Graham Center One-Pager

Family Physicians Make a Substantial Contribution to Maternity Care: The Case of the State of Maine

Family physicians provided nearly 20 percent of labor and delivery care in Maine in the year 2000. A substantial proportion of this care was provided to women insured by Medicaid and those delivering in smaller, rural hospitals and residency-affiliated hospitals. As family medicine explores its future scope, research identifying regional variations in the maternity care workforce may clarify the need for maternity care training in residency and labor and delivery services in practice.

Development of a sustainable maternity care model and clarification of the role of family medicine within that model requires examination of current practices. The 2000 Healthcare Cost and Utilization Project (HCUP) data for Maine identify the specialty of physicians attending all hospital births, revealing how often family physicians provide this care. There were a total of 13,047 deliveries (10,089 vaginal and 2,958 cesarean) in Maine in 2000. Five hundred and one family physicians (FPs) and 125 obstetricians (OBs) were practicing in the state of Maine, and FPs attended 19 percent of total deliveries and 23 percent of vaginal deliveries. In Maine, FPs attended 26 percent of deliveries covered by Medicaid and
15 percent of deliveries covered by private insurance. As a consequence, FPs provided a significantly greater proportion of their labor and delivery services for women insured by Medicaid compared with OBs (44 versus 29 percent, P <.001).

FPs made their greatest contribution to delivery care in hospitals in more rural counties. In completely rural counties or those with fewer than 2,500 people, FPs provided 37 percent of delivery services and, in metropolitan counties, FPs provided 16 percent of delivery services. FPs attended 16 percent of total deliveries in larger hospitals (more than 60 beds), compared with 35 percent of total deliveries in smaller hospitals (fewer than 60 beds). In the four FP residency-affiliated hospitals, which constitute Maine's largest in number of beds, FPs attended 906 deliveries, representing 35 percent of their total deliveries in the state.

Labor and Delivery Services Provided by OBs and FPs in Maine, 2000 OB contribution (%) FP contribution (%) Total Total deliveries* 10,149 (78) 2,571 (20) 13,047    Vaginal deliveries* 7,479 (74) 2,338 (23) 10,089    Cesarean deliveries* 2,834 (96) 68 (2) 2,958 Insurance (cases per specialty)*† 10,112 2,554 12,992    Private 6,731 (82) 1,303 (16) 8,187    Medicaid 2,945 (70) 1,126 (27) 4,228    Self-pay 98 (52) 75 (40) 187 Distribution of deliveries by hospital size*          Hospital >60 beds (n = 15) 8,523 (84) 1,586 (16) 10,149    Hospital <60 beds (n = 16) 1,626 (59) 969 (35) 2,761 Hospital location          Metropolitan statistical areas 4,530 (84) 845 (16) 5,375    Nonmetropolitan statistical areas 5,465 (76) 1,702 (24) 7,167 OB = obstetrician; FP = family physician. *--OB and FP contributions do not equal 100 percent because of contribution of others. †--Insurance distribution and hospital size data do not equal total deliveries because of missing data.

FPs provided a substantial amount of labor and delivery care in Maine in the year 2000. Similar analyses performed in other states will further define regional variations in FPs' practice of maternity care. Decisions that limit the provision of labor and delivery care by family physicians may impact access to services available to women, especially those who are publicly insured and delivering in smaller, rural hospitals.

NOTE: The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP.

Adapted from Graham Center One-Pager #20. Cohen D, Guirguis-Blake J, Jack B, Chetty VK, Green LA, Fryer GE, Phillips RL. Family physicians make a substantial contribution to maternity care: the case of the state of Maine. August 2003. Available at: www.graham-center.org/x409.xml. From the Robert Graham Center: Policy Studies in Family Practice and Primary Care, 1350 Connecticut Ave., NW, Suite 950, Washington, DC 20036 (telephone: 202-986-5708; fax: 202-986-7034; e-mail: policy@aafp.org).