“Supporting Family Physician Maternity Providers” by Dr Goldstein and colleagues1 is an excellent article that clearly describes what we need to do—work together. Alabama is predominantly rural and has one of the highest infant mortality rates in the country.2 The College of Community Health Sciences (CCHS) at the University of Alabama in Tuscaloosa has developed an interdisciplinary, collaborative practice model with OB/Gyns and family physicians that provides obstetrical care to rural, underserved West Alabama.
Medical school and community Ob/Gyns and family physicians practicing obstetrics share call, cover for one another, and work together, including scrubbing together when needed to provide high quality obstetrical care. In rural communities where there are no labor and delivery services, family physicians and Ob/Gyns provide regionalized prenatal care. When their obstetrics patients need to be hospitalized (such as for delivery), the patients travel or may be transported to the teaching hospital in Tuscaloosa. Their physician who practices obstetrics may travel to the main hospital to deliver the patient or the patient may be cared for by the physician providing obstetrics care. There is always a physician who practices obstetrics in the hospital if the outlying physician cannot come to the delivery, does not make it to the delivery, or if the patient only needs postpartum or postoperative care provided. All physicians sharing hospital call allows each provider to be reimbursed for deliveries.
In Alabama, family physicians often provide obstetric care in rural areas.3 Family physicians care for the mother, the newborn and the rest of the family. Family physicians are almost never sued, and their malpractice insurance costs a fraction of what Ob/Gyns pay.4 Reimbursement is the same. Outcomes and complications are similar, and family physicians have lower cesarean section rates because they perform more vaginal births after cesarean sections resulting in less expensive care and shorter hospital stays.5,6 Family medicine physicians trained in obstetrical and newborn care is one of the methods that can help to reduce maternal and perinatal morbidity and mortality in rural, underserved areas.
