Combining for Baby

In her article on midwifery, Karen Guilliland rightly commends supportive frameworks in which health professionals can flourish (July 17). However, as a retired British general practitioner working as a locum in Christchurch, I have been surprised and saddened by the separation of antenatal care from general practice.

Working on a remote Orkney island, I experienced the acute anxiety of trying to resuscitate mothers and babies far from hospital care. But this anxiety was eased by being shared with my colleague and friend, the island’s midwife.

In less difficult circumstances in the Scottish Borders, I worked with my practice-based community midwife to provide antenatal care for our patients. Medical, obstetric, psychiatric and social problem were monitored by the team of midwife, GP and visiting obstetrician.

The option of a home birth was available, but most deliveries were performed by hospital-based midwives with support from their medical colleagues. Returning home, mothers and their babies were visited daily for 10 days, or longer if necessary, by their community midwife and health visitor.

This involvement of the primary- care team in antenatal care gave us a wonderful opportunity to establish a relationship with the family on which to build their care.

We all felt that it was one of the most satisfying aspects of family medicine, one in which all members of the team had co- operated to use their skills in a positive way.

Contrast this with the fragmented system in New Zealand, in which I have heard caring and committed general practice staff greet the news of a new baby with surprise, unaware even of the pregnancy.

Dr DAVID MITCHELL

St Albans

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