Key Points

• The United States ranks 30th in infant mortality.

• The causes of infant mortality are preterm birth, birth defects, sudden infant death syndrome, respiratory distress syndrome, and maternal pregnancy complications.

The American Academy of Family Physicians (AAFP) describes the specialty of family practice as the enhanced expression of general medical practice that is uniquely defined within the context of the family. Providing care across the continuum of the family life cycle, the family physician provides care to the pregnant woman as part of the full expression of the field. The family physician incorporates a comprehensive approach to maternity care that includes the assessment and management of psychosocial and biomedical risk factors. The family physician provides care to patients with low-risk pregnancies and equips them to birth their children without unnecessary interventions.

The family physician brings a unique approach to the management of the pregnant woman, who is often a healthy individual undergoing a natural process. This approach is patient centered, prevention oriented, educational, and noninter-ventional. Nationwide, approximately 29.6% of all family physicians provide routine obstetric services as part of their hospital care (AAFP, 1998). This number has been steadily declining, with regional variations reflecting the needs of the population and local attitudes. The majority of family physicians do not desire to practice obstetrics because of lifestyle issues, increasing costs of malpractice insurance, and difficulty obtaining hospital privileges. However, the family physician may be asked to counsel or care for the pregnant woman, even if not part of daily practice. It becomes incumbent on the individual practitioner to have a fundamental knowledge and appreciation of the field of obstetrics, including the obstetric emergency. Given that the family physician may be the sole provider of obstetric services, particularly in rural or underserved areas, the need to maintain the knowledge and skills to treat the problems and emergencies unique to obstetrics becomes increasingly important. The Advanced Life Support in Obstetrics (ALSO) course developed in 1990 effectively incorporates the techniques of other established life support courses as it applies to obstetric care.

For the successful practice of obstetrics, it is imperative for the family physician to practice in concert with an obstetric specialist. A collaborative relationship among obstetricians, family physicians, and in some cases, nurse midwives is essential for provision of consistent, high-quality care to pregnant women. Access to reliable consultation and suitable referral facilities for the complicated patient will optimize patient care and outcomes.

The integration of prenatal care into the clinical practice of the family physician not only reflects the full scope of the field but also provides a continuous infusion of pediatric patients into the practice. It serves as a model for the training of medical students and residents interested in the practice of obstetric care in the context of family practice.

This chapter provides an overview of the field of obstetrics that includes prenatal, intrapartum, and postpartum care of the pregnant woman. An evidence-based approach to areas of controversy and empiric practice is used while addressing the unique needs of family physicians, emphasizing their contribution and role in the research and development of the obstetrics literature.

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