What is antenatal shared care?
Shared maternity care means that your antenatal (pregnancy) care is shared between a public maternity Hospital like the Royal Women’s (or the Mercy or Western Health etc), and a
community doctor or midwife who is affiliated with that hospital, aka your Shared Care
Affiliate.
This means that most of your antenatal care is provided by that affiliate. You have to
book into the hospital, attend there for a few visits along the way and then have your baby
there. After that, your affiliate sees you and your baby for the post-natal check. Shared care
GPs have to be credentialled with the relevant hospitals, provide evidence of prior experience and training in obstetrics, be involved in ongoing educational activities based at
those hospitals and apply for re-accreditation every 3 years.
Typically, antenatal care consists of ~ 4x weekly visits until 28 weeks, ~2x weekly visits until 36
weeks, and then weekly until the big day.
We have key referral and contact points at the hospital with a direct line to the shared care
coordinator and can arrange a prompt specialist assessment if necessary, along the way. The
crucial communication channels involving your care from the hospital to us and vice versa are
seamless. It’s a team thing - and you’re the captain.
Who is suitable for shared pregnancy care?
Shared care is a popular choice for healthy women with normal, low-risk pregnancies.
However, if you have significant medical problems like diabetes or a complicated past
obstetric history such as a previous Caesarean Section or certain issues arising during the
pregnancy, eg twins, then you may not be regarded as suitable for shared care.
What is the process of antenatal shared care?
Well, there’s a lot to cover! First, you need a GP who is an affiliate. So if your usual GP doesn’t do this, then ask them who does, or look on the practice website. You can also obtain a list of affiliates from the relevant hospital or go with the old word-of-mouth approach.
Confirmation of Pregnancy
Your GP will talk to you about pregnancy in general, check your past history, obstetric history, family history, mental health issues, breast issues when your PAP (now called cervical screening test) is due, medications, vaccinations, allergies, smoking status, blood pressure and weight.
Your Shared Care Pregnancy Journey Begins
The next step is to arrange an initial antenatal blood test to confirm the pregnancy and check vitamin D, immunity to rubella, blood group, iron, thyroid etc., advise you about diet and vitamin supplements, how to avoid certain relevant infections, discuss and arrange
appropriate screening tests, i.e. another blood test at 10 weeks (either the simple maternal
screening test – bulk billed, or cell-free DNA test, e.g. Harmony – a better test but @ $400 or
so), then plan an ultrasound scan at 12 weeks, which may also attract a private fee.
Sometimes an early scan ~ 7 weeks is arranged, especially if you have an irregular cycle, a
history of miscarriage or you just want to know the pregnancy is viable. Whoo! Are your
eyes glazing over yet? Often best to spread all this stuff over a few visits. And, of course, partners are always welcome!
The GP will then send a referral to the relevant hospital, who will contact you to confirm that
you are officially in the system. You will then see your GP again at ~ 14 weeks to discuss the
results of that first-trimester screening test. Incidentally, these stages of the pregnancy are
related to the number of weeks since the first day of your last period, which is used to
calculate your due date, i.e. 40 weeks after that day. Weird, I know, because that’s not when
the pregnancy actually started- it was probably around 2 weeks later when you ovulated,
but that’s the convention. (That predicted due date may be changed in light of the result of
your early ultrasound.)
During your first hospital visit, between ~ 12-20 weeks, your healthcare provider will discuss the various models of antenatal care, including shared care. If you opt for shared care, they will provide you with a routine schedule of visits, including 2 or 3 additional hospital appointments, and arrange antenatal classes.
You will typically have another ultrasound scan at 20 weeks or so to check the baby’s
growth and development. The GP arranges this.
The next hospital visit is often at 28 weeks, especially if you have an Rh-negative blood
group, and they will arrange a diabetes screening blood test around then and then again at
36 weeks when they will do a vaginal swab for a bacteria – the group B Streptococcus. If
the test is positive, they will give you antibiotics in labour to ensure the baby doesn’t get
infected. They may also re-check your iron levels, give you an ‘anti-D’ injection if you have a negative blood group and discuss the mode of delivery if you’ve had a Caesarean Section in
the past. The hospital will then plan to see you again around the due date, ie 40 weeks, or a little after, to plan for the big finale.
You attend your GP for regular visits in between, monthly and then weekly. Your GP will see how you are generally going, check your blood pressure (yes, we are obsessed about the BP), listen to the baby’s heartbeat with a foetal stethoscope, measure the height from the top of your uterus down to your pelvic bone to check foetal growth (conveniently it is @ 1cm per week) look for ankle swelling, and sometimes check your weight and urine.
From 20 weeks onwards, baby movements will be discussed and after 30 weeks the GP will
be checking the baby’s position, ie head first or bottom first. Once you reach ~ 36 weeks, they will check to see if the baby’s head has ‘engaged’ into your pelvis, especially during your first pregnancy.
Other issues discussed by the GP affiliate along the journey are vaccinations for the flu,
whooping cough and Covid 19, breastfeeding and maybe mental health problems, intimate
partner violence and social and family support.
This all goes on until you don’t turn up one day and we figure you’ve done the deed!
(Actually, the hospital does send us a comprehensive discharge summary about you and your baby.) Then we see you both at 6-8 weeks postpartum unless any issues arise earlier.
So, to summarise - shared care is convenient, cheap and safe. If your shared care GP is
close to home, then less time travelling to your private Obstetrician’s rooms or hospital, and
the clinic is often already familiar to you as well.
If that GP is your normal family doctor, you know him/her, and so does your family, and that
relationship is useful when you bring that new baby home. If it’s not your usual GP, ‘this
could be the start of a beautiful friendship’.
So, there you go. I must admit to a bias towards shared care because I enjoy it, and I am a big
fan of the Royal Women’s – Parkville and Sandringham. And the other maternity hospitals
are great too.
This article was written by our GP Expert, Dr Bill Bateman. For more information about Birth Purchase our Parenting Portal. Our library of stage-based videos, demonstrations and expert articles and guides by our team of Experts, or book In-person Birth Masterclass or Virtual Birth Masterclass.
