Give birth with your family doctor! Is it passé composé or is there still a future? A woman’s most intimate and life-changing experience is pregnancy, waiting and giving birth. By definition, “getting pregnant” and “being pregnant” are not an illness. A second axiom is that childbirth is a naturally normal physiological process. If evolution had gone differently, humans would not have become the most successful mammals.
The history of midwifery is complex and varied, and varies from country to country. For our neighbors to the north, home birth is an “intangible heritage” and is protected. Before gynecologists took over the normalization of pregnancy and childbirth, the GP played a crucial role that has now been completely lost. The personal relationship with the patient, her partner and family, as well as knowledge of important medical and psychological history, enabled them not only to provide appropriate care, but also to manage chronic illnesses and were invaluable in providing emotional support to pre-, peri- and postpartum.
General practitioners were at the center of women’s living environment. They were trained to supervise normal deliveries, training periods from the first to the last day of the month, 24 hours a day. Remember: they were doctors of medicine and obstetrics. Women were not to be redeemed, they gave birth and gave birth.
The unbridled growth of specialist gynecologists, initially rightly focused on the treatment of complications, has meant that they have come to play a leading role in the normal care of low-risk pregnancy. General practitioners are therefore no longer the primary care providers here.
The modern healthcare system requires specific knowledge, especially of physiology, but also of pathology, training, modern equipment and facilities that are not normally available from the general practitioner. A paradox in this evolution is that hygiene and sterility, the use of antibiotics, prenatal diagnosis, ultrasound and new drugs should have allowed the return to primary care for low-risk pregnancies.
Our high-performance, patient-payer-funded healthcare has ensured that there is a maternity service with on-call specialists available on almost every street corner in Flanders. Accessibility, permanence and continuity make this care process particularly safe for mother and baby. Mortality and morbidity in our region are among the lowest in Western Europe and have not decreased for 30 years, despite the increase in caesarean sections and interventions. This gave women the freedom and right to make their own choices!
In short, the question of whether giving birth with a family doctor belongs in the history books or still has a future is complex and depends on many factors. The advantages are obvious, but they also come up against enormous prejudices. There are, of course, challenges to overcome. It is up to our healthcare system and our policy makers to determine how this approach can be integrated into broader obstetric care for the well-being of mother and baby. What is certain is that the choice of where and with whom and how the woman wants to give birth is a profound decision that must be respected and supported.
Midwifery is an ever-evolving field. There is room for real collaboration, where we make sure we don’t trespass into each other’s territory, but use the strengths of each healthcare worker, gynecologist, general practitioner and midwife: partners in crime for a pregnancy and a I give birth healthy. Such an example is, for example, the “Le Cocon” project at the Erasmus Hospital in Brussels.
For the moment, however, the last GP will be able to turn off the lights in the maternity ward.
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2024-01-02 19:27:37
#obstetrics #lost