General Practitioner Obstetricians Research Articles

General practitioner obstetricians' models of care in rural Western Australia.

BackgroundIn Australia, a significant proportion of women live rurally and deliver their babies in services supported by general practitioner obstetricians (GPOs). While GPOs are known to be an important backbone in the provision of maternity care in Australia, little attention has been paid to their models of care.AimsTo describe the models of maternity care provided by GPOs across Western Australia.Materials and MethodsThis was a multi‐phase mixed‐methods cross‐sectional exploratory study. We invited rural GPOs in Western Australia to complete an online survey about their models of care and a sub‐group of GPOs agreed to an interview to further explore their responses.ResultsThirty‐five GPOs completed the survey and 12 completed an interview. We found that GPOs work in a variety of models, dependent on local community needs, resources and geography. Key attributes of GPO models are continuity of care, safety, generalism, accessibility and affordability. GPO care involves continuity of care beyond the time limits of pregnancy.ConclusionsGPOs’ models of care make up an essential part of rural maternity services and have evolved to meet the needs of the communities they serve. This work informs rural generalist trainees of career pathways and policymakers about rural service provision.

Satisfaction with general practitioner obstetrician-led maternity care in rural Western Australia.

To measure satisfaction with general practitioner obstetrician-led maternity care in Western Australia and to explore perspectives of maternity service users DESIGN: Women were recruited at antenatal visits with their general practitioner obstetrician. Participants completed a validated three-part survey about their satisfaction with antenatal, intrapartum and postpartum care. They were all offered a semi-structured interview. Nine general practitioner obstetrician practices located in regional Western Australia. 155 women receiving general practitioner obstetrician-led maternity care within the South West or Great Southern regions of Western Australia. 13 of these women also participated in an interview. We quantified satisfaction with aspects of antenatal, intrapartum and postpartum care using a Likert scale. Descriptive variables included demographic information and birth outcomes. Qualitative data described valued aspects of maternity care. 116 women completed all 3 surveys. General practitioner obstetrician-led care resulted in high rates of satisfaction across all 3 stages of care, with 78%-100% agreement with positively worded satisfaction statements. Thematic analysis identified four key aspects of care women valued when receiving maternity care: the woman-centred care experience, the skills of the general practitioner obstetrician, support from the health care team and the health care environment. General practitioner obstetrician-led maternity care is a highly regarded model of maternity care, valued by rural women with high rates of satisfaction.

Access and outcomes of general practitioner obstetrician (rural generalist)-supported birthing units in Queensland.

ObjectiveTo describe characteristics and outcomes of women birthing within GP‐obstetrician (rural generalist) supported rural (level 3) obstetric units in Queensland.DesignRetrospective descriptive study.Setting21 GP‐obstetrician supported birthing units in Queensland.ParticipantsWomen (n = 3111) birthing from January 2017 to December 2017.Main outcome measuresPatient, pregnancy and labour characteristics and key maternal and neonatal outcomes routinely recorded in the Queensland Perinatal Data Collection and Queensland Hospital Admitted Patient Data Collection were compared to Queensland public hospital aggregate data.ResultsWomen birthing in rural maternity units were significantly more likely to be Aboriginal or Torrs Strait Islander (16% v 9%), < 20 years old (7% v 4%), term deliveries (96% v 91%), achieve spontaneous onset of labour (67% v 51%), and birth (71% v 60%) (p<0.001) compared with all Queensland public hospitals. They were significantly less likely to be nulliparous (36% v 40%), use pharmacological analgesia (65% v 69%), or have continuous electronic fetal monitoring in labour (54% v 66%) (p<0.001). Neonatal outcomes were comparable; with no significant difference in stillbirth rate between rural units and all Queensland public hospitals (4.8 v 7.3 per 1000 births). Precipitate delivery was the most common labour complication (36% v 33%) (p<0.001).ConclusionGP‐obstetrician (rural generalist) supported rural birthing units in Queensland provide important access for low and medium risk women to deliver locally, with strong indicators of quality and safety.

Impact of traumatic birth on Australian obstetricians: A pilot feasibility study.

Traumatic stress can adversely affect obstetricians' mental health and may affect care provision. Little is known about the impact of traumatic birth on the Australasian obstetric workforce. To assess the feasibility of conducting a binational survey of Australia and New Zealand obstetricians, trainees, and general practitioner obstetricians, to determine the prevalence of trauma exposure and associated factors. Feasibility was assessed using a convergent mixed-methods design. The pilot online survey assessed traumatic exposure and included the Posttraumatic Diagnostic Scale, Copenhagen Burnout Inventory (work subscale), and Posttraumatic Growth Inventory (short form). Qualitative data were generated from survey comments and telephone interviews and thematically analysed. Using various recruitment strategies, 32 participants completed the survey, and eight completed interviews. Most participants were consultant obstetricians. Nearly all (n=31, 96.9%) had been exposed to traumatic birth(s). Three-quarters had current symptoms of traumatic stress, one-quarter had symptoms of work-related burnout, but over two-fifths reported significant post-traumatic growth. Thematic analysis revealed perceptions that 'obstetricians experience substantial trauma', there is a 'culture of blame in obstetrics', and only 'in some workplaces it's supportive and safe'. Feasibility issues included the need to identify the respondent's level of training at the time when their most traumatic birth occurred, ensure anonymity of responses, and use a different tool to assess traumatic stress symptoms. Conducting a full study of this important topic appeared feasible. Standardised measures were acceptable. Revision of some questions is required. Anonymity needs to be promoted.

General Practitioners providing obstetric care in New Zealand. What differentiates GPs who continue to deliver babies?

AIM To identify factors that have enabled some New Zealand general practitioner obstetricians (GPOs) to continue providing maternity care and factors implicated in decisions to withdraw from maternity care. METHOD Semi-structured interviews and one focus group (n = 3) were conducted with 23 current and former GPOs. Interviews were transcribed and analysed thematically. RESULTS Current and former GPOs practiced maternity care because they enjoyed being involved in the birth process and delivery suite environment. Their maternity practice was framed by a philosophy of lifelong continuity of care for patients. CONCLUSION GPOs still practicing in New Zealand do so because they find maternity care highly rewarding despite their perceptions that the current maternity care model is incompatible with general practice. They have often developed local solutions that support their practice, particularly around shared care arrangements.

Local birthing services for rural women: Adaptation of a rural New South Wales maternity service.

ObjectiveTo describe the outcomes of a public hospital maternity unit in rural New South Wales (NSW) following the adaptation of the service from an obstetrician and general practitioner‐obstetrician (GPO)‐led birthing service to a low‐risk midwifery group practice (MGP) model of care with a planned caesarean section service (PCS).DesignA retrospective descriptive study using quantitative methodology.SettingMaternity unit in a small public hospital in rural New South Wales, Australia.ParticipantsData were extracted from the ward‐based birth register for 1172 births at the service between July 2007 and June 2012.Main outcome measuresBirth numbers, maternal characteristics, labour, birthing and neonatal outcomes.ResultsThere were 750 births over 29 months in GPO and 277 and 145 births over 31 months in MGP and PCS, respectively, totalling 422 births following the change in model of care. The GPO had 553 (73.7%) vaginal births and 197 (26.3%) caesarean section (CS) births (139 planned and 58 unplanned). There were almost universal normal vaginal births in MGP (>99% or 276). For normal vaginal births, more women in MGP had no analgesia (45.3% versus 25.1%) or non‐invasive analgesia (47.9% versus 38.6%) and episiotomy was less common in MGP than GPO (1.9% versus 3.4%). Neonatal outcomes were similar for both groups with no difference between Apgar scores at 5 min, neonatal resuscitations or transfer to high‐level special care nurseries.ConclusionThis study demonstrates how a rural maternity service maintained quality care outcomes for low‐risk women following the adaptation from a GPO to an MGP service.

Novel Simulation Workshop Improves Performance in Vacuum Delivery

Background: Operative vaginal delivery is a common obstetric intervention, with the potential to cause harm to mother and baby. Training in operative delivery traditionally comprised junior trainees learning the skills under supervision, then practicing and refining them independently. Recently this model has come under scrutiny, with the advent of simulation-based training suggesting a method by which the skills of safe delivery may be taught without risk. Multiple training courses exist, but few have been subjected to evaluation. Aims: The primary aim was to investigate if a simulation-based training workshop, where the development of a successful technique for vacuum delivery occurs using a collaborative, problem-solving approach, improves the rate of correct vacuum cup placement. The secondary aim was to determine if the workshop leads to improvement in theoretical knowledge of vacuum delivery. Methods: Participants on three workshops were assessed for their performance in vacuum delivery prior to and following a multimodal training program. Participants included general practitioner obstetricians, obstetric trainees and resident medical officers. Evaluation occurred using a standardised Likert-scaled rating sheet and utilising a diagrammatic representation of cup placement. Results: The participants demonstrated significant improvement (median post-pre score 1, p in the accuracy of cup placement, in a variety of practical core skills and in theoretical knowledge of vacuum delivery. Discussion: Participation in a simulation-based vacuum delivery workshop improves the performance of obstetric trainees and GP obstetricians. Further work is required to evaluate the performance of such training modalities on clinically relevant outcomes.

Kyneton maternity services: Paving and promoting the way to normal birth in a rural setting

This poster will showcase Kyneton Health’s model of modified case load midwifery care, adapted to function in a regional, level 2 hospital setting in Central Victoria. The model consists of five caseload midwives and is further supported by a multi disciplinary team, including two general practitioner obstetricians. This presentation will cover some history of setup, satisfaction results collated thus far, birthingoutcomesand identifyandexplore current challenges faced; namely how to increase our birthing numbers. Through changes to the maternity services available at Kyneton Health and the ever changing public perception of pregnancy and birthing, there is much midwives can do to help pave and promote the way to normal birth in a rural setting.

“Tossing Out the Baby with the Bath Water”: New Zealand General Practitioners on Maternity Care

A rapid decline in the number of general practitioners practicing obstetrics followed legislative changes in New Zealand during the early 1990s that changed the maternity care landscape. The resulting repositioning of maternity care professions has seen medical dominance give way to midwifery dominance in the maternity marketplace. Drawing on our research, we suggest that current and former general practitioner obstetricians harbor grievances relating to (1) the loss of obstetrics from the ‘cradle to grave’ philosophy of general practice, and (2) policies encouraging competition between maternity care providers. We argue that these perspectives represent truth games that are generated by the disciplinary blocks of the maternity care professions, and reveal the moral nature of the political economy of maternity care.

GP obstetricians' views of the model of maternity care in New Zealand

The Lead Maternity Carer (LMC) model of maternity care, and independent midwifery practice, was introduced to New Zealand in the 1990s. The LMC midwife or general practitioner obstetrician (GPO) has clinical and budgetary responsibility for women's primary maternity care. To determine views of practising GPOs and former GPOs about the LMC model of care, its impact on maternity care in general practice, and future of maternity care in general practice. 10 GPOs and 13 former GPOs were interviewed: one focus group (n = 3), 20 semi-structured interviews. The qualitative data analysis program ATLAS.ti assisted thematic analysis. Participants thought the LMC model isolates the LMC - particularly concerning during intrapartum care, in rural practice, and covering 24-hour call; Is not compatible with or adequately funded for GP participation; Excludes the GP from caring for their pregnant patients. Participants would like a flexible, locally adaptable, adequately funded maternity model, supporting shared care. Some thought work-life balance and low GPO numbers could deter future GPs from maternity practice. Others felt with political will, support of universities, and Royal New Zealand College of General Practice and Royal Australian and New Zealand College of Obstetrics and Gynaecology, GPs could become more involved in maternity care again. Participants thought the LMC model isolates maternity practitioners, is incompatible with general practice and causes loss of continuity of general practice care. They support provision of maternity care in general practice; however, for more GPs to become involved, the LMC model needs review.

Mapping maternity services in Australia: location, classification and services

To describe maternity services available to Australian women and, in particular, the location, classification of services and support services available. A descriptive study was conducted using an online survey that was emailed to eligible hospitals. Inclusion criteria for the study included public and private maternity units with greater than 50 births per year. In total, 278 maternity units were identified. Units were asked to classify their level of acuity (Levels 2-6). A total of 150 (53%) maternity units responded. Those who responded were reasonably similar to those who did not respond, and were representative of Australian maternity units. Almost three-quarters of respondents were from public maternity units and almost 70% defined themselves as being in a rural or remote location. Maternity units with higher birth rates were more likely to classify themselves as providing higher acuity services, that is, Levels 5 and 6. Private maternity units were more likely to have higher acuity classifications. Interventions such as induction of labour, either using an artificial rupture of membranes (ARM) and oxytocin infusion or with prostaglandins, were common across most units. Although electronic fetal monitoring (EFM) was also widely available, access to fetal scalp pH monitoring was low. Maternity service provision varies across the country and is defined predominately by location and annual birth rate.

Education for the management of obstetric conditions in rural general practice. A curriculum statement for a major in obstetric studies in the Rural Training Programme of the Faculty of Rural Medicine, Royal Australian College of General Practitioners.

EDITORIAL COMMENT": The Editorial Subcommittee of this journal agreed to publish this important curriculum statement for advanced obstetric training for rural general practitioners partly because we thought that general practitioner obstetricians who comprise more than half of our 5,000 subscribers will be interested to read this document carefully if for no other reason than to check their own clinical abilities in the various sections provided.

Obstetric Training for Rural General Practice

In the current debate on the problems faced by rural doctors, lack of training in procedural disciplines such as obstetrics has emerged as a priority issue. With specialist obstetric services concentrated in metropolitan and major provincial cities, general practitioners will continue to provide rural communities with obstetric care. Postgraduate obstetric training programmes for general practitioners must provide procedural skills training for intending rural practitioners or risk being regarded as irrelevant to the needs of rural communities.

5 Social and midwifery support

Antenatal care in most Western countries is either directly provided by, or supervised by, obstetricians or general practitioner-obstetricians. Cynicism and despondence regarding the value of this 'traditional' antenatal care is widespread, even amongst those providing the care. It is therefore surprising that most retrospective reports by women about this care have indicated general satisfaction with it (Porter and Maclntyre, 1984; Canadian Medical Association, 1986). Several factors may work, however, to bias these results in favour of traditional care. Generally these women had recently undergone a pregnancy in these arrangements and consequently felt some obligation to report that these arrangements were the best possible ones (Porter and Maclntyre, 1984). There is a tendency to respond negatively to new arrangements until they have been experienced, which may also have influenced women to respond unfavourably to an alternative form of care. Also, the responses of women to questions about their care could have been influenced by their perceptions of what the interviewer wanted them to indicate (Lumley, 1985; Oakley, 1985). This latter criticism also applies to those retrospective assessments of women's satisfaction with obstetrical care which have drawn negative conclusions (Oakley, 1979). The principal criticisms of traditional antenatal care focus on the social aspects of the care in that it is impersonal, and that advice and information are either insufficiently or inappropriately provided (Garcia, 1982). The impersonal nature of traditional antenatal care is a particular problem for women who attend public clinics where they often see several different doctors during their pregnancies. Women's criticisms of the medical aspects of their care have likewise focused on poor communication of the results of screening tests rather than on the screening tests themselves (Reid and Garcia, 1989). These perceived deficiencies in antenatal care could be categorized as deficient social support (the social gratification received through interaction with others). Thoits (1982) has operationalized social support in two ways: expressive support (sympathy, empathy, understand-

General practitioner obstetricians.

General practitioner obstetricians.

Obstetric audit in general practice.

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.

The work load and distribution of obstetricians and gynaecologists.

A questionnaire to members of the College was returned, completed, by over half the members. It appears that very heavy work loads are carried by many members, and 44% of those in private practice consider themselves overworked. The opinion of 18% of the respondents is that too few specialists are being trained, and 61% of them said that too few general practitioner obstetricians are being trained. Eighty per cent believe that specialists and trained practitioners should practise obstetrics. Recertification is thought desirable by 79%, and continuing education by every respondent.

Principles of the role of general practitioner obstetricians and specialists in obstetric care.

Medical Journal of AustraliaVolume 2, Issue 25-26 p. 958-959 Medical Practice PRINCIPLES OF THE ROLE OF GENERAL PRACTITIONER OBSTETRICIANS AND SPECIALISTS IN OBSTETRIC CARE First published: 01 December 1976 https://doi.org/10.5694/j.1326-5377.1976.tb115544.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume2, Issue25-26December 1976Pages 958-959 RelatedInformation

Modern obstetrics and the general practitioner.

In a changing obstetric world we thought it timely to survey the work and attitudes of general practitioners with special obstetric training. Such a survey might have useful service and educa tional implications. We decided therefore to send a question naire to holders of the DObstRCOG qualification old enough to have settled into their practices but not so senior that they had begun to restrict their obstetric responsibilities. We were interested also to obtain some secondary information on gynaecology, family planning, and abortion from the viewpoint of the general-practitioner obstetrician.

Use by general practitioners of obstetric beds in a consultant unit: a further report.

Of 1,700 women booked for delivery by general practitioner obstetricians in a consultant unit, 1,399 had uncomplicated deliveries and the co-operation between practitioner and consultant was an obvious advantage for the 257 who were transferred completely to consultant care during pregnancy, labour, or puerperium. The scheme, which started in 1964, has enabled general practitioners to continue to give complete obstetric care to their patients. The number of participating practitioners has, however, declined from 80 to 16 indicating that many preferred to concentrate on antenatal work.