Oh no it’s not. It’s all political.

The headline is from the Herald. It originates from this BMJ editorial, whose first line is “Since the first report of the Confidential Enquiry into Maternal Deaths in 1952, the maternal death rate in the United Kingdom has decreased dramatically.” They say that “many doctors are unfamiliar with the interaction between pregnancy and medical disease”.

This is odd, since GPs used to offer maternity care, within their own practices, with visiting midwives and the odd hospital visit if scans or other interventions were needed. We were a team, the midwife who looks after normal pregnancies, and the GP who looks after women before and after having a baby, who probably know the family, other children, and where the health visitor is down the corridor.

The new ‘midwife-led’  system seeks to exclude GPs from normal pregnancy care. Women were advertised to via a press campaign featuring a midwife, and posters in Glasgow and told to ‘see me first’ – book direct with a midwife. Whereas, I would normally have seen women soon after they confirmed pregnancy, could check out the woman’s general health – any medication issues or other problems? – talk about folic acid, alcohol, smoking, etc.

Now our patients book centrally, are seen centrally, and we have no personal contact with the midwives looking after them.

Sure, I don’t think you forget how to deal with rare emergencies in pregnancy easily. But the overall experience that GPs have in dealing with obstetrics has changed because of politics, not evidence. Women haven’ t been given a choice about this, despite what the ‘choice agenda’ in the NHS says. There is plenty of GP training in obstetrics; just not much chance to use it.

The bigger problems are not about GPs being able to reduce risks in pregnancy, but about the risk factors pregnant women already have: obesity, hypertension and diabetes, for example. These are all conditions which GPs will see patients about before, between and after pregnancies. Fragmented care does not serve patients well.