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GPs urged to discourage women from ‘unnecessary’ hospital births, caesareans and epidurals

GPs should take a key role in discouraging women from 'unnecessary' hospital births, caesareans and epidurals, according to the Royal College of Obstetricians and Gynaecologists (RCOG).

A new report, produced in collaboration with the Royal College of Midwifes and parenting charity NCT, encourages CCGs and GPs to work to advise women to have a ‘normal' childbirth to reduce the costs of maternity services.

The report, which found that preventing each caesarean section that could be a normal birth would save the NHS £1,200 in tariff price alone, said GPs have a pivotal role to play because they are often the first point of contact for patients.

In addition to advising women on birth options, the guidance suggested that GPs assume responsibility for more unscheduled antenatal care, which currently counts for almost half of all spending on maternity care. Post birth, it said GPs should also work with maternity and local services to encourage women to breastfeed.

It said: ‘The new commissioning arrangements provide an opportunity to redress this imbalance [of medically eligible women giving birth in hospitals] by making midwifery-led services the default option for pregnant women… If women with low-level medical conditions can be supported and cared for in primary care (conditions such as swollen ankles and urinary tract infections are common in pregnancy), this will ease the pressure on busy maternity units and save commissioners money.'

The report added: ‘Women must receive consistent, positive information and advice from their health professionals if they are to have confidence in a normal birth. The first messages they receive will often be from their GP and these will powerfully influence their approach to their pregnancy.'

The guidance sets out normal birth as without induction, without the use of instruments, not by caesarean section and without general, spinal or epidural anaesthetic before or during delivery.

The national caesarean section rate in England currently stands at 24.5%. The NHS Institute for Innovation and Improvement has concluded that a 20% rate would be ‘achievable and sustainable', but NICE does not advocate target rates.

The RCOG guidance has come under fire from women's groups and some obstetricians who said putting pressure on women to give birth at home could lead to birth trauma and medical complications. 

Dr Felicity Plaat, consultant anaesthetist at Queen Charlotte's Hospital, London, said: ‘In the 21st century, where the resources are available, it's unacceptable and unethical to withholdeffective pain relief from women who require it. Furthermore, only the woman in pain can decide whether and what analgesia she needs.'

Dr Sarah Jarvis, a GP in Hammersmith, West London, said GPs should play a great role in advising women, but said not all had the required skills to do so.

Dr Jarvis said: ‘Often the GP will be well placed to decide which women should be most positively considered for home births, but the woman's desire and her suitability do not always correlate.

‘It very much depends on the services available in their area. Very few GPs are qualified to provide intra-partum care and cases need careful selection, with appropriate availability of a trained midwife and back-up emergency services. Most GPs are wary about home deliveries because of lack of personal experience and lack of up-to-date knowledge about services, which may change frequently.'

Dr Jarvis added: ‘It saddens me that over the past couple of decades, antenatal services have increasingly been moved out of primary care. I believe the important doctor-patient relationship during pregnancy has been eroded as a result.

‘Patients do not always see the GP as their first port of call for antenatal problems, and GPs may feel deskilled. I would welcome moves to reverse this trend, which might place GPs in a better position to have meaningful discussions with the patient about choices around delivery.'