Monday, January 15, 2018

Supporting family physicians who provide maternity care

- Jennifer Middleton, MD, MPH

An editorial on Immediate Postpartum LARC: An Underused Contraceptive Option in the current issue of AFP has generated a lot of interest. Several comments have been left online, and (as of this writing), all of them are quite positive. At a time when family physicians' interest in obstetrics (OB) continues to wane, these commenters exemplify the vibrant community of family physicians who do choose to provide OB care; as a specialty, we should support these physicians and the often underserved communities they care for.

Family physicians who attend deliveries are a critical component of improving the health of rural communities. Obstetrician/gynecologists (OB/GYNs) tend to cluster in metropolitan areas, with many rural counties in the United States reporting that family physicians are their only source for OB care. Supporting training opportunities in residency is critical to encouraging future family physicians to consider including OB in their practices; exposure to models of care like prenatal group visits and physician group coverage models may reduce concerns about the feasibility of doing so.

Even those of us who do not attend deliveries, however, have an obligation to advocate for those who do. Several of the comments left on the current AFP LARC editorial point to the need for state and national advocacy efforts to eliminate reimbursement barriers to providing this valuable service. This advocacy does not have to be time-consuming or burdensome; it's easy to send messages to your state AFP chapter and/or state legislators.

We also have an obligation to support preconception and prenatal care. All family physicians should discuss contraception and family planning with not only our expecting patients but all of our patients of child-bearing age. We should encourage folic acid supplementation for all women capable of pregnancy. We should discuss healthy birth spacing intervals at well child visits. There's an AFP By Topic on Family Planning and Contraception if you'd like to read more.

The comments regarding the LARC editorial enriched future readers' experience with their ideas and references. The ability to comment on articles online is one way you can directly engage with AFP; find us on Facebook and Twitter to join those conversations. Don't forget, too, about the opportunity to comment below here on the Community Blog every week.