by Dr Sharyn Wilkins
Defining the ‘primary carer’ in maternal care is not difficult as maternal care is a specialty area and the specialists in maternal care (namely the obstetricians and midwives) do not provide comprehensive primary care.
Any time a GP's patient is under the care a specialist, they still consider their GP as their primary carer, even though they may be admitted to hospital for a while in specialist care. GPs look after a woman before, during and after a pregnancy. As a GP giving antenatal care, I look after the woman before pregnancy (sometimes since before menarche), prepare them for pregnancy, diagnose the pregnancy, organise antenatal tests, care for their pregnancy, care for their general health (including intercurrent illnesses, general medical problems, vaccinations such as swine flu), follow up all results, coordinate specialist medical care (including antenatal clinics, obstetric care, endocrinologists, renal physicians, psychologists etc), help with breastfeeding, advise on infant care and contraception, perform the six week post partum check up for both mother and baby, vaccinate the baby and continue to care for them etc, etc, etc.
The only thing I don't do is deliver the baby (GPs not welcome in Sydney's hospitals).
The public hospitals pride themselves on their comprehensive antenatal care and improving continuity of care but they only see the women from around 14 weeks of pregnancy (note this is missing the ENTIRE first trimester) to a few days post partum (note this misses the six week post natal check up) and these visits frequently involve a mix of a couple of different midwives and doctors providing care (not much continuity in that).
Communication on discharge is often a problem as well, with some maternity hospitals continuing to have problems getting a discharge summaries to the GP - although how they expect GPs to give post-natal care when they don't know if or when the baby was born, is a mystery. They do not offer or have the capability to provide (both financially or practically) the continuity of care and the coordination and comprehensiveness of care offered by GPs.
The power struggles between midwives, obstetricians, and GPs in maternal care create barriers to communication and to the quality and coordination of antenatal care, and need to stop as the one who loses out most is the patients. Remember that the GP is the ‘primary carer’ but they often request and need help in specialty areas of care such as maternal care. Cooperation, mutual respect, communication and evidence-based guidelines would provide better care for patients!
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