Greater GP role urged in maternity services

GPs are often best-placed to know a woman's medical history and yet

often have little involvement in pregnancy care.

The study, from the King's Fund think tank, calls on GPs to play a bigger role through all pregnancy stages and to work more closely with midwives and consultants in providing joined-up services.

While women can now self-refer themselves to midwives, many still visit their GP to have the pregnancy confirmed or for a referral to a midwife.

This can lead to confusion among women about who to speak to if they need something, including in an emergency.

Today's report said GPs could play an important role in all pregnancies but particularly for women with complex medical or social needs. This might include managing weight gain in obese women, referral to stop-smoking services and discussing genetic testing for those women who need it.

A visit early in pregnancy could also check a woman's general health, including a review of medical history from medical records and a heart examination.

The report said a GP could prove vital because women do not always

share all their medical history with midwives.

"A GP will often have accumulated knowledge about the women, her

medical and family history, sometimes over many years.

"He or she will generally know more about a woman's previous medical history, medication and family than any other health care professional, and will be the only healthcare professional who currently has a complete record of a woman's medical history."

GPs need to be able to recognise and manage conditions such as pre-eclampsia (linked to high blood pressure), sepsis, headache and breathlessness in pregnancy, the study said.

After birth, women may need help with diabetes developed in pregnancy, high blood pressure, anaemia or mental health issues.

The report said GPs play a "critical role" in ensuring that all relevant information is communicated and shared with midwives or obstetricians.

However, the report says if GPs are to take on a greater role, they must receive training to ensure they are up-to-date with the latest advances in maternity care.

Evidence in the report shows that GPs no longer receive sufficient obstetric training to ensure safety, do not wish to encroach on their time off and do not feel they are paid enough to take on the responsibility.

The lead author of the report Anna Dixon, who is director of policy at The King's Fund, said: "It is right that those with specialist skills, such as midwives and obstetricians, take the lead role in caring for pregnant women but GPs have a vital role to play in pre-conception and shared antenatal and postnatal care."

The chief executive of the National Childbirth Trust, Belinda Phipps, said it was best to give women a choice of carer but "to actively promote midwife-led care to women".

n Women who experience pregnancy complications or a difficult labour are at higher risk of post-natal depression.

Suffering one complication increases the risk of the condition, but the chances are even higher if more than one thing goes wrong.

Dutch researchers analysed data for almost 5,000 pregnant women for the study.