Supporting Family Physician Maternity Care Providers.

Maternity care access in the United States is in crisis. The American Congress of Obstetrics and Gynecology projects that by 2030 there will be a nationwide shortage of 9,000 obstetrician-gynecologists (OB/GYNs). Midwives and OB/GYNs have been called upon to address this crisis, yet in underserved areas, family physicians are often providing a majority of this care. Family medicine maternity care, a natural fit for the discipline, has been on sharp decline in recent years for many reasons including difficulties cultivating interdisciplinary relationships, navigating privileging, developing and maintaining adequate volume/competency, and preventing burnout. In 2016 and 2017, workshops were held among family medicine educators with resultant recommendations for essential strategies to support family physician maternity care providers. This article summarizes these strategies, provides guidance, and highlights the role family physicians have in addressing maternity care access for the underserved as well as presenting innovative ideas to train and retain rural family physician maternity care providers.

A National CERA Study of the Use of Laborists in Family Medicine Residency Training.

BACKGROUND AND OBJECTIVES: Little is known about the impact of laborists (which we defined as "clinicians dedicated to providing L&D care services in the hospital environment for pregnant patients, regardless of who provided the prenatal care" for this survey) on family medicine residency training. We surveyed family medicine residency directors to assess characteristics about laborist services and their involvement in family medicine residency teaching. METHODS: Questions were included in the 2015 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency directors. Univariate statistics were used to describe programs, directors, and our questions on the use of laborists. Chi-square tests and Student's t tests were used to evaluate bivariate relationships using a P<.05 to denote statistical significance. RESULTS: A total of 250/473 (52.9%) of residency directors completed the laborist section of the CERA survey. Sixty-four percent of residency programs were community based/university affiliated, representing the expected range, size, and location of family medicine programs. Almost half of programs (44.4%) reported a laborist service in their main teaching hospital for L&D training. Of directors, 64.1 % viewed laborists as good/excellent educators; 54.3% reported little or no reduction in L&D teaching required of their faculty despite the presence of a laborist service. Fifteen percent reported that >30% of their graduates included L&D care in their first practice.. CONCLUSIONS: Laborists have an important role in family medicine resident obstetrics training and education. More research is needed to explore how laborists and family medicine faculty can collaborate to promote enhanced efficiency and effectiveness as residency teachers.

Multidisciplinary collaborative development of a plain-language prenatal education book.

During pregnancy, women actively seek out health information that promotes the well-being of themselves and their fetuses. For those with health literacy challenges, access to understandable health information can be difficult. Written information, in particular, needs to be readable and usable by the women served. Plain language is an essential component of effective health education material. In an effort to create standardized prenatal education materials for a diverse population of childbearing women, Boston Medical Center's midwifery service led a multidisciplinary initiative to develop a comprehensive plain-language prenatal education book. Midwives, obstetricians, family physicians, nurses, and community doulas contributed to the content of the book; art students provided graphic design skills; and a literacy consultant assisted in the wording and layout. The Hey Mama! book provides women with woman-centered, readable, comprehensive information about pregnancy, labor, postpartum, and newborn care.

Herb use, vitamin use, and diet in low-income, postpartum women.

INTRODUCTION: Little is known about herb use among underserved postpartum women and their patterns of communication about herb use with prenatal providers. METHODS: We interviewed women from the postpartum unit at an urban hospital about herb use during pregnancy, socioeconomic factors, prenatal vitamin use, and diet. We asked women if they discussed use of herbs and vitamins with their prenatal care providers and asked about their satisfaction with these discussions. We reviewed inpatient chart medication lists for herb use. RESULTS: Of 160 women surveyed, 39% reported using herbs during pregnancy. Sixty-five percent of participants took a prenatal vitamin. Fifty-seven percent of herb users (n = 40) reported taking prenatal vitamins. Herb users were significantly more likely to report making any dietary change during their pregnancies than non-herb users (P = .03). Only 38% of herb users discussed it with their prenatal providers, and 82% were satisfied with the conversation. Of all 160 participants, 125 had prenatal vitamin use documented, and no women had herbal medicine use documented in the medical record during their birth hospitalization. DISCUSSION: We report a higher frequency of herb use during pregnancy than other studies. The fact that women of all backgrounds and economic statuses report using herbs during pregnancy makes it even more important for all women to be asked about their use of herbs.

The birth of a collaborative model: obstetricians, midwives, and family physicians.

In the United States, the challenges of maternity care include provider workforce, cost containment, and equal access to quality care. This article describes a collaborative model of care involving midwives, family physicians, and obstetricians at the Boston Medical Center, which serves a low-income multicultural population. Leadership investment in a collaborative model of care from the Department of Obstetrics and Gynecology, Section of Midwifery, and the Department of Family Medicine created a culture of safety and commitment to patient-centered care. Essential elements of the authors' successful model include a commitment to excellence in patient care, communication, and interdisciplinary education.

How we built our team: collaborating with partners to strengthen skills in pregnancy, delivery, and newborn care.

We describe how collaboration with outpatient community health centers and other disciplines resulted in the creation of a novel interdisciplinary inpatient maternal child health system that focuses on safety and collaboration. Our maternal child health faculty team includes a mix of fellowship- and non-fellowship-trained, inpatient- and outpatient-based family physicians. Our team provides a sustainable framework for faculty to practice both inpatient and outpatient maternity care and provides strong role models for our trainees.

Family medicine obstetrics fellowship graduates: training and post-fellowship experience.

BACKGROUND AND OBJECTIVES: Family medicine obstetrics and maternal-child health fellowships offer family physicians additional training in pregnancy care. Our objectives were to assess the content of these fellowship programs, the clinical practices of fellowship graduates, and factors associated with inclusion of cesarean delivery in practice after fellowship training. METHODS: A survey was sent to graduates of obstetrics or maternal-child fellowships around the country regarding their fellowship experience and current practice characteristics. RESULTS: A total of 165 graduates responded, for a response rate of 64%. Cesarean delivery, postpartum tubal ligation, and dilation and curettage are taught in most fellowships. Involvement in residency education and caring for outpatient family medicine patients are also included in most fellowships. Forty-four percent of fellowship graduates practice in rural areas, 88% are based in community hospitals, and 49% are faculty in family medicine residency programs. Most fellowship graduates are comfortable caring for high-risk pregnancy patients and performing related operative procedures. Sixty-six percent of graduates reported obtaining cesarean delivery privileges. Practicing in the Northeastern part of the United States decreased the likelihood of graduates having cesarean delivery privileges while practicing in a rural community increased it. CONCLUSIONS: A majority of family physicians care for high-risk pregnancy patients and perform operative procedures related to pregnancy after completing an obstetrics fellowship.