GEP Medicine in Society Guide 2024/25

6. Themed Days - Primary Care

6.10. Pregnancy and childbirth

Preparatory work   

In preparation you should have: 

Watched this short 1 minute video where women discuss some of the changes to their body during their pregnancy and Midwife Suzanne discuss some of the symptoms of pregnancy. You should be able to recall these for the day and discuss why these might occur

Prepared some questions to talk to a pregnant woman about her choices for antenatal care and the birth of her child. This NHS website has specific useful information about antenatal care which can help you prepare.

In this 8-minute video, Midwife Lynn talks about what to expect during labour. You may need to take some notes again. What checks are undertaken? What things are offered to mum? What are the stages of labour? What do you think about the decisions and information mum has to undertake – do you think this has any impact on the process. Be prepared to discuss this on the day.

The MBRRACE-UK website, discusses the inequalities in maternal mortality. Read this infographic which highlights the key messages from the 2021 report.  You should think about 1 health promotion activity that might help to address this inequality and discuss this on the day.

Aims  

To understand the course of an uncomplicated pregnancy; to be aware of the choices women have about their pregnancy and childbirth and to gain an understanding of the importance in facilitating and respecting these choices. 

Learning Outcomes 

By the end of the day, you should be able to: 

describe an uncomplicated pregnancy and childbirth;

list some the possible choices that women can make in relation to ante-natal care and place of birth;

discuss the different factors that influence women’s choices about their pregnancy and childbirth;

describe a health promotion intervention for pregnant women provided by the practice;

critically consider the health promotion information available within the practice;

practise blood pressure measurement and urinalysis.

Example timetable 

9.30 – 10.30	Tutorial on pregnancy and childbirth. Please review and discuss the key learning points you have taken from the preparatory work.
10.30 – 10.45	Tea break
10.45 – 11.45	Prepare for patient encounters  Plan questions and observations     Patient encounters  Interview a pregnant, or recently pregnant, woman  Sit in with a midwife or GP for an antenatal appointment  Meet with a professional involved in providing care to pregnant women e.g. midwife, doula, person working for local voluntary organisation
11.45 – 12.45	Students feedback to group on their patient, or other, encounters
12.45 – 13.45	Lunch
13.45– 14.45	Health promotion during pregnancy
14.45 – 15.00	Tea break
15.00 – 16.00	Pregnancy timeline activity    Set homework for final session

Suggested Activities 

Tutorial on pregnancy and childbirth – could include discussion or debate of the question/s ‘is pregnancy a medical condition?’ and/or ‘what is the role of the medical profession?’; consider that the GP is often the first point of contact for a pregnant woman and what is covered in this initial appointment e.g. early discussion of choice about whether to proceed with the pregnancy, calculating gestation, discussing local antenatal care options; antenatal care schedule and check-ups including why do we check BP, urine, fundal height and fetal movements?

Pregnancy timeline activity –work in pairs/small groups to put key pregnancy milestones at the correct gestation.

Health promotion during pregnancy– could include group discussion of areas/activities this covers e.g.  advice around smoking, diet, exercise, alcohol and immunisations; consider what information is available within the practice and what services the practice offers?

Interview a pregnant, or recently pregnant, woman with a view to discussing her choices, and how she (and her partner/family) arrived at them; if possible, look at handheld antenatal notes.

Interview with a healthcare professional, or other person, involved in providing services for pregnant women.

Discuss informed consent and choices in the context of pregnancy and childbirth, the importance of communication skills, and the role of the GP, and other healthcare professionals, in in facilitating and respecting women’s choices; could use include role-play scenarios, case discussions, patient stories. The NIHR ‘Care and decision-making in pregnancy’ overview is a good starting point for some of these questions.

Practice blood pressure measurement and urinalysis.

Questions for you to consider 

How did you view pregnancy and childbirth before today?  Have your views changed at all because of today’s meetings and discussions?

How important do you think it is that women should have choices, and adequate information and support to make these choices, in pregnancy and childbirth?  Do you think this could pose difficulties for the healthcare professionals caring for pregnant women?  How might you deal with patients making choices that you did not agree with?