General practitioners (GPs) are uniquely placed to provide comprehensive, patient-centred primary care for both women and men for their reproductive health and experience of pregnancy. Pregnancy care encompasses the full spectrum of reproductive health from contraception, unplanned pregnancies, preconception, antenatal, intrapartum, postnatal care periods and termination options, with a focus on patient wellbeing, patient safety and joint decision-making.
In 2019, there were 303,054 babies born to 298,567 mothers in Australia.1 Statistics show that the national birth rate is falling, while the average age of women who gave birth has increased,1 with the highest proportion of mothers aged 30–34 years.1 In addition, the number of teenage mothers decreased dramatically over the past decade.2 Adding to the complexity of pregnancy care is that approximately 15% of couples will experience infertility.3 Failure to achieve pregnancy within 12 months of regular unprotected intercourse is likely to indicate infertility and further management is needed, although this may be commenced earlier in certain circumstances, including in women aged over 35 years or those who have a health condition that may impact their fertility.3,4
Access to culturally safe, appropriate and timely family planning and pregnancy services is vital to ensuring positive health outcomes for women and babies.5 Regular antenatal care in the first trimester is associated with better maternal and child health in pregnancy, fewer interventions in late pregnancy and positive child health outcomes.1,5-7 Access to services in Australia is impacted by location, socioeconomic status1 and other factors including culture, religion, language and health literacy. Appropriate access to maternal and infant health services remains a challenge within rural, remote and Aboriginal and Torres Strait Islander communities, which can lead to corresponding long-term consequences.7 This highlights the valuable role of the rural GP with procedural skills to provide quality obstetric care and continuity of care. The ability of the GP to identify and access relevant health assessments, government initiatives and health promotion programs appropriate is also important to this area of practice.
It is imperative that GPs can identify, manage or refer key red flags that may present in all stages of a woman’s reproductive and pregnancy experience. This includes screening, identification and management of short- and long-term health conditions that impact reproductive health, fertility and pre-conception care, as well as identification and management of complications that arise during and after pregnancy, including threatened miscarriage, mental health conditions, intimate partner violence and the management of terminations.
This area of medicine requires sensitive communication and consultation skills to assist women and their partners with contraception choices, pregnancy planning, unplanned pregnancy discussions, antenatal, intrapartum and postnatal care, high-risk pregnancies, access to assisted reproductive technologies, and access to termination services, with a focus on patient safety, wellbeing and joint decision-making. Skills in trauma-informed care and in delivering bad news are also essential. GPs will provide pregnancy and reproductive care within their scope of practice, regardless of whether they have obstetric training and will work collaboratively with other health professionals and cultural mentors within the private and public sector to provide shared care and continuity of care.