Shared Obstetric Care: The General Practitioner's Perspective

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EDITORIAL COMMENT: We accepted this paper for publication since it is a useful review of, the objectives of shared obstetric care from the point of view of the general practitioner. The proportion of shared care patients in teaching hospitals in Victoria is very low in comparison with other States and it is certain to increase. It is probable that about 80% of patients are suitable for shared care if general practitioners are available, and this seems to be the case. The increasing litigation in obstetric practice will probably not detract from shared care as most litigation arises from problems that are perceived by the mother or her advisers to have occurred during labour or delivery. The authors rightly stress that shared care requires good communication between hospital and general practitioner, especially concerning the reporting of special tests. In the editor's opinion ultrasonography at 18 weeks' gestation should be a routine test in all shared care patients so that procedures requiring accurate knowledge of fetal maturity (e.g. repeat elective Caesarean section) can be planned appropriately. This also facilitates clinical diagnosis of the small for dates and large for dates fetus.We also require information from patients about the acceptability of shared care since many women have a hospital based loyalty and may prefer to attend a midwives' clinic which is another antenatal service that is certain to expand. A teaching hospital based midwives' clinic has the other advantages of availability of interpreters for non‐English speaking women and, importantly, the provision of female staff to examine them during antenatal visits and to care for them in labour. Current availability of female obstetricians is such that no hospital is likely to be able to guarantee the services of a female consultant obstetrician in labour even in high risk patients.There is a new important dimension to the shared care programme, based upon financial rather than humanitarian considerations. All hospitals are now under intense pressure to reduce average bed stay and this will apply to low and high risk women with either normal or operative deliveries. Women who leave hospital earlier will require increased surveillance for continuation of breast feeding and proper management of postnatal problems involving either the mother or the baby e.g. the listless infant who is jaundiced and jittery. It is most unlikely that the Department of Health will provide the funding required for hospitals to sufficiently increase surveillance of mothers and babies after early discharge; neither will the setting‐up of hospital postnatal clinics be an alternative favoured by ourfunders although hospitals should lobby for this facility. The shared care general practitioner seems the ideal individual to come to the rescue of the early discharged mother and baby; we hope these practitioners will accept this duty and not be penalized by a rapid rise in their medical insurance levy.The final consideration is that there needs to be audit and publication of results of shared obstetric care performed by general practitioners and midwives. Such reports should consider perinatal mortality rates to ascertain the effectiveness of such antenatal care, and also include an assessment of whether antenatal patients find shared antenatal care an acceptable option. The editorial committee will be pleased to receive such reports for publication in this journal.Summary: Shared obstetric care between hospital and general practitioner (GP) is being developed in several States in Australia as an alternative model of care for pregnant women in the public hospital system. The aim of this study was to determine the attitudes of participating GPs to the shared obstetric care programme at the Royal Women's Hospital, Melbourne. Fifty GPs were randomly selected, and face to face individual interviews were conducted using qualitative methods. GPs feel that the continuity of care they can provide during pregnancy and the postpartum is a very important and valuable aspect of their role as shared care providers. They are generally satisfied with the programme at the Royal Women's Hospital but some suggest that communication between the hospital and the GP should be improved. There was significant interest in being involved in deliveries in shared care programmes in the future and GPs question the appropriateness of the diploma of obstetrics as the only acceptable qualification for shared care.

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