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Friday Feb 06, 2015

Maternity Care, Solid Team Training Build Strong Bonds

For me, nothing cements my relationship with patients and their families like the birth of a child. It is heart-warming for me to be part of the privileged minority of family physicians who continue to provide maternity care as part of a full-scope practice.

Getting here was no accident. I grew up in rural Washington, and when I was born in the local small community hospital, a family physician was there for the delivery. The same family physician delivered my sister and brother, and he later mentored me during high school when I worked the night shift as a hospital orderly to get a taste of a career in health care.

During my second year of medical school, I was fortunate to find a family physician preceptor for my continuity clerkship who not only practiced maternity care in the hospital but also provided care in patients' homes, working with a certified nurse midwife to provide home births and births in his office-based birthing center.

The experience of following families through prenatal care and then being invited into their homes to assist with a birth had me hooked, and watching those newborns grow and develop during the course of their well-child care set the hook for good.

In the multicultural community my medical school served, it was not uncommon to have multiple generations present for births and well-child visits. The safe birth of a healthy baby often came as a relief to the elder members of the families, whose previous experiences with childbirth had not always been so joyful.

The contrast between taking care of a selected, “low-risk” population of women having home births and my experiences as a medical student on the OB service of a quaternary care university hospital was enormous; I saw that a comprehensive education and residency training program in family medicine, taking care of the highest-risk/highest-acuity pregnancies, was definitely a necessary start on my path to a full-scope practice. Little did I know how much I would miss taking care of the low-risk patients until those first few months of residency in the county hospital, where every patient seemed to have a myriad of medical and social challenges. The vaginal delivery of a healthy, term baby was rare, except for patients who received prenatal care through our family medicine clinic. Although they had many of the same demographics as the rest of our county hospital patients, and many of the same obstetrical challenges, the clinic patients had the advantage of continuity of the team and integrated care of the family.

Now, more than 30 years after residency, I am sitting in the labor and delivery unit, reflecting on the experiences I have shared with the family I am caring for tonight. We have a long history together; this is their second child, coming more than 15 years after the birth of their first. That beautiful baby girl, who has grown into a mature young lady, is here with her dad, helping coach her mom during labor. Between her birth and tonight, there have been three miscarriages, including a molar pregnancy.

The couple had almost given up hope of another child, but tonight, hope comes home to stay. We have time to talk about their first childbirth and the family medicine resident who was there with me. That resident subsequently became a partner in my practice. We reminisce about that stubborn little girl who decided she was going to arrive in the wee hours of the morning. She had a compound presentation that required extra help and effort. Everything turned out fine, but I am reminded how challenging it was to keep panic out of the room that morning until help arrived.
And yet I am confident this evening -- working with another resident -- that no matter what the challenges may be with this labor and delivery, panic will not show its ugly face. How can I be so confident? I sum it up in one simple but profound concept.

Team.

A team of experts does not automatically make an expert team. That is one of the tag lines in the “Safety in Maternity Care” chapter I helped write for the AAFP’s Advanced Life Support in Obstetrics (ALSO) program when I joined the ALSO Board years ago. Teamwork training, as simple as it may sound, saves lives. There is a growing body of evidence that simulation and teamwork training specifically regarding obstetrical emergencies saves mothers and babies no matter the setting, whether it be in the regional perinatal center (like the one I am sitting in this evening), a rural hospital in Tanzania or the maternity hospital in Baghdad (where I taught an ALSO course last year).

Tonight’s team is different from the team I worked with nearly 16 years ago; everyone on the labor and delivery unit tonight has been through an ALSO course. Five years ago, after some adverse events that could have been prevented, the obstetricians, family physicians, nurse midwives, labor nurses and mother-baby nurses here voted to require ALSO certification and ongoing maintenance of that certification for every person working on the unit. We are proud that safety has become the focus of our care. Teamwork is integral to everything we do, and this high-risk perinatal center serving a high-risk, multiethnic population has the lowest C-section rate and highest safety ratings of any hospital in our state.

I salute the AAFP’s commitment to ongoing education in maternity care, from the ALSO courses for practicing physicians and other maternity care professionals, to the Academy's Family Centered Maternity Care course, to the Basic Life Support in Obstetrics courses targeted to medical and nursing students, prehospital care professionals and emergency department staffs and, finally, to the international work ALSO and Global ALSO continue to do.

I have to go now. The newest member of the family is about to arrive.

Carl Olden, M.D., is a member of the AAFP Board of Directors.

Posted at 08:00AM Feb 06, 2015 by Carl Olden, M.D.

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