enable more parents to be Ob & Gyn specialists

Ime it can take far too long to see a specialist in pregnancy. I have an underactive thyroid (which was the possible cause of some of my miscarriages - untested despite recurrent mc but that's another story) and in pregnancy early review by an endocrinologist is crucial. I was almost in the second trimester by the time I got to see one. Similarly, I was referred to an obs in my second pg, due to hypothyroidism and recurrent mc, but again was well into second trimester. The obs told me that if he had seen me earlier he would have put me on Aspirin but that there was now no point.

In answer to question 1. I've seen a gynae for both abnormal smear results and for subfertility. In total I have seen 3 different gynaes in 4 different locations over 10 years. Each have had very different bedside manners. The last one who I saw for both problems I think was the best. He had a local clinic and one at his base hospital(hence 4 locations)

Due to the reasons for seeing a gynae my GPs were very good refering me.

It is a little peculiar the greater majority of Gynaes being male but the clinics are set up to have a female nurse present at all times.

I think I have met one obstetrician after I had an early pg scan and I can't say I was overly taken with her.

Self referral (as suggested by a few mners) would be a disaster

Consultants would be inundated with the 'worried well' and have no time for the uneducated/ socially deprived and socially excluded women who really need them.

All the stats show that these are the women who are at risk, yet no one (apart from some midwife teams) seem to have schemes or stategies designed to improve their access to specialist care.

I can only answer re (1), and I don't know if this is entirely relevant - but here goes. I was classified as a 'high risk' pregnancy, and therefore automatically transferred to consultant-led, rather than midwife-led, care. But I only saw the consultant twice - and both times the response was brief, careless and insensitive - I felt rushed through the appointment, unable to ask questions and consultant was generally lacking in empathy. I had to be induced at term, and as soon as the consultant had booked me in, I never saw her again, and didn't see a doctor at all until, after four days of unsuccessful induction, one came in to decide on a c-sec.
Sorry the explanation is rather long, but my point is: if you're going to have consultant-led care, that is what it should mean - that you see the consultant, including (especially) once checked in to hospital. And if you can't physically see the same person, some impression that they actually talk to each other about your case (or read the notes first!), so you're not repeating the same thing over and over and over... I might be the tenth woman you've seen that day, but it's the first time I've ever been pregnant, and the term 'high risk' means something to me, even if it doesn't mean much to you... rant over!
Agree with the other posts about hand-held notes, and about the 6-week check. and with inhibernation - took ages to get the appointment through, then they ummed and arred about treatment, and ended up telling me (a few hours after an uneventful appointment) on the phone that I was to have daily injections.

I would like to see gynae's being more involved in the induction process - gaining fully informed consent (not just mentioning risks to the baby) and discussing options with the mother, much like the consultations surrounding ELCS. It is hard to "demand" to see a doctor when people bang on about natural processes and then put you on a conveyor belt of care. I would like doctors to be more visible on antenatal and postnatal wards.

I don't think that doctors careers are necessarily the same throughout their careers. The core work is the same (just like most jobs, such as teachers who will teach the same subject through the course of their career). The challenges and variation come from taking on teaching roles, being members of committees, taking on management responsibility, doing research etc. These opportunities exist or can be generated by career minded individuals, so it is down to them to plan careers accordingly. Alternatively they may decided to focus their spare time on building a lucrative private practice (less so in obs).

There is a risk that obstetrics becomes a bit of a Cinderella specialism due to the demands for 24 hour cover and the lack of private opportunities due to the cost of insurance. Consequently it may not attract women with the un-family-friendly hours and it seems that British trained doctors are not choosing to go into it as much as foreign trained ones.

I think nobody should be able to qualify as an obstetrician unless they have attended half a dozen home births, as due to the escalation in infections in hospital, in 15-20 years this may have to be a standard model for normal birth. Plus I think it would give a better view of normal birth anyway, rather than the institutionalised model that is more often the case. The last thing I would say is that vaginal repairs need to be given a higher priority. Half of Britain seems to be staggering around with avoidable damage and this comes down to a lack of surgical training in many hospitals, meaning an appalling standard of postnatal repair on wards and afterwards. There are many parts Kegels will never reach.

What is a post-natal check meant to involve? I took my baby along to our 6 week check and he was given a thorough examination. I, on the other hand, was treated to a conversation, where the GP asked me how I was feeling and had I thought about contraception.

Perhaps self-referral would be a disaster the way the NHS is set up, but it shouldn't be

Having lived in the US and France, where women can self-refer to gynae and thus bypass GPs, I feel very strongly that all women should have this right. I don't think the 'worried well' argument holds as much water here, it's not like my vagina can catch a cold or sprain its finger. Can we really not trust women to know when their symptoms are serious? Considering that the UK does not perform as well as other countries in terms of ovarian and breast cancer screening and survival rates, I think improved access to gynae services is really important.

If my heavy periods, intermittent spotting, easily irritated scar tissue, painful intercourse are bothering me then it's serious to me and it should be investigated. They may seem like a worried well to the GP and in the grand scheme of things those problems probably aren't life threatening but by gum are they depressing enough, even without having to battle the GP to take you seriously, and very worrying.

I thoroughly agree that if self-referral the way it's set up is a disaster then gynaes should be having drop in clinics so it won't be.

My 6 week check involved an internal (could have opted our) checking that my stitches were healed, my uterus was normal sized, my cervix closed. Also advice on breast care and contraception, a postnatal smear and reminder to book another (must do that), checking my emotional state and any plans for future pregnancies (and reassurance that there was no reason not to IYSWIM unlike a CS), an offer of a birth debrief and gentle nagging about pelvic floor physio.

Baby was dealt with by paediatrician.

I think an experience similar to this would contribute to the career of a gynaecologist and an obstetrician.

oops

Pain relief (lack of it) is the Elephant in the room !