Doctors push to work more closely with midwives

Family doctors want changes to maternity funding so doctors and midwives can work more closely together.

It follows new research released today showing that births where a GP or obstetrician is the lead maternity carer, rather than a midwife, result in substantially lower chances of poor results, such as oxygen deprivation for the baby.

The chair of the general practice council of the Medical Association, Kate Baddock, said the findings were very interesting.

She said under current maternity funding arrangements, set out in what's known as the Section 88 Notice, midwives stand to lose money if a GP is involved leading up to the birth.

Dr Baddock, a former GP obstetrician, said collaborative care and continuity with a woman's GP was better care.

"Funding has to change so that doctors and midwives can work much more closely with each other, so that these kind of outcomes, for whatever reason, don't occur."

She said since the move in New Zealand in 1990 to independent midwife-led maternity care, funding arrangements worked against collaboration with GPs.

"We have a very fragmented service. We have those who just go to midwives, we have those who just go to obstetricians, and those very few GP obstetricians who still remain."

She said a drive to have pregnant women "sign up" with a lead maternity carer when they were seven or eight weeks' pregnant meant a GP might see a patient once to confirm pregnancy, and then not again until six weeks after the baby's delivery.

Dr Baddock said she would like to be involved in pregnancy again, and so would many others - not necessarily at the delivery, but rather sharing the care through pregnancy and after delivery.

But College of Midwives president Deb Pittam said there was no need for shared maternity care for individual women.

"Why would you do that, because actually our outcomes are as good if not better than many other places in the world.

"We have a service that women are really happy with."

She said midwives also had a lot more time to spend with women.

But she added staffing pressures in hospital maternity units could cause delays.

"If there's one consultant on call and they're in theatre, then there's a delay in them [women] seeing the consultant.

"So the process is difficult and there's often a really chronic shortage of midwives in some of our hospitals, which makes actually [the] handover of the midwifery care very difficult as well."