Family practitioners are doctors who care for a broad spectrum of medical conditions, from earaches in children to heart failure in older adults. Family physicians generally have three years of training beyond medical school. Although the training and certification process for most family practitioners is very similar, some choose to emphasize obstetrics during their training and provide obstetrical care; others do not study obstetrics.
Most deliveries by a family practitioner are performed in rural areas where there are no obstetrical specialists. However, some family physicians do practice and deliver babies in major urban or university centers.
As a general rule, family practitioners care predominantly for low-risk patients and refer patients with significant problems to an obstetrician/gynecologist (OB-GYN, OB/GYN or OBGYN). Except in rural areas, most family physicians do not perform cesarean sections. Some family physicians are experienced in forceps and vacuum deliveries whereas others choose not to add these skills to their medical expertise.
Because the experience of family physicians delivering babies varies widely, you should be sure to discuss these issues with your doctor if you are considering a family physician for your obstetrical care. You should carefully inquire about your family physician's training and experience in obstetrics, experience in handling emergencies and performing cesarean sections, and the availability of backup by an OB-GYN. The continuity of care and experience from a doctor who knows your history and has previously treated you is an advantage. Potential disadvantages include less training in obstetrics and the possible need to call in another practitioner to help with a complication or emergency.
Most women in the United States choose to have their babies delivered by an OB-GYN. OB-GYNs are doctors who have completed four years of near-exclusive training in the fields of obstetrics and gynecology. These doctors are trained to provide a wide range of women's healthcare services ranging from normal to complicated obstetrics. Most OB-GYNs undergo very rigorous training and are required to be board-certified to practice in the United States. Thus, the uniformity of care provided by OB-GYNs may not be available from non-obstetric specialists. In addition, since these physicians have devoted four years exclusively to the management of obstetric and gynecologic problems, they are equipped to deal with the entire range of pregnancies, from uncomplicated, low-risk deliveries to many high-risk deliveries.
Maternal-fetal medicine is a subspecialty of obstetrics and gynecology. Maternal-fetal medicine doctors are sometimes called perinatologists. They are physicians who have completed medical school, a four-year standard training program in obstetrics and gynecology and achieved board certification in that specialty. They have, in addition, completed an extra two to three years of specialized training in dealing with problem or high-risk pregnancies and have gone through a second stage of board certification. Because of the extensive training required, the number of maternal-fetal medicine specialists in the United States is limited. Presently, less than 75 such specialists complete their training each year.
Maternal-fetal medicine specialists are trained to deal with the highest risk pregnancies. For the most part, they practice in either academic centers affiliated with medical schools or other large tertiary care facilities. They perform specialized procedures in addition to ultrasound and amniocentesis, and they generally provide consultation to community obstetricians and family physicians for patients with complex issues, such as:
- Serious medical illnesses;
- Prematurity; or
- Twin or multiple births.
In general, women without risk factors do not require care by these subspecialists.