The impact of family physicians in rural maternity care

Abstract

Background Reduced access to maternity care in rural areas of the United States presents a significant burden to pregnant persons and infants. The objective of this study was to estimate the impact of family physicians (FPs) on access to maternity care in rural United States hospitals, especially where other providers may not be available. Methods We administered a survey to 216 rural hospitals in 10 US states inquiring about the number of babies delivered from 2013 to 2017, the types of delivering physicians, and the maternity services offered. We calculated the percentage of rural hospitals in our sample where FPs performed vaginal deliveries, cesareans, and vaginal births after cesarean (VBACs), and the percentage of all babies delivered by FPs. We estimated the distance patients would have to travel for care if FPs were not providing care locally. Results The final study population consisted of 185 rural hospitals. FPs delivered babies in 67% of these hospitals and were the only physicians who delivered babies in 27% of these hospitals. FPs provided VBAC at 18% and cesarean birth services at 46% of the rural hospitals, but with wide geographic differences. Many patients would have to drive an average of 86 miles round‐trip to access care if those FPs were to stop delivering. Conclusions Family physicians are essential providers of maternity care in the rural United States. Family Medicine residency programs should ensure that trainees who intend to practice in rural locations have adequate maternity care training to maintain and expand access to maternity care for rural patients and their families.

The Role of the Family Physician in Rural Maternity Care

“…In this study, an average of 63% of babies were delivered by Family Physicians in these hospitals. 23 Similarly, a 2021 study of 185 rural hospitals in the United States demonstrated that Family Physicians delivered babies in 67% of the hospitals. They were the only delivering physician in 27% of the hospitals overall and in 40% of the hospitals in which Family Physicians did deliveries.…”

“…22 Of rural hospitals that provide maternity care, 46% have Family Physicians that provide cesarean deliveries as the primary surgeon. 23 In addition, in 38.6% of rural counties, they are the only physician performing them. 4 This further highlights the need to support Family Physicians providing not only maternity care but having the proper training and skillset to provide operative care, in particular in rural environments.…”

Understanding and Overcoming Barriers to Rural Obstetric Training for Family Physicians

“…Family physicians are the most common health professional providing rural OB care, but the number of family physicians practicing OB is declining. [1][2][3][4] The United States is also experiencing a national shortage of obstetricians and gynecologists (Ob-Gyns), more acutely in rural areas. 1,4 In 2019, more than half of rural counties had no family physicians who delivered babies, and nearly one-third had no clinicians practicing OB.…”

Impact of COVID‐19 on perinatal care: Perceptions of family physicians in the United States

“…Family physicians (FPs) play a significant role in improving perinatal health equity as they fill gaps in access to care in rural areas and among underserved populations, conducting seven percent of all deliveries (translating to approximately 280,000 deliveries per year) and an even greater percentage of prenatal and postpartum care 1 . FPs are distinctive in that they provide a comprehensive model of “dyad care,” providing longitudinal care for the family including reproductive and preconception care through postpartum, infant, and pediatric care 2–4 . Because FPs are trained in the biopsychosocial model to have a broad understanding of patients, families, and communities, and to understand multiple stressors placed on patients as seen in the COVID‐19 pandemic, they provide a unique perspective on the impact of the pandemic on the care of pregnant and postpartum patients 4,5 …”

“…1 FPs are distinctive in that they provide a comprehensive model of "dyad care," providing longitudinal care for the family including reproductive and preconception care through postpartum, infant, and pediatric care. [2][3][4] Because FPs are trained in the biopsychosocial model to have a broad understanding of patients, families, and communities, and to understand multiple stressors placed on patients as seen in the COVID-19 pandemic, they provide a unique perspective on the impact of the pandemic on the care of pregnant and postpartum patients. 4,5 Clinics and hospitals have implemented new protocols and policies aimed at reducing the spread of COVID-19.…”