The Royal New Zealand College of General Practitioners

The Ministry of Health has updated Guidelines for Consultation with Obstetric and Related Medical Services (Referral Guidelines) for Lead Maternity Carers LMCs). The guidelines were revised with input from an expert working group that included professional college and consumer representation. Mark Peterson was the Royal New Zealand College of GPs rep on the working group.

Revised Maternity Referral Guidelines

What you need to know:

• conditions have been identified that are appropriate for referral to GPs and other primary care providers and services
• LMCs may refer women to their GPs
• the consultation is a normal GP visit and the usual part charges apply
• it is expected that the results of the consultation will be communicated to the LMC in writing

The revised Referral Guidelines now identify referral to a primary health care provider.  The aim of the Guidelines is to ensure women are referred by their LMC to the most appropriate level of care for their particular condition.  As well as referral to a primary health care provider, the revised version adds guidelines for emergency transport and what to do when a woman declines referral, consultation or transfer of clinical responsibility.

It is expected that LMCs will advise the woman that she may be charged for a consultation with a GP or other primary care provider.

The Referral Guidelines identifies the following conditions as appropriate for primary referral:

Pre-existing and/or co-existing medical conditions

• Cardiac (arrhythmia/palpitations; murmurs)
• Endocrine (thyroid disease)
• Gastroenterology (symptomatic cholelithiasis, inactive inflammatory bowel disease)
• Infectious diseases (contact tuberculosis)
• Neurological (controlled epilepsy)
• Mental Health (current alcohol or drug misuse/dependency, depression and anxiety disorders)
• Respiratory disease (mild asthma, acute respiratory condition)

Previous maternity history

• SUDI (Sudden unexplained death of infant):

Current pregnancy

• Influenza-like illness

Services following birth - mother

• Postnatal depression

Services following birth - baby

• General (minor abnormal neonatal abnormalities)
• Genitourinary (undescended testes)
• Maternal factors (maternal medications with risk to baby)

It may also be appropriate for an LMC to advise the woman to consult her GP or other primary care provider for a condition that is not listed.

When a woman is referred by an LMC for primary care, the GP or other primary care provider may provide advice or ongoing management for the condition while the LMC retains the clinical responsibility for maternity care. In all cases there is a professional responsibility to maintain communication, collaboration and documentation and to inform the LMC, in writing, of the outcome of the referral.

The Guidelines for Consultation with Obstetric and Related Medical Services (Referral Guidelines) can be viewed online from January 2012 on the Ministry’s website.

If you have any questions please contact maternity@moh.govt.nz