In 1960, one-third of all births in England and Wales took place in women's homes.1 Michael Bull, looking back in 1980 over his professional life, quoted the words of the partner he had joined when he first became a GP: ‘When you look after a woman in pregnancy and deliver her, you will then have two patients for life’.2 For doctors working in the more competitive world before the days of the NHS, obstetrics was a fundamental part of medical care, partly because it was a way of winning the loyalty, and the custom, of young families.
LOSS OF CONTACT
The proportion of domiciliary deliveries fell for familiar reasons: a combination of declining interest, pressure from other professionals, and the final, powerful impetus from the diluted or abandoned responsibility for out-of-hours care. Generations of GPs had already decided that hospital delivery was either safer or preferred by their patients, or that they had neither the skills nor the inclination to continue a commitment to intrapartum care. GPs argued that continuing to care for women before and after birth was enough to fulfil the professional obligation for good obstetric care.
However, with changes to working hours, the restructuring of programmes allowing less time and fewer hospital posts for GPs in training, together with the absence of any need to qualify for the obstetric list, GPs' commitment to ante- and postnatal care may also be dwindling. Combine that with midwives keen to assume overall responsibility for all obstetric care, and we may be about to witness a gradual retreat of GPs as a body from all maternity care in the UK.
LATEST RESEARCH
Three papers published in this issue of the BJGP suggest that such a move would be misguided. In the study on preconception care offered to pregnant women with diabetes, Mortagy …