Cesarean Delivery in Family Medicine
The American Academy of Family Physicians (AAFP) recently published a position paper asserting that access to quality maternity care is a major public health priority in the United States. This assertion is based on an unfortunate fact: The maternal mortality rate in the U.S. is one of the highest in the developed world, with disproportionately high rates of mortality among black individuals, individuals with low income, and residents of rural areas. The AAFP believes that family physicians are well-equipped to help reduce these disparities in maternal morbidity and mortality, as they are trained to provide a continuum of care, including prenatal, perinatal, and postpartum, to the communities they serve.
Family physicians already provide a significant amount of perinatal care, particularly in rural and underserved areas. Of all specialties, family physicians have the highest percentage of practitioners living and working in rural communities, at 15.7%. Studies have shown that family physicians are indispensable for maintaining access to obstetric care in rural areas. For example, a study by the Journal of the American Board of Family Medicine in 2013 showed that family physicians were the primary practitioners performing both vaginal and abdominal deliveries in rural hospitals in 15 states.
Another study, published in the Journal of the American Board of Family Medicine in 2013, found that patients who received cesarean delivery from a family physician did not face increased overall risk. This is an important finding, not just for social and financial reasons, but also because cesarean delivery carries a significantly increased risk of maternal morbidity and mortality when compared with vaginal delivery. Additionally, the study suggests that individuals who receive perinatal care from family physicians may have lower cesarean delivery rates than those cared for by obstetrics subspecialists.
Board of Certification in Family Medicine Obstetrics® (BCFMO)
In 2009, the American Board of Physician Specialties (ABPS) launched its certification program for family medicine obstetrics through its Board of Certification in Family Medicine Obstetrics® (BCFMO). Recognized by the U.S. Department of Labor, the Council for Affordable Quality Healthcare (CAQH), and the Centers for Medicare & Medicaid Services, the BCFMO offers two options for certification—Family Medicine Obstetrics and Family Medicine Obstetrics With Surgical Qualification.
To be eligible to apply for initial board certification in family medicine obstetrics, an applicant must first satisfy the general requirements of the ABPS, which include being a graduate of a recognized U.S., Canadian, or international allopathic or osteopathic college of medicine, and holding a valid and unrestricted license to practice medicine in the United States, its territories, or Canada. The BCFMO has its own eligibility requirements for the two pathways, which include:
- Completing an ACGME- or AOA-accredited residency in family medicine, or a family medicine residency accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC).
- Current board certification in family medicine granted by a Member Board of the ABPS, the American Board of Medical Specialties (ABMS), the AOA, the RCPSC, or the CFPC.
Like the AAFP, the ABPS believes that family medicine is an important specialty in today’s healthcare system. By providing comprehensive care across diverse populations and geographic settings, family physicians can address a wide range of medical needs, including providing safe and effective cesarean deliveries. Additionally, family physicians can help close the gap in healthcare access in rural communities, providing much-needed medical services and helping to reduce health disparities and the rates of maternal morbidity and mortality.
If you would like to learn more about board certification in family medicine obstetrics through the BCFMO, contact the ABPS today.