GPs and their central place in maternity care

The Federal Department of Health recently announced two major initiatives in maternity care:
the release of its amalgamated and updated Pregnancy Care Guidelines: and the start of a new National Strategic Approach to Maternity Services (NSAMS), which is due to be finalised in mid-2019.
 
Dr Wendy Burton, the RACGP representative for NSAMS, told newsGP she is pleased to see a focus on collecting a broader range of input than was the case for the previous framework.
 
‘There will be opportunities for stakeholder feedback, with two series of workshops to be held in 12 locations around the nation, but with the expectation that there will be different locations for each workshop. So a total of 24 geographic locations,’ she said. ‘That should enable us to capture the urban, regional, rural and remote voices.’
 
Dr Burton is also happy to be representing general practice on NSAMS, as she believes that appropriately skilled GPs are qualified and well positioned to deliver comprehensive maternity care.
 
‘GP maternity care is not about providing care for six or seven months. It’s more than an episode of care,’ she said. ‘In the best of our models of care, it’s about years, decades and generations.
 
‘That continuity sets GP care apart from other craft groups.’
 
One of the key reasons Dr Burton believes GPs are so well placed to deliver excellent maternity care may, at first, seem somewhat counterintuitive.
 
‘If I’ve got a young woman presenting to me for a contraceptive pill, of course it seems absurd to ask if she is planning a pregnancy,’ Dr Burton said. ‘And yet these are opportunities to start the discussion about pregnancy timing, provide some education and, ideally, ask women to give us a few months’ notice when planning a pregnancy because there are things we want to check.’
 
With up to half of pregnancies unplanned, opportunistic discussions provide a way to introduce pre-conception information. This is increasingly important in a context in which average age, weight and likelihood of medical comorbidities at first pregnancy are all increasing.
 
‘GPs are beautifully positioned for pre-conception counselling,’ Dr Burton said. ‘We understand the medical issues, are well-skilled in the mental health burden that our nation is experiencing, are well-connected in our referral networks, and we are used to working as a team.’ 
 
The teamwork aspect is important for Dr Burton, who wants to emphasise that she is not advocating for GPs to take over maternity care from other specialist providers, but instead that they should be considered core team members and a vital workforce option.
 
‘It’s about wanting to do this journey collaboratively with our midwifery and obstetric colleagues, and about recognising the important role of anaesthetists, neonatologists, obstetric medicine physicians and the many other members of the extended care team,’ she said.
 
The point about teamwork is further emphasised when exploring another key role in maternity care that GPs are well placed to provide: screening.
 
‘Whether a woman is having private care or public care, GPs are a point around which services can pivot,’ Dr Burton said.
 
‘With the release of the National perinatal mental health guideline in October last year and the revision of the Medicare item numbers in November, GPs are now on higher alert about screening all [pregnant] women for mental health, domestic violence and drug and alcohol disorders.’
 
GPs are also in a position to provide care after the baby arrives – for the whole family.
 
‘GP care is measured in years and decades, and we do intergenerational care. We can look after not just mum, we can look after dad, siblings, baby, provide contraception choices and treat existing and emerging medical conditions.’ Dr Burton said.
 
‘GPs bring our very broad skill base and our referral networks with us when we’re involved in maternity care, which involves pre-conception, antenatal, postnatal and neonatal aspects of care.’

GPs-maternity-care maternity-care pregnancy-care-guidelines