Teamwork key to FP-midwife mix
To Valerie King, M.D., M.P.H., family-centered maternity care means family physicians and midwives working together.
King, a clinical instructor in the family medicine department at the University of North Carolina-Chapel Hill, first started working with midwives in Siler City, N.C., during medical school. Then she participated in an obstetrics clerkship in Scotland and learned about a midwife-based system.
Valerie King, M.D., of Chapel Hill, N.C., believes the family physician and midwife partnership is invaluable.In medical school, a clerkship in Scotland showed her the pluses of a system that uses midwives.
(Photo by Leigh Ann Bathke/AAFP)After she returned to America, King said she found the American way of birth rather shocking.
"The system I saw in Scotland trusted women to give birth and didn't interfere unless it was necessary. I have learned about things like alternative positions, massage and whirlpool tubs for pain relief from midwives," said King, who is also a postdoctoral research fellow at the Cecil G. Sheps Center for Health Services Research in Chapel Hill. "The American system is more like the Ford production line, with lots of intervention, much of it not necessary or desirable."
During King's first year on the university faculty, she worked with some of the same Siler City midwives she had encountered during her medical school preceptorship.
The midwives had started a birth center in town called Piedmont Women's Health Center under the auspices of Piedmont Health Services, one of the longest-running community health centers in the United States.
King, along with other family physicians at UNC-Chapel Hill and Piedmont Health Services, helped them develop the center and serves as its primary consultant, on contract from the UNC family medicine department.
The UNC-Chapel Hill residency benefits from the center in several ways:
- There's a referral base of patients unable to deliver at the birth center because of risk and insurance status.
- The center provides an educational opportunity for family medicine residents to act as consultants for community health providers.
- Residents are exposed to a selected population of women and families, many of whom have specific expectations for their birth experience and a high commitment to breast-feeding.
King said midwives are good at understanding where a woman is in her labor, "so women get the level of care they really need. An important part of the midwife's role is to show residents how a midwife can help a patient--and show them how to do the same."
The residency program is also one of the first to have a midwife, Trish Payne, C.N.M., M.P.H., as part of the department. She also has full privileges at UNC hospitals.
"Residents are exposed to a whole new way of pregnancy care and birth," said King. "They learn a lot of low-intervention techniques and alternatives. If you can get a baby out by changing the mother's position, then it's good for the mother and better for the baby. Their box of tricks is more full when they graduate."
Residents participate in an integrated rotation. They take care of women who are due to deliver during the month when the resident will be doing deliveries.
"That way they work with the mother all through the pregnancy. They really get to know their patients," King said. "And the residents see it as part of what family physicians do regularly, not just in the middle of the night."
King said she's had several residents start the program saying they didn't want to do obstetrics, then change their minds.
And the patients love having midwives and family physicians to help them through their pregnancy. King said the volume of pregnant women coming to the family practice center has increased because of the presence of midwives.
In 1996, the Academy adopted a position stating that certified nurse midwives should function only in a collaborative practice arrangement under the direction and responsible supervision of a practicing, licensed physician qualified in maternity care.
Some family physicians worry about whether midwives are competition. King said she hasn't seen that in her community; in fact, just the opposite has occurred.
"I think family physicians and midwives are a natural fit," King said. "They each have skills the other can use. It's a partnership that really needs to be explored."
FP Report is published by the AAFP News Department. Copyright © 1998 by American Academy of Family Physicians.
