In the current reorganisation of health services, maternity services are under close scrutiny and the proposals to have commissioning of services led by the NHS commissioning board makes sense - due to the uniqueness of maternity services and the needs of pregnant women and their babies.
The current problems in maternity care are caused not by the principle of less GP involvement but rather by the lack of supportive systems to make the role of the lead carer, midwife or consultant obstetrician, easier and seamless. A partnership needs to emerge between the health professionals involved in the care of pregnant women, when they are well and when they are unwell.
Birth is a normal, physiological process and the majority of women who are healthy, with a straightforward pregnancy, do not require medical involvement either at general practitioner or hospital consultant level. A social model of care is therefore preferable which is why midwife-led care should be offered to all women. Some women will benefit from the involvement of a GP or require specialist help from dieticians, substance abuse services or social services and some will want to maintain their relationship with their GP. However, many women find getting to know a midwife they can trust and who will be with them through their pregnancy and birth is vital.
Commissioning of services thus needs to be done by a multidisciplinary body and involve a full appreciation of the needs of pregnant, labouring and postpartum women and their babies. GP knowledge on maternity issues has fallen behind current evidence and a considerable amount of retraining and multidisciplinary working would be required to enable them to fulfill their role in commissioning maternity services.