Obstetric audit in general practice.

Abstract

Many recent papers have tried to show how inadvisable it is for general practitioners to undertake obstetric care and more especially obstetric deliveries.1-3 The high proportion of artificially induced labours, the enthusiasm for the increasing mechanisation of labour, descriptions of unexpected and sinister disease that the inexperienced obstetrician would not detect have all made general practitioners less confident in obstetrics. By virtue of the very breadth of their specialty GPs find it difficult to aggregate sufficient numbers of cases to refute the allegations of mediocrity made about their obstetric care and the possibly poor obstetric outcome achieved by them. I will describe the results of the obstetric care in a practice that works closely with a specialist unit, and they are far superior to national averages. With the development of effectively functioning primary health care teams, increasingly containing vocationally trained general practitioner obstetricians, en couragement of this style of obstetric care could improve the overall national statistics. We believe that modern obstetrics should aim at normal pregnancy, labour, delivery, puerperium, and a healthy mother and breast-fed baby. Care should take place in a setting that the mother, after consulting her obstetrician, be he general practitioner or specialist, believes to be in the best interests of herself and her baby, not only physically but also socially and psychologically. When patient participation is becoming increasingly encouraged obstetrics above all specialties should be the one in which the mother's wishes and desires are met, as well as the rather narrower clinical dictums of the obstetrician himself.Future perinatal, neonatal, and maternal mortality and morbidity statistics will increasingly be viewed not in absolute terms but will be set against the amount of deviation from the normal process described above. Anderson, Turnbull, and Baird6 suggested that since the health of pregnant women was improving and the maternal age at first birth was falling, the need for obstetric interference should actually be getting less. We have attempted to implement that suggestion.