Family Medicine Obstetrical Care: Partners in Providing Maternity Care and Improving Outcomes
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n the state of Minnesota, Family Medicine physicians are an integral part of the primary care workforce, and the role of family physicians varies significantly in communities and practices across the state. Family physicians are ubiquitous within a variety of healthcare settings throughout the state, from urgent cares and emergency rooms to long-term care facilities, tertiary care centers to critical access hospitals. We are in rural, suburban and urban community clinics, large hospital system-based clinics, FQHCs, direct primary care practices including mobile clinics and tribal clinics.1 We have addiction medicine and gender affirming hormone practices, we teach in our state’s medical schools and we serve in local and state government. We are also a strong presence in labor and delivery rooms and nurseries.1 The philosophy of Family Medicine is wide-reaching and yet very specific: we care for individuals, families and communities from birth to death and everything in between. Our guiding principles include listening deeply to our patients, families and communities, balancing their needs and preferences with evidence-based medicine. Comprehensive care for the whole person is our area of expertise. The American Academy of Family Physicians (AAFP) states on their website, “Unlike other specialties that are limited to a particular organ or disease, Family Medicine integrates care for patients of all genders and every age, and advocates for the patient in a By Andrea Westby, MD, FAAFP and Cora Walsh, MD, MSc
MetroDoctors
complex health care system.�1 As we work together as a medical community to address complex issues such as maternal morbidity and mortality and the racial disparities within these outcomes, Family Medicine physicians remain an important partner in the Twin Cities medical community. For many family physicians, obstetrical and prenatal services Cora Walsh, MD, MSc are an essential component of Andrea Westby, MD, FAAFP the care they provide, contributing to significant joy in practice, stavdelivery. Family physicians often see paing off burnout, and preserving a wider tients who are among the most vulneraspectrum of practice. Nationally, 18% of ble during the pregnancy and postpartum family physician members of the AAFP period such as women of color, Medicaid report providing obstetrical care, and 32% recipients, people with unstable housing 2 provide newborn care in their practices. or living in poverty, and people with a In the United States, approximately onenumber of significant chronic diseases such third of pregnant women report having as substance use disorders, hypertension, received care from a family physician in diabetes and other mental health condithe previous year.3 tions.4,5 In situations where patients have While more often thought to be very high obstetrical or medical risk, family associated with rural settings, family physicians are an important touchpoint for physicians are currently providing comspecialist, obstetrician and maternal-feprehensive obstetrical care across the tal-medicine referrals and overall coordiTwin Cities metro area through North nation of care. Memorial Health, Allina Health, Health In a 2019 editorial in American Family East/Fairview/MHealth, HealthPartners/ Physician, Katy Kozhimannil, PhD and Park Nicollet, Hennepin County Medical Andrea Westby, MD outlined how famCenter, Northpoint Health and Wellness, ily physicians are part of the solution to Northwest Family Physicians, Entira Famreducing maternal mortality.6 They highily Clinics, United Family Medicine, and lighted the unique role of family physicians MN Community Care (formerly East Side in addressing health risks in the postparCommunity Health). In the majority of tum period such as breastfeeding issues, cases, family physicians continue to remain postpartum depression, and intimate parton-call for their individual obstetrical paner violence during newborn visits, as a tients in order to preserve continuity in the physician-patient relationship through (Continued on page 16)
The Journal of the Twin Cities Medical Society
March/April 2020
15
