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Wednesday Jan 16, 2019

Why Do I Provide Maternity Care? The Answer's Simple

There were some big changes going on in the world when I was completing my medical training in 1985, including some events whose significance I might not have appreciated at the time.

[newborn baby with id bracelet]

Microsoft was on its way to making computers a vital part of our day-to-day lives with the introduction of Windows.

Nintendo revived a lagging videogame market with the U.S. launch of its entertainment system.

Coca-Cola rolled out New Coke with much fanfare, regretted it, and reintroduced Classic Coke -- all in less than 90 days.

Mikhail Gorbachev became General Secretary of the Communist Party of the Soviet Union, and his reform efforts eventually led to the inadvertent dissolution of the Soviet Union and the end of the Cold War as we knew it.

It was an interesting time.

One thing that hasn't changed is my passion for maternity care. More than 30 years after completing residency, I'm still delivering babies and plan to continue to do so for as long as I am able.

Unfortunately, I'm in the minority. The percentage of family physicians who practice high-volume maternity care (more than 50 deliveries per year) fell by half between 2009 and 2016.

Last year, research published in Family Medicine showed that nearly 25 percent of family medicine residents intended to provide maternity care when they applied for their initial certification, but less than 10 percent reported providing such care when they were recertifying.

That's unfortunate, not only for patients but for physicians. Research published last year in the Annals of Family Medicine showed that new physicians who practice broad scope family medicine -- such as inpatient medicine, maternity care and home visits -- were less likely to experience symptoms of burnout.

The reasons family physicians stop providing maternity care are numerous. A few years ago, a study broke down the multitude of factors into more than a dozen categories. The accompanying chart that illustrated the scope of the problem didn't fit on one page.(www.aapsus.org)

The reasons many family physicians continue to provide maternity care are much simpler. AAFP President John Cullen, M.D., recently wrote a brilliant essay about the importance of family physicians delivering babies in rural areas, like his, in the face of a growing OB/GYN shortage.(news.aamc.org)

On a personal level, maternity care is important to me because I love establishing a deeply intense, rapidly acquired, meaningful continuity relationship that leads to health changes that can last a lifetime. Pregnancy is a critical time in the life cycle of a woman and her family. During the 40 weeks of pregnancy, a deep relationship is established with the woman and her support system. Early in pregnancy, it is important to be present during periods of doubt, uncertainty, decision-making, nausea and profound physiologic changes.

In this trusting relationship, healthy behaviors can be implemented when needed. Women who want the best for their babies will improve their diets, stop using dangerous substances, avoid toxic exposures and develop an exercise routine. Late in pregnancy, the groundwork for breastfeeding and healthy parenting can be laid. Safety measures like car seats, smoke detectors and healthy baby sleeping arrangements can be planned ahead of the delivery.

Having a trusted physician in the delivery room reduces anxiety and facilitates interventions when necessary. After the arrival, the family is more prepared to bring the baby into a healthy, safe, environment. Healthy changes made by a mother during pregnancy may require continued encouragement, so the baby and the entire family can maintain a healthy lifestyle.

As an added benefit, I get a new patient for my practice, and this keeps my practice young and growing.

The AAFP has a member interest group devoted to maternity care, clinical guidelines, as well as live and online CME resources to help us provide the best care possible.

Robert Raspa, M.D., is a member of the AAFP Board of Directors.

Posted at 01:56PM Jan 16, 2019 by Robert Raspa, M.D.

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