Barriers faced by family physicians providing advanced maternity care: A qualitative study

Background: Maldistribution of maternity care (MC) providers in the U.S. limits access to full spectrum MC services. OB/GYN physicians are concentrated in urban areas with many rural areas reliant on family physicians (FP) to provide MC, including cesarean sections.  Fewer FPs are providing MC, exacerbating access problems. This study aimed to understand the challenges FPs face in gaining skills in and providing advanced MC.

Methods: We conducted semi-structured interviews with 51 family medicine (FM) maternity care providers and educators, including 21 FM-OB fellowship directors, 19 past fellows, and 10 FM residency directors of programs with advanced MC training. Interviews were recorded, transcribed, and analyzed using a deductive approach to qualitative content analysis and computer-assisted qualitative data analysis software (MAXQDA).

Results: Three primary challenges for FPs providing MC emerged from the interviews. 1) Training: most FM residency programs do not provide sufficient surgical OB training, so fellowship training is needed to enhance skills. 2) Credentialing: obtaining hospital privileges to perform cesarean sections is unpredictable and highly variable by institution. 3) Professional relationships: “turf battles” with other MC providers can limit FPs’ ability to provide care commensurate with their level of training.

Conclusions: As the predominant provider of MC in rural areas, FPs need to be enabled to provide advanced MC services. Strategies to accomplish this include: enhanced FM training in MC; institutional (hospital) and state/national level policy changes to address credentialing inconsistencies; and improved team-based care for pregnant women to ensure that every woman has access to high quality maternity care.