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Tuesday
Apr202010

Are Obstetricians More Likely to Perform Cesareans than Family Docs?

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According to one physician who asked to remain anonymous, there are options out there “for people who really want a physician involved in their birth, but are tired of the OB model.” 

They wrote via e-mail:

I actually am one of the few family physicians in the country who not only deliver vaginally, but also do C-sections when needed.  I think that it’s important to include the choice of a family or general practitioner as opposed to an OB/GYN when talking about ways to lessen the chance of a C-section.  There have been multiple studies saying that outcomes are similar with FP/midwifes and OBs in low risk pregnancies, even though fewer interventions are practiced by FPs and midwifes.  This includes not only C-sections but other interventions as well. 

Of course there will always be exceptions to any rule, but in my experience, there is a very different attitude and style between OBs and FPs.  In my training, I worked with and was taught by both, and while I learned a lot from my OB supervisors, I also learned a lot about what I was NOT going to do when I got out of residency.  I think it comes down to this: OB/GYN is a surgical specialty, Family Medicine is a medical specialty.  It’s like the old saying: “When all you have is a hammer, everything looks like a nail.”  If you are a surgeon, you are going to be much more likely to pull that trigger than if you are not. 

I think some other benefits to family medicine in pregnancy are:

1) We take care of people from “the womb to the tomb,” and many of my colleagues have delivered 2 or even 3 generations in one family (I’m not quite old enough for that yet!) Imagine how much trust and understanding you miss out on if the person delivering your baby meets you at your 10 week visit vs. meeting you at your own birth. 

2) Family medicine has more training in psychology and has a culture and health model based on holistic care.  This is really helpful in understanding and dealing with the anxiety of birth.  It can also be really helpful in the event that a C-section IS needed. Helping to minimize guilt and the feelings of failing is something that I deal with on a daily basis from helping someone grieve over the loss of a loved one, a relapse into alcohol or drug use after being clean, etc.  Obviously, these things are not exactly the same, but the tools that we use for helping deal with these losses are very helpful in helping someone deal with the loss of the birth they wanted. 

3) Family medicine has more training in the medical problems (such as high blood pressure, diabetes, depression, seizures) than OBs because we take care of it in men, women (pregnant and not pregnant) and children.  I treat probably 15-20 people a day with diabetes.  I guarantee that most OBs do not unless they are high risk only. This also means that when you have medical difficulties that are not specific to OB, you can have them treated without having to find yet another doctor.  Again it goes back to holistic care, do you want to be seen by a doctor that treats your womb or a doctor that treats YOU?

4) Family medicine treats mom and baby both before AND after birth.  At most, OBs may perform the circumcision after birth.  Mom’s health (both emotionally and physically) are dependent on the baby’s health (and vice versa).  One of the things that I love about post-partum care is that we get to see moms back at 2 weeks when they bring their babies in for their first check up.  Most OBs don’t see them for 6 weeks post-partum.  I can’t tell you how often I have given mom’s much needed help at these 2 week checks that aren’t even scheduled for them.  I also can’t tell you how often I have heard pediatricians lament that they can’t treat mom because of the negative impact Mom’s health (or lack thereof) is having on the baby. 

5) Family medicine is often more receptive to doulas and midwifes than OBs.

 

Studies:

A comparison of pregnancy care delivered by family physicians versus obstetricians in Lebanon. (1993)

Practice variations between family physicians and obstetricians in the management of low-risk pregnancies (1995)

A comparison of family physicians’ and obstetricians’ intrapartum management of low-risk pregnancies (1993)

Relation of family physician or specialist care to obstetric interventions and outcomes in patients at low risk: a western Canadian cohort study. (1989)

 

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Reader Comments (22)

"...the tools that we use for helping deal with these losses are very helpful in helping someone deal with the loss of the birth they wanted."

Bingo.

What will it take to get people, much less practitioners, to understand that women are not griping about loosing an experience? We are griping about having experiences which are medically questionable forced upon us through coercion, failure to provide informed consent, and through blind trust. And some of us are griping about forced procedures!

Other than the constant reduction of women into thrill seekers looking for a sanctimommy high, I'm all for FP's delivering.

April 20, 2010 | Unregistered CommenterAndAnon

I so need to sleep more. There is a difference between coerced and forced procedures, although it doesn't read like there's much of one in the above comment. 3 am feeds!

April 20, 2010 | Unregistered CommenterAndAnon

I love FP Doctors! My community lost FP care for pregnancy when OB liability go so expensive they couldn't afford to attend births any longer. One wonderful FP Doctor commented that he would have been paying tens of thousands of $ for the privilege. It would be a good change to see the pendulum swing back to more Family Practice Doctors and CNMs in the hospitals. Let the OBs and Neonatologists manage the high risk pregnancies and perform surgery. It is what they are very good at!

April 20, 2010 | Unregistered CommenterMargy

I think I just cried a little. so wonderful to hear this. =)

April 21, 2010 | Unregistered Commentermommymichael

My question is this: how do we find these FPs? As far as I know, in my city (of 1.8 million people), there is only one, and she doesn't take insurance. It would be fantastic if there was some sort of database for birth-friendly FPs.

April 21, 2010 | Unregistered CommenterMaggie

Maggie - I don't know that there is a specific database for FP's that will do births... but if we could encourage more moms who are able to utilize the services of an FP to fill out The Birth Survey, it would help build that database!!! (www.thebirthsurvey.com).

I have a great FP who I actually have not approached about my impending birth because I plan to stay well away from the hospital... but I look forward to bringing the baby to him for the early checkups. I was so disgruntled by the state of local pediatrician clinics when I had my daughter and I was grateful to find my FP. He sees all of us, which is soooooo nice!

April 21, 2010 | Unregistered CommenterJennifer

So very true. I had a FP for my VBAC in a ban hospital, and I am positive I would not have gotten my VBAC with an OB. Not just because a OB is a surgeon, but also because the FP knows all my family and what impact a RCS and the resulting recovery time (physical and emotional) would have had on all my family, not just the new baby.

April 21, 2010 | Unregistered CommenterSilja

Mercy hospital in Pittsburgh is having FPs shadow the midwives and OBs. It will be interesting to see where that goes. Currently, I do not know of any FPs who attend births in Pittsburgh. Maybe in the outermost suburbs, but definitely not near the city and immediate suburbs.

April 21, 2010 | Unregistered CommenterVanessa Manz

A doula in my town told me she has started referring to the family practice clinic instead of the midwives because she believes the FP docs are giving better, more evidence-based care than the midwifery practice (yet another lesson in "it's not the label on the practitioner, it's how they actually practice". Although there is a midwife on the FP staff who supervises/trains the FP residents on the floor, I think she has something to do with their practices too!) One of the FP docs there told me she has a patient considering a VBA2C and they are supportive as long as she understands the risks/benefits. Wow!!

Teaching hospitals are probably a good place to find FP docs who do deliveries (although I'm sure that not all of them are places to find good/mother-friendly FP docs).

April 21, 2010 | Unregistered CommenterBryn

The problem I see, in addition to the one mentioned above about FINDING an FP to assist...is that the way insurance systems work. I knew a girl who was only allowed to be in "transitional" care for 28 days. She didn't have to use the OB her primary recommended, but only had 28 days to search out WHO she wanted to deliver her baby or her coverage could be dropped. ...And then also hope that person accepted her insurance. If not, she had to submit claims every time she had a check up to be reimbursed only 60% of her out of pocket costs.

It took me 3 months to find a care provider for my second pregnancy. All I had to go off of was the phonebook. The internet searches I did were unreliable.

April 21, 2010 | Unregistered CommenterMaegan
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