In the last 20 years general practice obstetrics has retreated from a position where we were central to pre-pregnancy counselling, diagnosis of pregnancy, antenatal care, and in many cases intrapartum and postpartum management, to being almost completely separated from any woman who contemplates or embarks on pregnancy. This might superficially appear a good thing: midwives are experts in the field of normal pregnancy, with complications better left to specialists who have the means to intervene at hand.
We have to consider whether as family doctors it is a good thing to have distanced ourselves so far from this important family event. The article by Griffiths et al1 suggests that specialist clinics may have done more harm than good by emphasising the abnormal rather than the normal.
Experience tells us that women were happy to have a GP present, offering a feeling of familiarity and confidence at an uncertain time. The derivation of obstetrician comes from the Latin ‘to stand by’. Our branch of our profession may have forgotten the importance of simply being there for patients, and seeing pregnancy as not just embarking on a new venture, but within the great continuum of life. The disappearance of maternity care from our duties may not be in the interests of patients who need a personal service at an emotional time. Not to mention the fulfilment of the GP/obstetrician.
- © British Journal of General Practice, 2008.
