Family physicians make a substantial contribution to maternity care: The case of the state of Maine

Family physicians provided nearly 20 percent of labor and delivery care in Maine in the year 2000. A substantial proportion of this care was provided to women insured by Medicaid and those delivering in smaller, rural hospitals and residency-affiliated hospitals. As family medicine explores its future scope, research identifying regional variations in the maternity care workforce may clarify the need for maternity care training in residency and labor and delivery services in practice.

Cohen D, Guirguis-Blake J, Jack B, Chetty VK, Green LA, Fryer GE, and Phillips RL

Development of a sustainable maternity care model and clarification of the role of family medicine within that model requires examination of current practices. The 2000 Healthcare Cost and Utilization Project (HCUP) data for Maine identify the specialty of physicians attending all hospital births, revealing how often family physicians provide this care. There were a total of 13,047 deliveries (10,089 vaginal and 2,958 cesarean) in Maine in 2000. Five hundred and one family physicians (FPs) and 125 obstetricians (OBs) were practicing in the state of Maine, and FPs attended 19 percent of total deliveries and 23 percent of vaginal deliveries. FPs delivered 26 percent of women in Maine insured by Medicaid and 15 percent of women with private insurance. As a consequence, FPs provided a significantly greater proportion of their labor and delivery services to women insured by Medicaid compared with OBs (44 versus 29 percent, P < .001).

Labor and Delivery Services Provided by OBs and FPs in Maine, 2000
	OB contribution (%)	FP contribution (%)	Total
Total deliveries*	10,149 (78)	2,571 (20)	13,047
Vaginal deliveries*	7,479 (74)	2,338 (23)	10,089
Cesarean deliveries*	2,834 (96)	68 (2)	2,958
Insurance (cases per specialty)*†	10,112	2,554	12,992
Private	6,731 (82)	1,303 (16)	8,187
Medicaid	2,945 (70)	1,126 (27)	4,228
Self-pay	98 (52)	75 (40)	187
Distribution of deliveries by hospital size*
Hospital >60 beds (n = 15)	8,523 (84)	1,586 (16)	10,149
Hospital <60 beds (n = 16)	1,626 (59)	969 (35)	2,761
Hospital location
Metropolitan statistical areas	4,530 (84)	845 (16)	5,375
Nonmetropolitan statistical areas	5,465 (76)	1,702 (24)	7,167
OB = obstetrician; FP = family physician. *--OB and FP contributions do not equal 100 percent because of contribution of others. †--Insurance distribution and hospital size data do not equal total deliveries because of missing data.

FPs made their greatest contribution to delivery care in hospitals in more rural counties. In completely rural counties or those with less than 2,500 people, FPs provided 37 percent of delivery services and, in metropolitan counties, FPs provided 16 percent of delivery services. FPs attended 16 percent of total deliveries in larger hospitals (more than 60 beds), compared with 35 percent of total deliveries in smaller hospitals (less than 60 beds). In the four FP residency-affiliated hospitals, which constitute Maine's largest in bed size, FPs attended 906 deliveries, representing 35 percent of their total deliveries in the state.

FPs provided a substantial amount of labor and delivery care in Maine in the year 2000. Similar analyses performed in other states will further define regional variations in FPs' practice of maternity care. Decisions that limit the provision of labor and delivery care by family physicians may impact access to services available to women, especially those who are publicly insured and delivering in smaller, rural hospitals.

Cohen D, Guirguis-Blake J, Jack B, Chetty VK, Green LA, Fryer GE, Phillips RL. Family physicians make a substantial contribution to maternity care: the case of the state of Maine. Am Fam Physician. 2003 Aug 1;68(3):405.

August 2003