The GP's role in maternity care

Abstract

In an Editorial in this issue, Westin and Bakketeig bring up the important question of whether uncritical use of ultrasound scanning in pregnancy can imply potential harm to the foetus. The Editorial evoked discussion among the national editors of this journal concerning the role of general practitioner in relation to maternity care. In the Nordic countries, as well as widely elsewhere, the care for healthy, pregnant women is generally organised within a primary health care setting. There are three main professions responsible for these preventive activities: general practitioners, midwives and gynaecologists. In Sweden, pregnancy care is usually organised in separate maternity units staffed mainly by midwives. Other countries organise primary clinical care and preventive care more or less under the same roof, served by a team of different professions. Primary care professionals are usually responsible for referring expectant women to routine ultrasound screening. In some instances, there is also ultrasound equipment at the local health care centre. In Iceland, where there is no referral system, a large number of pregnant women choose to consult a privately practising gynaecologist, often as early as in gestational weeks 7/9. These gynaecologists usually have ultrasound instruments in their office and will thus perform a scan to certify the presence of a vital embryo. This opportunity to experience ‘‘a first encounter’’ with the child-to-be could readily become part of the culture surrounding pregnancy. Why wait for weeks in uncertainty when a scan can tell immediately whether the foetus looks alive and well? During this first appointment, an Icelandic gynaecologist is likely to inform the pregnant women about the possibility to have a next ultrasound examination in pregnancy weeks 11/14 (early ultrasound screening). This is a scan designed to detect chromosomal aberrations and certain other foetal anomalies. It usually does not replace ultrasound screening in weeks 18/20, which has been a routine in many countries for 15/20 years. In a recent Editorial in SJPHC (1), Getz stated that primary health care personnel should not regard ultrasound in pregnancy as a specialist topic belonging solely within the sphere of obstetricians. As GPs, we want the health care system to deliver optimal care for pregnant women and their unborn children. When applying medical technology on a large scale in a preventive setting, it is paramount to ascertain that it does not entail the potential for unintended damage. Primum non nocere / first if all, do no harm.