Eriksson Ulf wrote:
> Swedish NHS has just recently made an national evaluative survey of antenatal
> care. The routine has therefore been altered in our county of Sweden.
>
> A specially trained nurse/midwife sees the mother in week numbers:
> 8+25+30+32+34+36+37+38+39+40.
> There is an ultrasound-screening carried out in week number 17 or 18.
> A doctor (specialised in obstetrics or, more seldom, family medicin/general
> practice) examines the mother week no 11 + possibly 36 (+ .42)
> (The change is: Less visits in the beginning)
> Women who are well and have previously had normal partus, skip the last visit to
> the doctor. All higher-risc-pregnancies make more visits to the doctor,
> depending on the conditions. Smoking mothers have extra ultrasonic examinations
> in w. 32 + 36 to determine the size and growth of the child.
>
> ++++++++++++++++++++++++++++++++++++++++++
> Dr Ulf L Eriksson,
> General Practitioner
> Karlskrona
I note the very limited family practitioner involvement with the mother
(ie. only "medical" rather than maternity-oriented visits. Is this
because they (the GP's) are not actually present at the deliveries??
We see our patients at the "midwife" intervals, which is how we get to
know our patients well, their expectations, their likely pain tolerance,
etc etc. Three visits would just make us "back up technicians".
Our patients normally expect us to "bring their baby into the world".
Indeed they quite enjoy reminding us when they get to ten years old!!
That is the nature of the general arrangement and Dr-Mother bond.
Midwives here are not trained to a high level (in the vast majority)
have no desire and are unable to perform common obstetric interventions
such as pudendals, Wrigleys, Neville Barnes, and even episiotomies in
many cases. The Government of course would like to change that, but that
is not what our mothers want. Unfortunately our Government (Ministry of
Health) is not brave enough to actually ask the mothers (in properly
designed surveys) which is why our maternity services at present are in
a total state of disarray coming up the the elections.
The Government honestly thinks they know what our mothers want, but they
have seriously misjudged them and their GP-obstetric practitioners.
Jon Wilcox
GP Obstetrician
Auckland
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