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The waiting game

This contractual postnatal checks idea is giving me sleepless nights


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I have good news, bad news and worse news.

The good news is that I’ve just discovered something wonderful about a recurring chore in general practice that I’ve only endured over the years because I assumed I had to: I don’t have to.

Apparently, the pointless ritual known as the ‘six-week postnatal check’ which has mums mumbling, as they leave, ‘That was a waste of time’ – largely because it was – is not mandatory. I’ve been doing them for as long as I can remember, and I’m guessing you have, too, as I’ve always assumed they were a specified part of the maternity Additional Service contract.

But they’re not. Trouble is, I’ve only realised this because someone has now decided that they should be. And that’s the bad news. For reasons which utterly escape me, incorporating the six-week check into our contract is part of the 2019/20 contract negotiations. The even worse news is that the National Childbirth Trust seems to be the frontrunner in coming up with the check’s format. Yup, that’s right. The NCT.

We all know that postnatal checks are a worthless, unscientific tradition

I’ve got nothing against them personally, even if an NCT antenatal class 28 years ago did make me miss the England v Germany World Cup semi-final. But I have to say that, if I was looking for an evidence-based approach to support post-natal checks, the NCT wouldn’t be my first port of call.

Then again, anywhere I’d look would prove pointless, because this is an evidence-free zone. We all know that postnatal checks are a worthless, unscientific tradition, so let’s not regress to the dark ages. Midwives and health visitors can do the routine, proactive touchy-feely bits.

New mums are welcome to see me whenever about whatever. I’ll even try to make opportunistic enquiries in the post-natal period, if you like, though I’ll probably steer clear of one of the NCT’s suggested questions – ‘Does your perineum feel OK?’ – especially if she’s just come in with a sore throat.

But please: no arbitrary six-week check which wastes patient time and a precious appointment. On the other hand, if mandatory six-week checks are the forceps that lever out a shiny, healthy, GP-friendly new contract and there are no other nasty perinatal surprises, then feel free to completely disregard the above, Mr Vautrey. Like I said, I’m doing them already.

Dr Tony Copperfield is a GP in Essex

Please note: this headline was changed at 9:45am on 6 November 2018 to reflect that Copperfield is referring to postnatal checks - not 'baby checks', as the original headline implied

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Readers' comments (18)

  • Cobblers

    Left the post natal to the nurses (midder/HV/PN) 14 years ago when it left the contract.

    But the 8 week baby check was useful in getting them in for the first set of vaccs and it was fun time after a long surgery.

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  • A classic example of something that is done because there is pressure from politicians, some members of the public (and possibly some traditionalist medics) rather than because there is any evidence base for it. Now, what else can I think of along those lines...

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  • Remember guys, that's what you get with socialised medicine/state intervention lol What happens in the free market? I here you ask. We do them when we need to do them, and the parents are fully responsible for deciding when to ask us to do them. Sensible?

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  • Baby checks are not only a complete waste of time but potentially dangerous because they create a false sense of security.They've very poor sensitivity in picking up major disorders such as congenital heart disease etc and by falsely reassuring parents you're digging your own grave for the future.

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  • Hi there - a quick note to say that the previous headline caused some confusion, and that is my fault as the editor. This is not a piece about baby checks - it is a piece about postnatal checks.

    We've changed the headline, and this better reflects the substance of Copperfield's argument.


  • doctordog.

    Here here!
    And the ‘fun’ soon wears off.

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  • GP in UK has been ‘evidence free/lite’ for some time (most of that supposed ‘evidence’ has been a concoction of Big Pharma or some other agency (like NHSE, NICE, RCGP, GMC etc) with their own and frequently perverse vested interest.

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  • I like doing baby checks. But that’s not the point. I think it is a good use of our time. It’s an opportunity to discuss and advise about baby’s health, and to pick up things like post natal depression if it has been missed. There are far fewer postnatal midwife and HV visits so post natal depression is in danger of being missed. And please note, we hardly have health visitors any more. Their numbers have been cut and there are more cuts to come. In our area they are an endangered species and I suspect its the same everywhere as the public health cuts are universal. General Practice does have a social and health promoting role and I think that for young parents, especially first time mothers, its really important that they have that one dedicated appointment where they can talk about their health concerns and any concerns about their baby. It is also a good opportunity to explain about and motivate for vaccination, and parents tend to trust the advice of a doctor so it helps with vaccination uptake. I think talk of “lack of evidence” is a bit rich as there is so much that we do for which there is not hard evidence. But absence of evidence is not evidence of absence. The UK has one of the worst child health outcomes in Europe. We know that prevention and health promotion are important. With cuts to all the other preventive services the GP is often the only one who is in a position to pick up problems. Instead of arguing ourselves out of our role, how about demanding proper funding so we have enough time to do this important work?

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  • I lost count of the number of times that I picked up a congenital cardiac defect in babies at the six week check after they had been given the all clear by a junior doctor upon discharge from hospital. I suppose that’a called ‘experience’ so in my eyes the six week check wasn’t a waste of time. The midwives have taken over all obstetric care for years so if that’s what they wanted then they have to take full responsibility for such expectations. Some of us older doctors actually did more obstetric jobs than the six month GP rotation job and missed having everything taken away by the midwives but I accept that was then and this is now.

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  • The reason this is being discussed is so actual obstetric/midwifery services don't have to do anything about their own p**s poor postnatal care - instead of looking at the real failings in intrapartum and postnatal care shown by increasing rates of postnatal depression, PTSD, poor breastfeeding support for those that want it etc they are shoving a token 10 minute appt onto GPs which will achieve nothing for mums but will allow the government to say 'something has been done' as we all know using GP time is the best solution as it is essentially free.

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  • I take your point about failure to address the shortage of midwifery and HV care and, of course, GPs should not be used in a tokenistic way, substitute for inadequacies elsewhere, and as a bottomless pit of resources. But I still think that, medically speaking there is value in a dedicated appointment with the GP for maternal and child health at 6-8 weeks. I could be persuaded that the post natal appointment may not be needed if there were sufficient midwives and health visitors to do the job, who would only refer those women who had a medical problem to the GP. But I do think there is important medical input for the child 6-8 week check. Not only do we sometimes pick up conditions that have been missed or that don’t present til that point, but it's also an opportunity to advise about less serious problems but which are worrying for parents, and for which they value medical input. I am thinking of conditions like infantile eczema, feeding difficulties, reflux and bowel function problems, persistent crying/colic, concerns about weight gain, minor skin abnormalities and blemishes, all the odd little movements and snuffles that parents worry about but are usually normal. All these things come up regularly in the 6 week check (and at other times in infancy) and they are the kinds of things that health visitors refer the child to the GP for anyway. Occasionally one of those things turns out to be something serious but usually they are normal and the parents can be reassured. Does no-one remember Illingworth’s “The Normal Child”? And does the GP not have a role in helping parents distinguish between disease and normality and major and minor illnesses and give them confidence to manage their child’s everyday problems?

    This is from the introduction in the BMJ review of Illingsworth’s “The Normal Child”:

    "Variation in humanity is so great that it is sometimes challenging to tell the normal from the pathological. This distinction is critical in paediatrics, where variation in children’s growth, physical appearance, behaviour, and emotional development can be enormous without amounting to disease. Recognition of the normal child is an acquired skill; one that is fraught with the dangers of overinvestigation and of the failure to reassure parents. Ronald Illingworth’s The Normal Child, a landmark in the paediatric literature, saved countless doctors—specialist and non-specialist—from the perils of misdiagnosing normality in children."

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  • Marie Louise this is nothing to do with the 6-8 week check for babies, that is standard GP care. The article is about the postnatal check for mum which isn't contractual or standardized. They are talking about introducing a postnatal check for mother's into the GP contract in lieu of actually improving maternity services.

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  • Let common sense prevail

    When I entered General Practice the routine for a postnatal check included mandatory examination of the breasts, and an internal vaginal exam. Not only have those drifted into obsolescence, I suspect that they would land you in court, or at least with a nasty local reputation!!

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  • @Chris Ho
    Because the free market would never offer useless non evidenced based screening which might harm patients?

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  • Cobblers

    DrA 9:50pm I think that the ambiguity has been caused by Copperfield in that his headline mentions one thing and the article is about another. That being said until 2004 the two, PNs and Baby checks were conflated, at least in my practice.

    And, yes, baby checks were fun! Even for an old fart like me.

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  • It's not often I disagree with Dr Copperfield, but this is one such occasion. Totally agree with Marie-Louise Irvine and another last man standing ...over the past 20 years I've picked up dozens of cardiac defects in babies, (several requiring surgery) 3 babies with congenital hip dislocation, 2 babies with serious chromosomal abnormalities missed at the birth check, a baby with persistent jaundice that mum had not noticed due to biliary atresia who required a liver transplant and numerous other medical problems. The postnatal check is an ideal opportunity to look for postnatal depression and anxiety.

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  • 6 week checks can pick a few things up but one needs to be careful these days in the toxic uk environment. Ask a question about bleeding, perineum or discharge can get you in hot soup. If you are damned if you do and damned if you don't then I might as well save the effort and be damned anyway unless it is compulsory.

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  • Some 36 years ago my GP told me I needed to,attend his surgery for a 6 week post natal check.he was very surprised when I turned up.”where’s baby?” he asked. “You asked to,see me,” I replied. “Yes but but that means with your baby, “ he retorted. “You should have specified” I said. He struck me off his list. And yes, the visit was a total waste of time.

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  • @Angus P
    totally agree

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