What women expect of family physicians as maternity care providers

Roles in relation to others’ roles

The roles women described for their family physicians greatly overlapped with those described for other maternity care providers. Of particular importance to family physicians were activities that overlapped with the activities of labour and delivery nurses because these two professional groups often work closely together as part of childbirth care teams. Informational support and emotional support have been identified as key domains of nurses’ maternity care in the literature.5,6 Bowers says that caring and emotional support are conveyed through presence, words of encouragement, and continuity of caregiver.6 The women in our study highly valued the emotional support they received from their family physicians in all 3 of these areas. Expectations of support varied, however, with some women clearly identifying their physicians as support people and others consciously excluding them from this role.

Another area of variability was in women’s expectations of their family physicians with regard to decision making. Such differences in women’s expectations of nurses with regard to support, comfort, and decision making have also been described in the literature.7 Mackey and Lock concluded that, given these variations, it is important to explore women’s preferences and expectations before birth to avoid miscommunication and conflict.7 It would logically follow that this would also apply to women’s expectations of their family physicians. It might, therefore, be prudent for family physicians to discuss their patients’ expectations of them as maternity care providers to facilitate good communication and high-quality patient care.

Advocacy, another role described for family physicians in our study, has also been described in the nursing literature.4 Specifically, the women in our study described the importance of physicians’ listening to them, respecting their wishes, and discussing management options with them. They also described how their physicians seemed to sense what was important to them and how they took proactive steps to ensure that women’s wishes were respected.

Further questions

The results of our study raise some further questions. First, how are family physicians’ roles related to those described for other maternity care providers? Are they complementary, additive, or redundant? Are different professional groups aware of their respective roles? For example, how does a woman’s expectation of her family physician as a source of emotional support differ from her expectation of her nurse? These are practical questions, and it is important for members of the childbirth care team to be aware of the scope of care that each provides in order to facilitate high-quality, efficient, comprehensive care.

Another question is how do physicians’ characteristics influence their roles as maternity care providers? Recent studies indicate that physicians providing maternity care have a range of practice styles from a midwifery type of style to an obstetricianlike style.8 Family physicians whose practice has a predominantly mid-wiferylike style might provide more personalized emotional support. In contrast, family physicians who have a more obstetricianlike style might see emotional support as primarily a role for nurses. This would suggest that family physicians need to be aware of their own styles and clearly communicate them to their patients to avoid misunderstandings and mismatches in patient-physician values and expectations.

Limitations

First, as a qualitative study, this work was designed to generate, not prove, hypotheses. Consequently, further studies are needed to clearly outline the nature and importance of women’s expectations of their family physicians, including the expectations of women from different social and cultural backgrounds. The relatively small number of participants might limit the breadth of the data. While we believe that saturation occurred in our sample, it is possible that a larger study would generate additional information about physicians’ roles. Also, our study does not explore physicians’ own perceptions of their roles as maternity care providers. It is possible that physicians perceive their roles quite differently from the way women perceive them. Regional and institutional resources might also affect the type of maternity care provided by family physicians.

Our study is the first to explicitly explore and describe women’s expectations and experiences of family physicians as maternity care providers. While the number of participants was small, the information generated was rich in content. The similarity of our findings to those described for other maternity care providers supports the validity of our findings with respect to women’s expectations and experiences. What is not clear is how family physicians’ roles differ from those of other maternity care providers.

The changing face of maternity care is a factor to consider in trying to generalize these results. All the women in this study were attended by the same family physicians who provided their antenatal care. There is a move toward development of alternative models of maternity care in which the delivering physician is often different from the physician who provides antenatal care.9 Women’s expectations of an unknown physician might be quite different from their expectations of a physician with whom they have an existing relationship.

Conclusion

The results of our study suggest that, from patients’ perspective, family physicians assume a range of roles as maternity care providers. The major themes identified included informational support, advocacy, emotional support, and professional competence. Women consistently expected their family physicians to communicate information about their medical care, listen to and respect their wishes, and provide them with competent medical care. In contrast, women had different expectations of their physicians with regard to emotional support, decision making, and preparing them for labour and delivery.

Similar roles have been described for other maternity care providers, particularly labour and delivery nurses. Research is needed to better define how these roles are related and how they interface during patient care. Research on family physicians’ own perceptions of their roles as maternity care providers is also needed.

This is a critical time in family physician maternity care. Maternity care gives us a unique opportunity to connect with our patients and their families. Loss of this opportunity through the further decline of family physician maternity care will undoubtedly have a negative effect on our profession, on women, and on communities. We hope family physicians will find a way to continue to be involved in this important and rewarding aspect of family medicine. By continuing to help women navigate through the journey of birth, we can continue to contribute to the health of this and future generations.