Pregnancy Care, the Family Medicine Way (2024)

As a family physician, being present for the birth of a child and helping the parents and baby thrive is one of the most meaningful and powerful experiences of one’s professional practice. When everything goes well, and everyone is healthy, the feeling of being able to impact a new family is inspiring. However, when something goes wrong, or the birthing person needs a cesarean section, or forceps, or magnesium, or when you spend the wee hours of the morning watching a fetal heart rate tracing with decelerations or variables, this process can be incredibly stressful.

Higher-risk pregnancies are more stressful to manage, and data show that rates of pregnancy complications are increasing. The rates of gestational diabetes rose from 6% of all singleton pregnancies in 2016 to 8.3% in 2021. 1 The rate of hypertension in pregnancy has also risen over the last several years (13% in 2017 up to 16% in 2019). 2 Add to the stress of the increased rates of high-risk pregnancies, the unpredictability of labor, interrupted plans, missed life events (eg, piano recitals, birthday parties, graduations), and sleep deprivation, and most family physicians are deciding not to continue practicing. 3 Estimates suggest that only 15% or fewer family medicine residency graduates include obstetrics in their practice. 4 It is just so hard.

Practicing obstetrics appears to both protect against burnout and worsen it. 5 This paradox makes perfect sense. The joy of being present for the delivery of a healthy baby is protective and brings meaning to daily practice. However, the disruption and stress associated with being constantly “on call” for pregnant patients is exhausting and challenging. A paper in this issue of Family Medicine describes an open-ended survey of more than 1,500 mid- to late-career clinicians who have kept pregnancy care in their practice for at least 10 years. 6 The survey asks questions about factors that help these clinicians successfully keep obstetrics in their practices. The family physicians who responded describe both barriers to pregnancy care (time, stress, higher acuity pregnancies) as well as facilitators (good relationships with obstetric colleagues, call groups). The respondents also discussed the importance of maintaining work-life balance and adequate training. Maintaining optimum skills focused on obtaining adequate training during residency as well as continuing educational opportunities during practice (taking an advanced life support in obstetrics course or attending the American Academy of Family Phsyicians Family Centered Pregnancy Care conference).

The 4 “C’s” of primary care (first Contact, Continuity, Comprehensiveness, and Care Coordination) exemplify the deep-rooted relationships that family physicians develop with young families. 7 These relationships are vitally important and long lasting. Family physicians see patients for health maintenance visits, to discuss preconception counseling, for prenatal care, during the birth of a child, for newborn care, to discuss issues with breastfeeding, child care, going back to work, discussions of the stress of being a new parent, for postpartum visits, and well-child care. This longitudinal and comprehensive care model is the epitome of what family medicine is and does. We see entire families through the course of their lives.

The Centers for Disease Control and Prevention (CDC) recently reported that one in five birthing people described mistreatment during pregnancy over the last year, with the numbers being significantly higher for Black birthing people (30%) and Latinx birthing people (29%). 8 The people interviewed describe mistreatment as being disrespected, not listened to, being shouted at or scolded, and being coerced into agreeing to certain treatments both during prenatal care and the birthing process. Obviously, this is not acceptable and likely relates, at least in part, to racial bias.

How can family physicians improve the patient experience? Based on the results of the survey by Taylor, et al, 6 organizations can support the work of practicing obstetrics as a family physician. Leaders can facilitate strong relationships between the obstetricians and family physicians by developing joint working groups and collaborative clinical care guidelines. Practices can assure that family physicians who attend deliveries have adequate time away from their direct patient care if they were up all night and will not be penalized for cancelling a clinic session. Organizations can also provide time and financial support for all family physicians who practice obstetrics to attend continuing education focused on obstetrics. Residencies can enhance training about obstetrics above the basic requirements for anyone who is planning to practice obstetrics after residency and assure confidence in their skills. This enhanced training may include special rotations, conferences, and extra experiences that will support residents who are graduating and planning to include obstetrics in their practice. The ongoing relationships between family physicians and birthing people and their young families have the potential to improve overall pregnancy care. We as a discipline should focus on supporting our colleagues who continue to include obstetrics in their practice.

References

1. QuickStats: Percentage of Mothers with Gestational Diabetes, by Maternal Age - National Vital Statistics System. Centers for Disease Control and Prevention. 2016. https://www.cdc.gov/mmwr/volumes/72/wr/mm7201a4.htm [PMC free article] [PubMed]

2. Hypertensive disorders in pregnancy affect 1 in 7 hospital deliveries. CDC Newsroom. Apr 22, 2022. https://www.cdc.gov/media/releases/2022/p0428-pregnancy-hypertension.html

3. Tong S T, Makaroff L A, Xierali I M. Proportion of family physicians providing maternity care continues to decline. J Am Board Fam Med. 2012;25(3):270–271. [PubMed] [Google Scholar]

4. Barreto T W, Eden A R, Hansen E R, Peterson L E. Barriers faced by family medicine graduates interested in performing obstetric deliveries. J Am Board Fam Med. 2018;31(3):332–333. [PubMed] [Google Scholar]

5. Barreto T W, Eden A, Brock A. The impact of practicing obstetrics on burnout among early-career family physicians. Fam Med. 2020;52(6):408–413. [PubMed] [Google Scholar]

6. Taylor M K, Barreto T, Goldstein J T, Dotson A, Eden A R. Providing obstetric care: suggestions from experienced family physicians. Fam Med. 2023;55 doi:10.22454/FamMed.2023.966628. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

7. Starfield B. Primary Care: Concept, Evaluation, and Policy. Oxford University Press; 1992. [Google Scholar]

8. One in 5 women reports mistreatment while receiving maternity care [press release] CDC Newsroom. Aug 22, 2023. https://www.cdc.gov/media/releases/2023/s0822-vs-maternity-mistreatment.html

Pregnancy Care, the Family Medicine Way (2024)

FAQs

How much is the check-up for pregnancy? ›

A: The package costs 12, 000php with all laboratory tests, ultrasound procedures, and 9 consultation sessions with OB-Gynecologists. Q: Do I have another option that is cheaper than this? A: You have 2 options for our Pregnancy Care Package. Option 1: Pregnancy Care Laboratory Package (4, 500php only).

Is 20 weeks too late for the first prenatal visit? ›

Prenatal care can start as soon as you know you're pregnant. Typically, you will have monthly doctor visits until week 28 of your pregnancy. After this point, visits increase to once every three weeks until week 36, when check-in appointments become weekly until the baby is born.

What type of care is usually given to pregnant? ›

Prenatal visits to a health care provider usually include a physical exam, weight checks, and providing a urine sample. Depending on the stage of the pregnancy, health care providers may also do blood tests and imaging tests, such as ultrasound exams.

What are the 5 importances of prenatal care? ›

What are some key aspects of prenatal care? Regular checkups with your healthcare provider, screenings for health conditions, monitoring fetal development through ultrasounds, addressing your nutrition and lifestyle choices, and receiving guidance on labor and delivery are all crucial aspects of prenatal care.

How much does it cost to check if you're pregnant? ›

Generally, home pregnancy tests cost between a few dollars and $20 or more. Blood tests done in your doctor's office will likely cost more and insurance coverage varies widely.

Is a pregnancy test covered by insurance? ›

Insurance covers a pregnancy test if it's ordered by a doctor. Depending on your plan, you might have to pay something, especially if you haven't met your deductible or your plan requires a copay. You won't usually have coverage for a test you buy yourself.

When should I call my obgyn after a positive pregnancy test? ›

When to See a Doctor After a Pregnancy Test. Ideally, you should contact a doctor within the first few days after taking a pregnancy test. It's best to schedule an appointment with a medical provider to confirm pregnancy test results around the eighth-week mark after a missed period.

When to tell Dr. you're pregnant? ›

You should contact your GP surgery or local midwife service as soon as you find out you're pregnant (before 8 weeks into the pregnancy). It's important to see a midwife as early as possible to get the antenatal (pregnancy) care and information you need to have a healthy pregnancy.

When to start clinic when pregnant? ›

It's best to have your first antenatal visit before 10 weeks into your pregnancy. Ideally this will happen when you are about 6 to 8 weeks pregnant. This is because there are lots of things to learn about. Also, some tests are recommended early in your pregnancy.

How often does a woman see her doctor when she is pregnant? ›

Follow your recommended schedule of visits

Most women have a schedule of prenatal visits that follows this timing: One visit every four weeks during weeks 4-28 of pregnancy. One visit every two weeks during weeks 28-36 of pregnancy. One visit every week during weeks 36-40 of pregnancy.

How many weeks are in a trimester of pregnancy? ›

Pregnancy is roughly divided into 3 stages known as trimesters of about 3 months each : first trimester – conception to 12 weeks. second trimester – 13 to 27 weeks. third trimester – 28 to 40 weeks.

What behaviors help or harm a developing baby? ›

Healthy eating practices will provide the nutrients that mother and child need. Avoid using alcohol, tobacco or other drugs that can have a negative impact on your child's development. Even minimal exposure to such substances can harm a developing child. If taking medication, consult your health-care provider.

How much is pregnant checking? ›

Cost of Urine Pregnancy test in Delhi:

This pregnancy profile test price ranges from INR 160-280.

What does a pregnancy check up consist of? ›

At your first prenatal care checkup, your provider: Gives you a physical exam and checks your overall health. Your provider checks your weight and height to figure out how much weight you should gain during pregnancy. Checks your blood, blood pressure and urine.

Do you have to pay for a pregnancy test? ›

You can buy pregnancy testing kits from pharmacists and some supermarkets. They can give a quick result and you can do the test in private. The following places provide free pregnancy tests: sexual health services.

When should a pregnant woman start going for a check-up? ›

It's best to have your first antenatal visit before 10 weeks into your pregnancy. Ideally this will happen when you are about 6 to 8 weeks pregnant. This is because there are lots of things to learn about. Also, some tests are recommended early in your pregnancy.

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