The effectiveness of family practice maternity care. A cross-cultural and environmental view.

All 17 studies of family practice maternity care have shown reduced procedure rates for comparable populations of women cared for by family physicians versus those cared for by obstetricians, while maternal and infant outcomes are as good or better for the patients of family practitioners. System issues are the most predictive of positive outcomes such that in settings in which continuity and intimacy is high and women of no defined risk are cared for by providers specifically oriented to such care, outcomes are the best. In contrast, when such women are cared for by providers specifically oriented for high-risk or tertiary settings, their care becomes medicalized and they become sick. Staff attitudes, rules, and organizational structures are more predictive of outcome than professional labels. Family physicians in all settings can do more to lower their intervention rates and "humanize" care.