Maternal/Child Care (Obstetrics/Perinatal Care)

Maternal/child care is a core discipline of the specialty of Family Medicine. The scope of practice for family physicians in maternity/child care may range from only managing medical problems during pregnancy, prenatal care only, or comprehensive care of low-risk pregnancy to comprehensive care of high-risk pregnancy, including performing cesarean deliveries. The American Academy of Family Physicians (AAFP) advocates that ALL Family Medicine residents receive basic maternal/child care training and that those residents who plan to practice the full scope of maternal/child care receive advanced training to include management of complications and surgical intervention.

The American Academy of Family Physicians further advocates the maternal/child care privileges should be based solely on the individual physician's documented training and/or experience, demonstrated abilities, and current competence and not by specialty-specific designation alone. This may be accomplished by providing documentation of acceptable supervised training and experience during residency and/or fellowship training, or successful completion of an approved, recognized course when such exists. Family physicians should evaluate fellow family physicians in credentialing and privileging determinations.

Both the American Academy of Family Physicians and the American College of Obstetrics and Gynecology (ACOG), the two major organizations of physicians who provide maternal/child care in the United States, recognize that there are health care disparities for women in rural areas and that in some rural areas these disparities include critical access to maternal/child care. ^1,2 Women living in rural settings tend to lack insurance, have a lower income level, and often rely on Medicaid and Medicare; due to the distance and access to care, they must often travel father and have a decrease in frequency of care than their counterparts living in urban settings. ACOG recognizes that in some rural settings family physicians provide 100% of obstetric care.²

The AAFP affirms that it remains committed to its policy of access to quality health care for all Americans and its willingness to collaborate with governmental and private agencies as well as ACOG and other appropriate professional organizations to provide appropriate access to maternal/child care for all women wherever they reside.

The AAFP will employ the following strategies to accomplish this goal:

1. Aggressively promote and support family physicians to provide maternal/child care, especially in rural settings.
2. Promote excellence in basic maternal/child care training for all family medicine residents by family physicians.
3. Establish evidence-based national guidelines for quality maternal/child care by family physicians.
4. Encourage the expansion of rural medicine and maternal/child care fellowships.
5. Advocate with ACOG for its active support of the joint AAFP-ACOG guidelines for specialty-neutral credentialing at the state and local levels.
6. Reinforce and expand currents efforts to:
   1. Promote maternal/child care by family physicians to the public.
   2. Advocate for national tort reform and specifically for relief in maternal/child care critical access areas.
   3. Aggressively assist family physicians who have appropriate training and demonstrated competence in obtaining and maintaining privileges in maternal/child care.
   4. Encourage research in outcomes-based data in maternal/child care provided by family physicians.

References:

1. AAFP-ACOG Joint Statement on Cooperative Practice and Hospital Privileges. Accessed January 9, 2012.
2. American College of Obstetricians and Gynecologists (ACOG), Committee on Health Care for Underserved Women, Health disparities for rural women. Accessed July 26, 2016.

(1989 COD) (2017 COD)