Does anyone out there work with enlightened GPs? I ask this because every GP I’ve ever worked with hates the idea of homebirth despite all the evidence and literature about now which pertains to their safety. I’ve just booked a 43 year old woman today who has decided to have a homebirth and is dreading telling her GP. He of course did not even offer homebirth as an option but just said, “You’ll be going to hospital for the birth, of course”.
“Of course” she replied – and then dreaded her first meeting with me in case I condemned her for her decision. We’re going to meet on a regular basis at home for her antenatal checks so she needn’t see him in pregnancy at all and I’ve said that I’ll tell her GP after the baby is born that s/he was born at home.
I hate doing this because it feels sneaky but I cannot bear to think about all the pressure she might come under if he finds out about her decision beforehand. We all know how good some doctors and midwives can be at shroud waving.
Are there any GPs out there who truly offer a full set of options to women when they see them initially? We all know that the woman is not obliged to book with a GP for maternity services but most do, making it difficult to get to those women who might book a homebirth before the GP has frightened them off of the idea.
Wonderful GP (Essex)
I must say in Colchester my GP, Dr Thiabaut, is a wonderful doctor and was there at the birth of my second child. My sister and I have both had home births with him and when I was in labour he brought the resus. equipment round and to check that all was well. He then arrived again just in time to see my son born. Both midwives and doctor work very well together. He never once tried to talk me out of it. All he suggested was that I keep an open mind just in case something did go wrong. This was good advice as with my third child I also wanted a home birth but due to the fact that my waters broke at 35/40 weeks I went in to hospital. Lucky as it was undiagnosed breech and even though we tried for a natural delivery my son had other ideas and didn’t want to come out so I ended up with a caesarean. My doctor was very good coming to see me at home afterwards. I can’t praise both my doctor or the midwives I have seen enough as they have always been very supportive. I feel very lucky as I have heard some horror stories.
… and South Devon
Yes, we are really fortunate in our area (South Devon/SE Dartmoor) – even if the GPs don’t like the idea of homebirth, they respect client’s choice. And many of our GPs like homebirths to such an extent they have had one! (though a few have waited until they have birthed successfully before telling colleagues!) and we even have two GPs who are not averse to attending the occasional (very occasional) home birth.
It wasn’t always like this. It has happened over time, as the option has been taken up by more and more women. It’s become more acceptable as a result of Teams and Group Practices being able to assess all women at home in labour, and women being able to choose place of birth when they want. Our home birth rate has risen steadily to about 20%.
GPs have become more home birth friendly as they realise they won’t be expected to bail out in an emergency, and also that the morbidity and mortality stats haven’t risen sharply (I guess these are two of the reasons, anyway).
I had a problem with a GP at my last practice, who used scare tactics with women thinking about home birth. His opinion was coloured by his own experience – his daughter had meconium aspiration syndrome (hospital birth!). I booked an appointment with him, to show him the evidence for and against home birth. After that he used to direct women to me to discuss home birth!
We also have a GP/midwife agreement locally – which spells out intrapartum responsibilities of all concerned – this was also very helpful in improving attitudes.
From my own experience, I did not involve a GP in my home birth booking at all, having written to AIMS and ARM for advice on this before I even got pregnant! However, when I got pregnant I did not have a GP at all and needed to sign on to a practice in the area.
I decided that I did not want to give my `custom’ to a practice that was not supportive of home birth, so although they were not to be involved in the booking, I did enquire at the nearest surgery about the doctors’ attitudes to homebirth. The receptionist phoned up the senior partner to ask, while I was there, and he just said that this was no problem at all, but that he advised women wanting home births to book directly with the community midwives and their telephone number was as follows….
I’ve only been back a few times. Doc asked where I was planning to have the baby and I told him… all he said was “Oh, right”, although my tone probably told him that this was not up for discussion. Next contact: baby’s newborn check, where another GP came round and asked if it was a planned home birth. Yes, why? ” Oh, just asking because the last one I went to was an accident!” – again, no negative comments. Then, finally, I saw a great woman doc for my postnatal check, who asked where I had the baby. When I told her, she said “Good for you -probably the best way”.
I was at my friend’s house in Tooting, South London, last week a few hours after she had her baby – 2nd baby, 2nd home birth – when a young woman doc came round to do the newborn check. No negative comments at all, but the young doc seemed a bit overawed by it all and did keep saying “You’re so brave” to my friend, which we both found entertaining. Wendy restrained herself from explaining that it would require a lot more bravery to give birth in St George’s hospital…
Only anecdotal, but so far, so good…
Not keen but happy for us to get on with it
In the practice that I cover, one of the partners was very keen on antenatal care and used to see all the women before sending them to us for the remainder of their care. When he retired, the remaining GPs were debating who should continue this… Of course we (the midwives) suggested that we provide this care … and they agreed! So now, the women can see us in the surgery (we have a set clinic day, with our own appointment book) and we do all the initial booking-in and paperwork. This of course gives us the ideal opportunity to ask the open question, “Where do you want to have your baby?”, and outline the choices available. If they want a home birth, we book them for midwifery-led care, so the only time that they go near a hospital is if they want a scan.
This doesn’t mean to say that the GPs are keen on homebirth, but they are happy to let us get on with it, they know that we only need them to complete a health check on the mum antenatally (heart and lungs), perform a newborn baby check, and write out prescriptions as needed!
GP Maternity Payments
A GP in my area has refused to prescribe pethidine on prescription to a woman wanting a home birth because he doesn’t agree with them and wants no part in it. He has, however, got this woman to sign the form which allows him to claim for providing maternity care! Surely this is fraud as he is claiming for care he is not giving.
Finding a GP
When I went to tell my GP I was pregnant for the first time, and wanted a homebirth, I went prepared for battle. I was astonished that he said “OK, fine”.
When I went to tell my GP I was pregnant again, and wanted a homebirth, even though my last delivery had been by caesarean, I saw a different GP. She was OK with it as well, since she knew me and knew I was well informed and determined. The GP whom I had seen during my first pregnancy (in the same practice) was DEAD against it, and wrote me a frankly astonishing letter, which said something like “if you are determined to risk your own life and that of your baby in this reckless manner, we will have to support you” or something (I have the letter on file somewhere) amongst other insulting, threatening, and misinformed things. Fortunately, I received the letter two days after having my baby at home (uneventfully – in obstetric terms, although it was a momentous event in my own terms), and so it was merely amusing.
The same doctor turned up to check on me a couple of days further. Unannounced, and uninvited, he turned up and my husband let him in. I think I would have sent him away with a flea in his ear.
“How are you?”
“How are your stitches?”
“How’s your scar?”
“How’re your breasts?”
“Fine”. (I promise, this is verbatim)
“Oh well, goodbye then”
“Goodbye”. He then patted me on the head and left.
I desperately want to change my GP, but I’m afraid of getting someone just as bad, because I have the impression he’s not unique. I wish I could interview a few GPs to find someone whose attitude to health and medicine is at least roughly in tune with my own. But although patients are supposed to have the right to choose, they only have access to the scantiest information on which to make a choice, so it cannot be an informed choice. It still seems to be more a matter of GPs selecting patients than the other way around.
Doctor Knows Best
Ha! All our GPs are claiming maternity payments and do they see the woman? Do they hell! Which is fine by us `cause we want it that way and if we make a fuss they will stop women opting for midwife-led care (Yes I know it should be their choice but around here if the Dr says “No” they abide by it!)
Abuse of Power
The system is very unfair. One word from the GP and women do as they’re told. What an abuse of power. Still in understanding that power I find my own ways round it and manage, hopefully, to give as individualised care as possible. GPs are in a very powerful position and in maternity care they have far too much say in a process that they haven’t a hope of really understanding.
The GPs I work with insist on seeing `all their patients’ because they `like to maintain contact with them’. Ha! I note that this keenness to `maintain contact’ does not extend to those women who opt for ante-natal care at home owing to lack of transport and the rural nature of the area. Do the GPs make an effort to give any antenatal care then and `maintain contact’? Do they heck!
Links to other sources of information:
On this site:
A Student Midwife’s Impression of Homebirth
On other sites:
Association for Improvements in the Maternity Services
Tactical advice on booking a home birth and dealing with reluctant doctors.
Home Birth Reference Site
AH updated 8 June 2000