According to a recent publication by the Robert Graham Center, the number of family physicians practicing high-volume obstetrics (more than 50 deliveries per year) dropped by over one-half from 2.3 percent of practicing family physicians in 2003 to 1.1 percent in 2016.1 In small corners of the country, though, innovative training programs continue to foster these skills among learners and build supportive communities for family physicians to safely practice obstetrics.
Throughout my residency training, I felt fortunate to train in one of these innovative types of places, where obstetrics remained an integral part of family medicine. As a health care provider, I believed that the care my patients received from family physicians at our health center and hospital was on par with the care provided at any other institution.
Feeling so positive about the hospital where I trained, my husband and I made the decision to deliver our second child there. When the time came to pick a provider, however, we selected my OB/GYN mentor rather than a family physician. Anticipating another “routine” vaginal delivery like with our first child, we did not expect to have much exposure to my family medicine colleagues. Perhaps some morning-after doughnuts, we imagined, but no real clinical involvement. (Of course, as anyone who has practiced obstetrics can attest, presuming any delivery will be “routine” is, indeed, the cardinal sin.)
Moments after I began to bleed at home in my bed, I called my neighbor to stay with my three-year-old son. I stood in the tub, losing blood faster and faster as I tried to fashion a pair of towels into a type of wrestling singlet. I was 38 weeks exactly. My husband was out of town for work and would fly back to Chicago the next morning. Fortunately, my mom was staying the night with us. I woke her, and we quickly drove the five minutes to the hospital. I called my OB/GYN from the car.
When I arrived at OB triage, the nurse — a veteran OB nurse — stayed calm despite his disbelief at the sheer volume of blood I was losing. I gave him my history, and he tried to get my baby on the monitor as he called the in-house maternal child health fellow on-call, my family medicine colleague.
Within a minute, Ray was bounding down the hallway. As a nurse entered my room a few strides ahead of him, I caught a glimpse of his face. The OB triage nurse had relayed my history and acuity over the phone but had left out my identity. I saw Ray’s face drop precipitously, shocked that the 30-year-old gravida 2, para 1 lady with a massive hemorrhage at 38 weeks (and no fetal heart tones yet) was actually me.
His shock was compartmentalized as he found the baby’s heart tones, and prepared me for the inevitable — a crash C-section that would save both my baby and me. My OB/GYN arrived seemingly seconds later. With Ray’s assistance, my OB/GYN delivered my son less than an hour after I first started bleeding at home. As I went under general anesthesia, my friend, Yvette, a C-section privileged family physician, held my hand, and my co-resident, Anastasia, gowned up to resuscitate my baby.
I felt exceedingly lucky to be surrounded by my small family medicine army. I had been through both joyful and trying times with all of these people. When he first started his fellowship, I had a heated debate with Ray about the discharge criteria for babies at our institution. We talked about our disagreement honestly, realizing we were on the same page and far more similar to each other than we initially thought. From there, we built a real friendship. When I saw him bounding down the hall, I felt relief. I knew that he would do everything he could to help my baby and me.
My son, Zachary, was delivered — screaming and pink. He is going on three-weeks old, and by my wholly unbiased assessment, he’s perfect. I’m eating my leafy greens and wearing a touch more bronzer than usual as my hemoglobin recuperates from Zachary’s tumultuous arrival. My mom was awed at the expediency and professionalism of the team that cared for me that night.
As a patient, I was beyond grateful for the care I received, but as a physician, I wasn’t awed or surprised. Throughout my training, I have been a part of similar teams and seen countless tragedies averted by sound clinical judgment and effective teamwork. Obstetrics is ridden with risk and heartbreak and pain. It’s not reason to stop practicing, though, but it’s a reason for us to look together for more sustainable models to continue the practice of obstetrics within family medicine.
As I mentioned, I felt lucky to be surrounded by my small family medicine army on the night Zachary arrived. The truth is, though, that that army shows up at our institution, no matter the patient’s credentials, and by my (again) wholly unbiased assessment, I think any patient would be lucky to have such an army.
Patricia Martin is a family physician.
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