BACKGROUND: This cross-sectional study was designed to explore the impact of the availability of maternity care services on the infant mortality rates in nonmetropolitan (rural) counties in Florida. METHODS: We evaluated the sufficiency of physicians providing maternity care in each rural county. We then constructed a mathematical model to compare physician availability with the infant mortality rates for each county, while controlling for socioeconomic variables. RESULTS: Thirty-one family physicians and 974 obstetrician-gynecologists were delivering babies in Florida in 1991. Forty-seven counties were lacking in maternity care services; 45 of these counties had family physicians who practiced in the county but did not provide maternity care services. There was a negative correlation in rural counties between availability of maternity care services and infant mortality (R = -0.42, R2 = 0.176, P = 0.012), implying that 17.6 percent of the variation in rural Florida's infant mortality was explained by a ranking in physician availability. Multivariate analysis revealed that increasing infant death rates can be predicted by decreasing physician availability (P = 0.003). A multiplicative risk model developed for this study demonstrated that the loss of 1 family physician delivering babies would predict the increase of infant mortality by 2.3 percent, and the loss of 1 obstetrician-gynecologist increased infant mortality by 9.6 percent. CONCLUSIONS: Access to maternity care for women in rural Florida is a problem that could be hampering Florida's ability to reduce its infant mortality rate. Family physicians appear to be the most geographically distributed health care providers in Florida; therefore, strategies should be developed to recruit Florida's rural family physicians into maternity care.

Cross-Sectional Studies↗

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Family practice maternity care in America: ruminations on reproducing an endangered species--family physicians who deliver babies.

BACKGROUND: The majority of family physicians do not deliver babies. One reason might be the family physician's intrinsic comfort with person- or patient-centered care compared with the common obstetric approach of disease or physician-centered maternity care. Another reason might be the uncritical intrusion of technology into maternity care. In addition, family physicians often are made to feel unwelcome in many maternity care systems. METHODS: The medical literature from 1984 to 1994 was searched for the topics of obstetrics, maternity care, family-centered birthing, and family practice education. Reasons to argue whether family physicians should provide maternity care were selected, and articles were chosen that described the self-reported reasons students, residents, or physicians give whether to provide maternity care. RESULTS AND CONCLUSIONS: There is no scientifically supportable reason for excluding family physicians from maternity care in any setting, and the current maternity care system, in many locations, creates an attitude of taught helplessness among family physicians. In addition, family practice educators must for a variety of reasons be the primary role models and teachers of family-centered birthing for family practice learners. Generally, the groups that should be involved in providing maternity care in the future should include (1) better informed and more independent pregnant patients, (2) maternity care nurses, (3) doulas, (4) midwives, (5) family physicians, and (6) specialized physicians. Specifically, family physicians and midwives have a historic and philosophic similarity that would argue for a much closer working and practicing relationship between these two professionals. Family-centered birthing provides excellent outcomes. Birthing is both foundational and intrinsic to family practice. Conversely, without family physicians maternity care in America might not be able to reach its full potential.

Attitude of Health Personnel↗

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Obstetrics in family practice.

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Family Practice↗

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From the front lines: balancing demands on time for teaching, productivity, and family.

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Clinical Clerkship↗