Family Practice Obstetric Physicians
Family Medicine Obstetrical Care at NRGH – An aspirational vision for best care
Women who are pregnant and their families, deserve optimal collaborative perinatal care from skilled care providers. The Nanaimo Regional General Hospital (NRGH) Perinatal Unit is the family-centered care facility for the great majority of intra-partum obstetrical care in the Nanaimo and Central Vancouver Island Region. This document provides an aspirational vision to achieve ideal care.
All women should have early access to appropriate skilled care providers. This includes obstetricians, family physicians, midwives, perinatal nurses, pediatricians, residents and allied health professionals working in a collaborative manner of care, in a patient-centered model. The care providers work in an inter-dependent manner.
Consultant obstetricians provide expertise and specialized care for patients with significant risk factors. Family physicians providing obstetrical care have comprehensive skills for the majority of perinatal care needs. Family physicians and midwives provide care to healthy women. Appropriate informed patient preference should be respected.
The literature is clear that collaborative, respectful relationships between care providers is best practice and optimizes outcomes for mothers and their babies. Family physicians with intra-partum training and experience can provide ideal comprehensive care to most women with pregnancies. A learning attitude in the perinatal care units led by evidence-based care provider leaders, reduces unnecessary interventions, and improves outcomes for women and babies.
The literature concerning maternal and newborn outcomes with obstetrician, family physician, and midwives are from other community settings, differing methodology, and the conclusions may reflect bias and other challenges. In collaborative well-supported perinatal environments, good care can be achieved for all women by certified care providers.
Engaging the most appropriate human resources and capacities for ideal patient care is our goal. To achieve best care, patients should be informed of and understand the scope of practice of each of the care providers. This might be achieved by a community-wide document that is available to patients via many modalities.
The Nanaimo Family Physicians Maternity Care group provides care for their own patients, except those who do not have a family physician and women from other physicians for their maternity care. This ensures ongoing care for the family beyond the perinatal period. All maternity care patients who wish a family physician for their maternity care will be accommodated. We welcome new family physician maternity care providers to build capacity for both maternity and primary care in our community/region.
Primary care providers who do not provide intra-partum care are encouraged to refer low-risk obstetrical patients to a family physician or at patient preference to a registered midwife. For optimal care, this referral should be made early in the pregnancy. This care provider will consult other physicians as needed for patients with higher risk issues.
Most patients should deliver in a hospital setting to benefit from the extensive resources available in a timely manner to ensure safety, best care, and outcomes. An on-site NRGH prenatal/postnatal clinic may be helpful to facilitate best care practices and the transitions of care that can be anticipated. This clinic may be an expansion or incorporation of our NRGH Assessment Room and NonStress Test Clinic process/system.
NRGH is an accredited regional teaching facility and welcomes all learners and this benefits patients, care providers, and the community. Teaching and research should always be part of our collective opportunity at NRGH. Evaluating our effectiveness of care and our outcomes for patients, families, and providers should be enhanced. Engaging learners in the care of pregnant women is essential for building capacity and mutual respect.
1. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. Janssen PA, Saxell L, Page LA, Klein MC, Liston RM, Lee SK. CMAJ. 2009 Sep 15;181(6-7):377-83. Erratum in: CMAJ. 2009 Oct 27;181(9):617. PMID: 19720688 Free PMC Article + Comment in: The safety of home birth: is the evidence good enough? [CMAJ. 2009] + Stillbirths before 28 weeks? [CMAJ. 2009]
2. A three-tier model for the delivery of rural obstetrical care using a nurse midwife and family physician copractice. Hueston WJ, Murry M. J Rural Health. 1992 Fall;8(4):283-90. PMID: 10122983
3. The attitudes of Canadian maternity care practitioners towards labour and birth: many differences but important similarities. Klein MC, Kaczorowski J, Hall WA, J Obstet Gynaecol Can. 2009 Sep;31(9):827-40. PMID: 19941707
4. Inter-professional collaboration in delivery suite: a qualitative study. Hastie C, Fahy K. Women Birth. 2011 Jun;24(2):72-9. PMID: 21074507
5. Effect of a collaborative interdisciplinary maternity care program on perinatal outcomes. Harris SJ, Janssen PA, CMAJ. 2012 Nov 20;184(17):1885-92. PMID: 22966055 Free PMC Article
Nanaimo Regional General hospital Family Practice Obstetrical Group April 28, 2015