One of few remaining GPs handling deliveries quits

Once Dr Ferguson leaves the field, New Zealand will have just 14 obstetrician GPs.

William Ferguson, GP, DipOb, is so well-liked in West Auckland, even midwives call him "Sweet William". But in January he will put away his baby doctor bag. That means there will be just 14 obstetrician GPs in New Zealand.

Earlier this year, after a decade-long battle to save his profession, Dr Ferguson, 49, resigned as spokesman for the Royal New Zealand College of GPs on Maternity Issues.

"I'd given up in despair."

Dr Ferguson's drive to deliver babies is because he sees pregnancy, birth and the first year as the pivotal period in a woman's life.

"To lose her out of primary care at that time is plain wrong. For 10 years we've lived in hope things would change to make it viable for GPs to function in the maternity service, but even the most optimistic have fallen by the wayside. My last baby will be born in January."

Problems go back to money and ideology. GPs practised the medical model: healthy mother and baby first, fulfilling experience second. Midwives aimed for natural childbirth: fulfilling experience first, medical intervention second.

When then-Health Minister Helen Clark introduced her maternity care model in 1990, it was a mixed blessing. Obstetric outcomes were excellent, but by 1996 the budget was blown. Something needed to happen. Midwives, paid at the doctor's overtime rate, often for 15 hours a delivery, averaged around $3000 per birth. GPs, who stayed only a couple of hours, cost around $780.

The 1996 overhaul meant women had to hire a lead maternity carer (GP or midwife) who was paid for the entire pregnancy, birth and post-natal care at the reduced rate of $1300. GPs backed out of maternity care in droves: 2000 in the first three years, a further 1000 recently.

"The way the budget was sliced was clearly designed to get us out," says Dr Ferguson. "Leaving a busy practice for hours to attend an entire labour wasn't an option. If we purchased midwifery care it meant we got half the fee each. And $650 per birth wasn't viable for either of us."

The system drove a wedge - "an ugly thing with spikes on" - between the professions. Until 1996 his most enjoyable working relationships had been with midwives. Now it changed.

GP Jackie Mills, 45, who retired from obstetrics two years ago, remembers a midwifery conference in the late 1990s.

"Helen Clark [a speaker] deeply celebrated the fact that GPs were back in primary care and out of obstetrics. She got a standing ovation."

Dr Mills was devastated.

"The working relationship [between GPs and midwives] had been so good and offered astounding care for women. We sure didn't want to give up."

The doctors list their concerns about the midwife-only system: undiagnosed post-natal depression, less breastfeeding, escalating intervention rates and post-natal readmissions, fall in immunisation rates, a blow-out in undiagnosed Down's syndrome, the lack of auditing outcomes when this major change came in.

"I had many worries about the new system," says Dr Ferguson. "But I never thought that 800 babies born each year with chlamydia would be one of them."

Nor is he tempted to return to the debating table, after the $18 million funding boost for the sector announced last week, and the ministry's "keenness to talk" to GPs about their role in maternity service.

"I'll believe them when they come up with something that shows we're welcome. When they do something, rather than just say something."