Family practice maternity care in America: ruminations on reproducing an endangered species--family physicians who deliver babies.

BACKGROUND

The majority of family physicians do not deliver babies. One reason might be the family physician's intrinsic comfort with person- or patient-centered care compared with the common obstetric approach of disease or physician-centered maternity care. Another reason might be the uncritical intrusion of technology into maternity care. In addition, family physicians often are made to feel unwelcome in many maternity care systems.

METHODS

The medical literature from 1984 to 1994 was searched for the topics of obstetrics, maternity care, family-centered birthing, and family practice education. Reasons to argue whether family physicians should provide maternity care were selected, and articles were chosen that described the self-reported reasons students, residents, or physicians give whether to provide maternity care.

RESULTS AND CONCLUSIONS

There is no scientifically supportable reason for excluding family physicians from maternity care in any setting, and the current maternity care system, in many locations, creates an attitude of taught helplessness among family physicians. In addition, family practice educators must for a variety of reasons be the primary role models and teachers of family-centered birthing for family practice learners. Generally, the groups that should be involved in providing maternity care in the future should include (1) better informed and more independent pregnant patients, (2) maternity care nurses, (3) doulas, (4) midwives, (5) family physicians, and (6) specialized physicians. Specifically, family physicians and midwives have a historic and philosophic similarity that would argue for a much closer working and practicing relationship between these two professionals. Family-centered birthing provides excellent outcomes. Birthing is both foundational and intrinsic to family practice. Conversely, without family physicians maternity care in America might not be able to reach its full potential.