• Family Physicians Make a Substantial Contribution to Maternity Care: The Case of the State of Maine

    One Pagers | Aug 01, 2003
    Donna Cohen, PhD; Janelle Guirguis-Blake, MD; David Jack, MD; V.K. Chetty, PhD; Larry Green, MD; Ed Fryer, PhD; Robert Phillips, MD, MSPH

    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.

    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).

    Table. Labor and Delivery Services Provided by OBs and FPs in Maine, 2000

    Type of Service 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


    6,731 (82) 1,303 (16) 8,187


    2,945 (70) 1,126 (27) 4,228


    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.

    The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP. 

    Published in American Family Physician, Aug 1, 2003. Am Fam Physician. 2003;68(3):405. This series is coordinated by Sumi Sexton, MD, AFP Associate Medical Editor.