In an effort to establish the trend between caregivers and prenatal care, a research group studied women and their prenatal choices. Obstetricians and Family Physicians were compared in the study with a significant decline being noted in the care given by Family Physicians between 1995 and 2004.

Researchers examined more than 6,000 records (244 million visits for prenatal care). Between the years of 1995 and 1996, nearly 12% of the pregnant population utilized their family physicians for prenatal care. This percentage declined to nearly 6% between 2003 and 2004. There was an even more marked decline in the utilization of family physicians in prenatal care in the community of mothers living in non-metropolitan areas.

Researchers believe the overall decline can be attributed to the decrease in maternal age and increase in mothers covered by Medicaid services.

These research results are concurrent with surveys taken by family physicians in 1986 and 2006. In 1986, 43% of family physicians reporting being a part of a birth. That number declined to just 28% in 2006.

Medical records for the study were pulled for a 10 year period in order to establish the trend in family physician care versus obstetrician care and the pregnancy situations associated with the choices. Researchers found that out of the 244 million prenatal visits, more than 222 million were attended to by obstetricians with a mere 21 million visits to a family physician. The most common characteristics of mothers choosing a family physician included either Medicaid or self-pay status.

The Results of the Study and the Future of Prenatal Care

Researchers found a 50% decline in the use of family physicians for prenatal care over the last 10 years. This decline was most pronounced in rural communities and with patients who were covered under Medicaid insurance or no insurance at all. This decline is concurrent with an increase in the number of patients choosing obstetrician care for their pregnancies, but there is a downside to the results.

Many non-rural areas do not have obstetricians to render care for pregnant mothers. If the decline in family practice prenatal care continues, the family physician may find it necessary to stop offering this type of care. If the rural family physicians do not offer prenatal care, a sector of the population who depends on the family physician for their care, may not have access to prenatal coverage.

Researchers also noted the decline in prenatal visits to family care providers may not be directly related to obstetrician care at all. The authors of the study hypothesize that not all prenatal care is being covered by either a family physician or obstetrician those these are the only two medical entities included in their study. There is some thought that prenatal care may be covered by public health offices in rural areas and thus the decrease in the use of family physicians for prenatal care.

Journal: Annals of Family Medicine
Authors: Donna Cohen, MD, MSc and Andrew Coco, MD, MS
Date Published: 2009