Shared Antenatal Care in Brisbane

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Abstract
EDITORIAL COMMENT: This paper was accepted for publication to remind readers, both general practitioners and specialist obstetricians, that shared antenatal care exists and will become increasingly popular. Shared antenatal care has been endorsed by Government as a means of reducing the expense of provision of outpatient facilities, although the most expensive first visit, at which most routine investigations are performed, remains a hospital service. Some hospitals have a policy of routine 18‐week ultrasonography for all patients attending general practitioners or midwives clinics (hospital based ‘shared’ care), so that an accurate assessment of fetal maturity avoids errors of management later in pregnancy. The hospital consultants are then more likely to approve of shared care for high risk patients such as those with a past history of Caesarean section. Shared antenatal care satisfies patient, hospital staff (doctors, nurses and administrators) and general practitioner, but requires good communication, the 2 main requirements being an antenatal card kept by the patient and filled in by all care‐sharers and an efficient system whereby copies of results of all investigations performed in the hospital are promptly sent to the general practitioner.Many general practitioners wish to share antenatal care but not be called for delivery; those general practitioners who do wish to deliver ‘their’ patient should be encouraged to do so and all metropolitan and country hospitals should provide for approved general practitioners to have staff status. In the editor's experience few city generalpractitioners at present wish to deliver their patients in the major hospitals, but hopefully this will change. As increasing numbers of general practitioners receive postgraduate training in obstetrics and neonatal paediatrics it is envisaged that more will seek positions on the staff of major/teaching hospitals. The need to reduce the duration of postnatal care in hospital favours this role of the general practitioner, since the woman and her newborn baby will remain under his care following early discharge from hospital. There is no rigid formula of requirements for shared care, any more than there is for the philosophy of Birth Centre care. A reasonable regimen is3 hospital visits for shared‐care ‐first visit for documentation and routine testing, second at 30 weeks' gestation to review the patient and test for glucose tolerance and fetoplacental function (an editorial opinion not endorsed by the recent booklet produced by the Health Care Committee of the Royal Australian College of Obstetricians and Gynaecologists), and the third at full term.Summary: The prevalence of antenatal care shared between general practitioner (GP) and public hospital services in Brisbane, and its acceptability to patients was assessed. Responses to questionnaires put to women in the immediate puerperium of the public wards of 2 major teaching hospitals are presented. Antenatal shared‐care was undertaken in 54% of pregnancies. Indications of advantages for women to undergo antenatal shared‐care were identified with convenience of appointment time, and decreased travel and waiting time. An important cooperation between GP and hospital obstetric services appears to have evolved in the area of antenatal care that provide benefits at least for patients' convenience.

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