sMater | Dr Maggie Robin | GP Shared Maternity Care

This new series of sMater focuses on GP Shared Maternity Care, and  is led by General Practitioner Dr Maggie Robin who coordinates Mater's GP Shared Care education program.

Maggie discusses the value of GP shared care, how GPs can be accredited and the benefit of collaboration with specialists to achieve optimal outcomes for mothers and babies.

GP Education activity log:
  Podcast title - sMater: GP Shared Maternity Care
  Provider - Mater Misericordiae Ltd
  Date published - August 02, 2024
  Certificate of completion - click here

For more on the GP Shared Care Program, visit https://www.materonline.org.au/whats-on/gp-maternity-shared-care-alignment

To learn more about Mater, visit https://www.mater.org.au/

Transcript

Hello and welcome to this episode of sMater. A podcast by clinicians for clinicians brought to you by Mater, an Australian leader in healthcare for more than a century. My name is Jillian Whiting and we're coming to you from Meanjin the land on which this podcast is being recorded. Hello I'm Maggie Robin, Community GP rural GP obstetrician at Beaudesert Hospital and coordinator of Mater's GP shared care education program.

In this conversation we're taking a deeper look into GP shared maternity care, what are the positives the challenges and what lies ahead. Welcome to sMater.

We are Mater, We are Mater, We are Mater, This is sMater.

Maggie, back to basics just from the beginning. What do we mean when we're talking about GP shared maternity care - it's in the name I figure.
Ah yes so shared maternity care is collaborative care and that includes care before pregnancy during, pregnancy and after the pregnancy where you have multiple health care professionals who are all providing care for a woman and that might include a GP

but also midwives Obstetricians and Obstetric Physicians sometimes and then allied health professionals as well sometimes physios, dietitians, diabetes educators, psychologists, social workers. It's a recognition that maternity care can be multidisciplinary and it's really beneficial for women to have an array of caregivers around her, supporting her through pregnancy and when we talk about GP shared care specifically the GP becomes the primary caregiver for the woman during and after the pregnancy and usually the woman will have her baby at a maternity hospital. They'll probably see her a couple of times during the pregnancy and they'll do the immediate postpartum care but then the woman returns to a GP for ongoing care after that. 
Talking about the Mater program specifically, how many GPs are part of it?

So currently we have close to a thousand aligned GPs so when I say aligned that means GPs who have done Mater's education program for GPs, helping them to feel confident in delivering perinatal care. So this is a specific education program that Mater has developed and there's several other maternity hospital around Australia that have similar programs some of those are optional programs in the case of Mater it's actually a compulsory program. So if GPs want to share care with Mater for their patients, they need to do this program and maintain their alignment every 3 years by renewing that.

I think we'll go into that a little bit in in depth in a moment but I just wanted to talk about how GPs talk about this with their patients and what if the patient is private, all those kind of things. What do GPS need to know?

So, often this is something that comes up at that first visit when someone's newly pregnant and they know they're pregnant and they know they probably need to come to the doctor but they're not sure what happens next and there is a massive amount of things that you can potentially talk about at that first visit and those very early pregnancy visits but one of them is models of maternity care and options for care and there's actually a lot of different options in Australia it can be quite over whelming and hopefully if it's a GP who lives and works in our community they'll be aware of Mater and Mater's program and yes if someone's privately insured typically they will go through private Obstetrician

but for public patients and hoping to have their baby at Mater, GPs can let them know at the start of the pregnancy so one of your options for care is to have most of your care here with me and you'll have your baby at the hospital and then back to me after the baby is born so GPs will usually offer that and if the GPs keen and the patient is keen then they just let the hospital know that on the referral that this patient would be appropriate for GP shared care. And part of that conversation I imagine you're talking about the benefits of shared care, what are the benefits?

Yeah so firstly the ongoing relationship is a really big benefit so often this is a GP who's looked after the patient since childhood potentially has looked after to their family as well knows them really well. Some people may have had a long journey to become pregnant and the GP may have been with them through that journey as well so it's really exciting and happy when they are pregnant so there's that there's that comfort and familiarity sometimes as well. It's just easier to get to your local GP than to drive into the hospital, find a park, pay for a park, waiting clini, you know it can be less stressful to get to your GP. Often the waiting times are a bit shorter and also your GP can still give holistic care through your pregnancy so pregnant women still get coughs and colds and sprained ankles and you know the GP can still look after all of those things.

Is there an ideal patient that shared care is best for?

Yeah ideally someone with a fairly straightforward singleton pregnancy so more complex pregnancies - things like multiple pregnancies or conditions with underlying medical complexity potentially not appropriate - although the GP can still have a role in the care and ideally it's someone who knows and trusts their GP as well so you've got that pre-existing relationship.

I think most women when they think of midwives and obstetricians 

for pregnancy but how many would know really that the GP can provide this service as part of a multi-disciplinary team?

I think a lot of women don't know that particularly if they are having their first baby or if they come from another part of Australia or another part of the world where care models might look quite different so I think it is really helpful if GPs are aware of this and aware of this option to offer to their patients.

According to the Australian Institute of Health and Welfare, there are approximately 1,000 models of care across 251 maternity services in Australia. The most common model of care is public hospital maternity care which comprises 41% of all models of care followed by shared care at 15%. Midwifery Group Practice Care and Private Obstetric Specialist Care are the next most common models of care.

What about accreditation, we mentioned that before. What do GPs need?

So they need to complete Mater's shared care alignment program. We offer usually four or five workshops a year, it's a half-day workshop so an 8:00 a.m to 1:00 p.m. face to face workshop and we have a basic module called alignment one that we usually run a couple of times a year and that's the introductory one that we really like everyone to do as their first one and they need to do that every 3 years but when they come to needing to renew that there's many options for renewing that so they don't necessarily need to repeat the basic alignment. We have an alignment two that has a focus more on fertility and preconception. We have alignment three and that is more around perinatal mental health and we're creating alignment for four at the moment that's going to come out later in the year which has a focus around bereavement and trauma informed care so what we're trying to do is offer education that's interesting for GPs and we recognize that there's GPs who do lots and lots of perinatal care and they don't want to repeat the same education again every three years so we're trying to keep it interesting and relevant and current for GPS. There's also online options for realignment for people who for whatever reason coming to a face to-face workshop is not great at the time and if they've done a shared care education program with another health service there's a bridging course they can do to align with Mater, they don't have to do the full program so on the Mater website there's links that show GPs what the options are and how to sign up for those.

So those who choose to join the alignment program, what are they have access to beyond that sort of alignment?

The aligned GPs as well are given links to the Mater's GP shared care maternity guideline which lives online and gets updated quite regularly and they also get to build connections I guess at these days with our hospital-based clinicians so that they can put a face to the name and they know that there's someone at the other end of the phone when they need to phone a friend for help.

The Midwifery Futures project, a national initiative aimed at ensuring the Midwifery Workforce of the future addresses the needs of of Australian women, conducted a literature review Guided by the Joanna Briggs Institute framework the review published in science Direct in March 2024 revealed four key themes among Australian women regarding their maternity care needs. These include continuity of care, being seen, and heard being safe and being enabled.

How important is consistency of care and how do you ensure that, what are the big challenges in that?

One of the challenges is communication and that is really hard because we all use different electronic record systems and they don't talk to one another and so that puts an onus on GPs and hospitals and anyone who's looking after a patient to make sure that they document well and also that they communicate really well with any other caregivers looking after the patient so that's a big challenge and that's something that it's a you know it's a two-way street. The hospital has to be  accountable and so does the GP so that's something that we always really try to encourage us you know trying to build better communication systems.

What research has been done and what evidence is there to support the benefits of that shared care model?

Well there has been some research done not a huge amount I would say and that speaks to the challenge of doing research in a primary care environment because the way that GPs work where usually small business owners or contractors essentially we work in little clinics we're usually busy doing face-to-face clinical work and there's not a lot of infrastructure set up around us to do research so there's not as much extensive research into the benefits of GP shared care but where there has been research done it looks really positive like the small numbers of data that there are look really encouraging.

Do we need more research?

Absolutely always.

Well what areas in particular would you like to see?

I would like to see more qualitative and quantitative research into maternity outcomes and maternity satisfaction rates of GP shared care

because there's a lot of research about midwifery continuity of care and we see that as the gold standard of maternity care.

We know the outcomes for women and their babies when they have continuity of care with a known

provider are always better and all of that data almost is in midwifery of care but it would stand to reason that

another really well-known trusted safe competent caregiver you would expect to also have positive results and I would hope that one day we can create that kind of level of research for GP shared care too.

A 2022 study by the School of Public Health and Social Work at Queensland University of Technology compared patient reported outcomes and experiences in alternative models of maternity care in Queensland. The study which involved more than 2,800 women revealed women who received GP shared maternity care were more likely to report that their care providers talked to them with kindness and respected their decisions compared with women who receive private obstetric care or standard public midwifery care.

You mentioned that research and about how kindness came up really high, how do you reflect on those results about kindness coming through so strongly?

I think building relationships takes time and we're all busy we're all time pressured and if you've got that long-term relationship with a caregiver over time there's not so much weight relying on a very a single encounter so you know when people go through the public system and they're cared for by a different person every time it's hard to build that long-term meaningful relationship and I think you know it's if you know someone really well and got that basis of knowing them for weeks and months then if you do have to have a really brief quick interaction it can feel more positive.

Now let's talk about the strength of GPS and perinatal care.

Preconception is a really key area for GPs. Often women don't actually see a midwife or an obstetrician until they're already pregnant and often into their second trimester so that pre-pregnancy time can be a fantastic time for GPs to be opportunistic to really try to optimize someone's health in preparation for pregnancy to have a healthy pregnancy and then early pregnancy is now a really intense time of information gathering I would say there is so many testing options now for genetic carrier screening and Aneuploidy screening, so screening for chromosome abnormalities, and navigating that and trying to decide as a pregnant person what tests are you going to have and what are you going to do with those result that's really challenging and most of that counseling and unraveling that is done by GPs so I think GPs have a really important role there and then postnatally as well you their care will go way beyond those first 6 weeks when we see this 6 weeks is this magic sort of oh 6 weeks postpartum you graduated yes but the GPs likely going to become the baby's doctor as well and have this ongoing relationship with mum and baby and see the baby for all their routine checks and vaccinations and follow mum up as well to see how she's going and we know as well that conditions in pregnancy like preeclampsia and gestational diabetes actually have lifelong impacts for the woman they actually influence her health risks for her whole life and they need to be remembered and they need surveillance and GPs are perfectly positioned to do that so I know if I have a pregnant patient and they develop preeclampsia I put that on their condition list and I leave that there forever because that reminds me that she's at increased cardiovascular risk for life.

And also the first year postpartum is high risk for development of anxiety and depression as well.

Absolutely and I think if you've got a known caregiver who knows you pre- pregnancy, during pregnancy, post pregnancy they can very quickly recognize when you're not okay and a GP is really well placed to start therapy and monitor postnatal anxiety and depression and do that for the long term.

So you've said birth should be local and feel local is this what you're talking about is this what you mean? Yes so we know from the existing research that I was referring to before that women really value continuity of care and continuity of caregivers really highly in their maternity care that research shows that again and again and so ideally they need a caregiver who's local and accessible someone they can get into without needing to wait too long and for many during their pregnancy that will be in the form of a continuity of care midwife but for others that can easily be their GP as well.

Okay what changes are coming or what would you like to see. We've got the crystal ball happening here Maggie yes what do you see?

I would love to see strengthening of relationships across the disciplines from primary care to hospital care and I would really like to see everybody treating each other with mutual respect and I'd like to see a move away from the tribalism in maternity care of people feeling that one particular profession has ownership of anti-natal postnatal care I think together we can do better so I would like to see better 

relationships. If I really could get on my soap box I want to see better funding for Primary Care particularly the maternity Medicare numbers. We know that  being able to get into a GP in a timely way who is affordable is a huge challenge for a lot of people but it's a huge challenge for GPs to actually be able to provide sustainable affordable care to patients as well because we know the Medicare numbers are not well remunerated and I would love to see that recognized particularly in the maternity item numbers.

And finally what would you want GPs to remember all of this chat we've talked about different elements of GP shed maternity care is there one main thing that you'd like them to remember?
I actually just would like to encourage GPs to feel confident to be involved in maternity shared care. It's actually a really special thing that you can do and I know when a woman comes back to see me in my GP clinic with her new baby after she's come out of hospital that's one of my favorite consults to do and I just want GPs to know that they can do it and they can do it really, really well and that there's a lot of resources out there to support them to do it well.

Okay Maggie before we go we're going to introduce you to a little segment we call The Checkup so this is about getting to know Maggie the medical professional as well as Maggie the person so we've got 5 quick questions you ready.

What's your superstition?

So I have a superstition that if you plan for it won't happen so in maternity care obviously particularly looking after women in labor you don't know which way it's going to go and sometimes that keeps me awake at night if I'm on call and I've got someone in labor and so I actually sit down and I think okay well if this happens I'll do this and if that doesn't work I'll do that and if that doesn't work I'm going to do that and then I can go to sleep because I have this idea that if I've got the plan I won't need the plan but if I don't have a plan it's all going to happen and do you take that into your personal life as well planning everything yeah a little bit of obsessive planning there.

Okay who do you admire?

Oh gosh, Dr Katherine Hamlin. So she was an Australian obstetrician gynecologist who traveled to Ethiopia with her husband and set up a Fistula Hospital there. I was lucky enough to travel and visit the Fistula hospital and met with her just the year before she passed away actually and she is just an inspirational person.

She is I've heard her speak she is incredible.

If you could impart one piece of knowledge on a med student what would it be?

I would like to tell medical students that they've chosen an amazing vocation and they should feel excited about what they've chosen and also to let them know that it's amazing because it's so diverse. Do you have a a secret skill or talent?

I'm a Knitter. I'll take that. I knit beanies and hot water bottle covers and tea cozies and all kinds of stuff.

That's fabulous. And finally how do you want patients to see you as a human being first and foremost before a clinician?

I want them to feel that I'm relatable and that I can get them as a person as well as a patient.

Thanks so much Maggie. You're welcome it's been fun.

For our listeners at home or in the car or having a well-deserved break between patients, thank you for tuning in. See you next time on sMater.