GPs afraid to treat pregnant women

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FAMILY doctors want to give up responsibility for caring for pregnant women at home as part of their NHS contracts.

Doctors are concerned that many women expect specialised care during labour from their GP, but that most family doctors do not have the necessary up-to-date skills to deal with an acute obstetric emergency in the home.

Some doctors have removed women patients from their list if they have requested a home birth, because of fears about claims for negligence.

The British Medical Association has issued legal advice to its 26,000 GP members that unless they actively participate in obstetric care - such as in GP-run maternity units - they should not carry the required drugs and instruments for this work in their bags.

It says it will seek the removal of care during labour from maternity medical services provided by ordinary family doctors, whether they are on the obstetric list - a list of doctors providing maternity services - or not. Doctors can choose whether to provide maternity services for their patients or not.

"We think that practitioners who are going to provide intrapartum care (care during labour) should be the relatively few GPs who are highly skilled and practised in this area," said Dr Judy Gilley, deputy chairman of the BMA's GP Committee.

"It may be more appropriate in future for doctors who wish to provide intrapartum services to do so via a contract with their health agency as a provider of non-general medical services."

In the legal advice sent to doctors, the BMA says it is important that GPs should make clear to their patients whether they regard themselves as GP obstetricians or not, and whether they are prepared to conduct home deliveries.

The BMA guidance continues: "Those who are not should make clear at the moment of signing for maternity medical services that they are not experienced in this aspect of medical care."

It recommends that this information is given in practice leaflets, to midwifery service organisers and to any deputising services for out of hours care which the practice uses.

The BMA says there have been several cases recently where doctors have been summoned to emergencies by midwives who have got into difficulties, or relatives who are concerned about a patient. It says it is concerned that doctors may find themselves vulnerable to complaints and claims brought by patients who have "unrealistic expectations of what can be achieved for them by GPs on the obstetric list".

A Department of Health report, "Changing Childbirth", published last year, said women should be given more choice in where they give birth, whether at home, in a consultant-led hospital unit, or a GP-run maternity unit.