Response to “Certified Nurse Midwives as Teachers of Family Medicine Residents”

I read with interest the February 2020 article1 by Dr Farahi and colleagues on the role of certified nurse midwives (CNMs) in family medicine maternity training. I am a family physician and current fellow in nonsurgical obstetrics at the University of Colorado’s Anschutz Medical Campus. I agree with Dr Farahi that CNMs are well positioned to teach maternity care to family medicine residents. I’d also submit that, for those seeking postgraduate training in maternity care, CNMs are an underutilized resource.

During my third year of residency I searched—unsuccessfully—for a women’s health fellowship that was midwifery-based and included inpatient adult medicine practice. Fortunately, with the support of the University’s midwifery department and our family medicine department, I was able to create my own. A core component of my fellowship is shifts with the midwives where I am involved in obstetric triage, labor management, deliveries, and postpartum care.

I was lucky to train alongside this same midwife team during my residency, developing connections that eased the development of my fellowship. Together, we worked out how I could fill a gap on the labor deck and also learn in an interdisciplinary fashion. Specifically, I perform obstetric triage for OB and midwifery groups and I care for the midwifery group’s labor patients with their support and instruction. I can say without hesitation that my fellowship has significantly improved my skill and confidence in obstetric triage, labor support, and delivery management. I think the midwifery style of obstetric care nicely complements the family medicine model, and our residents seem to agree. When I supervise on the family medicine service, for example, I regularly get feedback from residents that they enjoy learning about nonpharmacologic interventions for pain management, birthing positions that can help with fetal malposition, and ways to integrate patient and family into their own birth experience—all skills that I learned from the midwives.

As Dr Farahi’s article suggests, experience in team-based care is essential and CNMs have a great deal to offer doctors in training. They ought to have a larger role. While some academic centers like Boston Medical use midwives as instructors in their collaborative maternity care models for residents and medical students,² I am not aware of any examples in postgraduate training. This is likely a missed opportunity for family medicine residents who graduate with low obstetric volume but would like to include maternity care in their practice. Embracing this approach could also help remedy the decline of family physicians as maternity care providers.³ I would strongly encourage family medicine residency programs to find novel ways to draw on the rich experience of our CNM colleagues, both in residency curriculum and postgraduate training.