Maternity care in general practice.

General practitioners are essential providers of maternity care, particularly in rural and remote locations T hroughout the world, the role of general practitioners in maternity care is changing and being redefined. Over 10 years ago, a decline in GP-led obstetric care in North America, Europe, Australia and New Zealand was noted, and this trend appears to have continued. 1,2 There were 481 GP obstetric proceduralists listed in the Rural Health Workforce Australia 2013 survey — 142 less than a similar survey in 2008; however, it is unclear whether these figures truly represent the total number of GP obstetricians or their skill level. 3 Accurate figures for Australian births with GPs as the primary carer are difficult to find, as GP and specialist obstetric care are often combined under a heading of " private care ". 4 In a recent Queensland-wide survey, 5 only 11% of women reported that a GP attended their labour and birth (Yvette Miller, Queensland University of Technology, personal communication). For many women in rural and remote areas, obstetric workforce shortages (both specialist and GP) and the closure of 50 birthing services Australia-wide between 2006 and 2011 have resulted in less than ideal maternity service provision. The need to travel outside their community to give birth causes family disruption and increases the risk of women not giving birth in hospital or giving birth in health care facilities not equipped or staffed to manage labour and birth. 6 Further reductions in the number of GP obstetricians will exacerbate this situation. The 2009 report of the Maternity Services Review highlighted the importance of GP obstetricians (and anaesthetists) in maintaining maternity services in rural locations. It emphasised the need for " improved access to training and ongoing support " to encourage and retain GP proce-duralists. 7 Funding is now available through the General Practitioner Procedural Training Support Program for GPs and GP registrars to upskill by completing the advanced diploma of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, which enables them to undertake caesarean sections and other forms of assisted delivery. Training, however, is only one part of the solution. Early consolidation of newly learnt skills within a general practice environment, ongoing clinical support and men-toring, and maintenance of professional networks have been identified as strategies that improve confidence and competence and enhance further interest in procedural work. 8 Research published in this issue of the …