Womens Health

Family Doctors Less Likely to Perform C-Sections than OB/GYNs?

| by Unnecesarean

According to one physician who asked to remain anonymous, there are options out there “for people who really want a physician involved in their birth, but are tired of the OB model.” 

They wrote via e-mail:

I actually am one of the few family physicians in the country who not only deliver vaginally, but also do C-sections when needed.  I think that it’s important to include the choice of a family or general practitioner as opposed to an OB/GYN when talking about ways to lessen the chance of a C-section.  There have been multiple studies saying that outcomes are similar with FP/midwifes and OBs in low risk pregnancies, even though fewer interventions are practiced by FPs and midwifes.  This includes not only C-sections but other interventions as well. 

Of course there will always be exceptions to any rule, but in my experience, there is a very different attitude and style between OBs and FPs.  In my training, I worked with and was taught by both, and while I learned a lot from my OB supervisors, I also learned a lot about what I was NOT going to do when I got out of residency.  I think it comes down to this: OB/GYN is a surgical specialty, Family Medicine is a medical specialty.  It’s like the old saying: “When all you have is a hammer, everything looks like a nail.”  If you are a surgeon, you are going to be much more likely to pull that trigger than if you are not. 

I think some other benefits to family medicine in pregnancy are:

1) We take care of people from “the womb to the tomb,” and many of my colleagues have delivered 2 or even 3 generations in one family (I’m not quite old enough for that yet!) Imagine how much trust and understanding you miss out on if the person delivering your baby meets you at your 10 week visit vs. meeting you at your own birth. 

2) Family medicine has more training in psychology and has a culture and health model based on holistic care.  This is really helpful in understanding and dealing with the anxiety of birth.  It can also be really helpful in the event that a C-section IS needed. Helping to minimize guilt and the feelings of failing is something that I deal with on a daily basis from helping someone grieve over the loss of a loved one, a relapse into alcohol or drug use after being clean, etc.  Obviously, these things are not exactly the same, but the tools that we use for helping deal with these losses are very helpful in helping someone deal with the loss of the birth they wanted. 

3) Family medicine has more training in the medical problems (such as high blood pressure, diabetes, depression, seizures) than OBs because we take care of it in men, women (pregnant and not pregnant) and children.  I treat probably 15-20 people a day with diabetes.  I guarantee that most OBs do not unless they are high risk only. This also means that when you have medical difficulties that are not specific to OB, you can have them treated without having to find yet another doctor.  Again it goes back to holistic care, do you want to be seen by a doctor that treats your womb or a doctor that treats YOU?

4) Family medicine treats mom and baby both before AND after birth.  At most, OBs may perform the circumcision after birth.  Mom’s health (both emotionally and physically) are dependent on the baby’s health (and vice versa).  One of the things that I love about post-partum care is that we get to see moms back at 2 weeks when they bring their babies in for their first check up.  Most OBs don’t see them for 6 weeks post-partum.  I can’t tell you how often I have given mom’s much needed help at these 2 week checks that aren’t even scheduled for them.  I also can’t tell you how often I have heard pediatricians lament that they can’t treat mom because of the negative impact Mom’s health (or lack thereof) is having on the baby. 

5) Family medicine is often more receptive to doulas and midwifes than OBs.

Studies:

A comparison of pregnancy care delivered by family physicians versus obstetricians in Lebanon. (1993)

Practice variations between family physicians and obstetricians in the management of low-risk pregnancies (1995)

A comparison of family physicians’ and obstetricians’ intrapartum management of low-risk pregnancies (1993)

Relation of family physician or specialist care to obstetric interventions and outcomes in patients at low risk: a western Canadian cohort study. (1989)