Sparrow/MSU Family Medicine Residency Program
Maternity Care Policy
Updated 11/3/2015
All residents will be trained in Ambulatory Maternity Care as defined by the Council on Academic Family
Medicine (CAFM). The goal of this training would be to ensure residents’ competency to provide
prenatal and postpartum care, as well as to identify and refer medically and obstetrically complicated
patients and manage a precipitous spontaneous vaginal delivery. These graduates would not deliver
inpatient maternity care as a routine part of their practice.
Specifically this training will involve:
1. Two months during first year on ROGES service – see separate objectives
2. At least 20 vaginal deliveries
3. One or more “continuity cases” – i.e. providing prenatal/postpartum care with every effort
made to provide intrapartum care as well. When a residents continuity patients become
pregnant and they have already completed one continuity case, they MAY have the option of
transferring that patient to an OB track resident.
4. Assisting in Sparrow Women’s Health Center Family Medicine OB clinic when needed.
5. Completing ALSO provider course once.
Maternity Care Track (OB track for short) Residents will be trained in Comprehensive Maternity Care as
defined by CAFM. These graduates will be competent to delivery comprehensive obstetrical care, with
consultation as appropriate. Their graduation letter will include a statement to this effect.
Specific NEW objectives for this track will include:
1. Competence in targeted OB ultrasound
2. Competence in assisting at c-sections (assist with at least 5)
3. At least 40 vaginal deliveries, with a goal of 80
4. At least 5 perineal repairs
5. Aspire to at least 5 instrumented vaginal deliveries (vacuum assisted)
Specifically this training program would involve:
A. Required elements:
1. All training for Ambulatory Maternity Care
2. Staffing the Sparrow Women’s Health Center Family Medicine OB clinic once a week
unless on inpatient or other rotation with limitations on time away.
3. Two months during first year on ROGES service – see separate objectives
4. Participation in call schedule for “Maternity Care Pool” patients.
5. Participation in monthly Journal Club
B. Recommended but optional elements:
1. Two week RNICU rotation focused on neonatal resuscitation – in addition to first year
newborn nursery rotation.
2. One or two additional months of maternity care electives – site to be determined.
3.
4.
5.
6.
Two week obstetric ultrasound rotation
Participation in ALSO provider course annually
ALSO instructor course/certification
Attendance at AAFP Family Centered Maternity Care course.
Maternity Care Pool Patients: All patients from the Sparrow Women’s Health Center Family Medicine
OB Clinic will be part of a “Maternity Care Pool”. The Maternity Care Track residents will provide on call
availability for these patients. There will be significant periods of uncovered time, at which time the
inpatient service will be backup for their care. When a Maternity Care Track resident is on call, they will
be available in the same way that continuity residents are.
Continuity Cases: All continuity patients will come from either the Central or Mason practice sites. All
residents will be assigned one or more continuity prenatal patients. Residents should make every effort
to be present for these deliveries. Residents who are on vacation or out of town or have another major
life event will be excused from these responsibilities. If not excused, residents are expected to cancel
clinic or leave other rotations for the sake of continuity deliveries. Excused residents’ deliveries will be
covered by OB track residents if scheduled on call during that time, or by inpatient service if not.
Postpartum and newborn care of all delivered patients will be the responsibility of inpatient service.
Nonetheless any resident is welcome to see patients postpartum at their discretion.
Residents are expected to be present for their continuity or maternity care pool patient’s delivery when
the patient is eight centimeters dilated for a nulliparous patient and six centimeters for a parous
patient. Inpatient service should contact the primary resident for continuity cases or the OB track
resident for Maternity Care Pool patients when the patient is admitted to apprise them of the situation
and give them the option of taking over management earlier.
Time spent in the hospital caring for an intrapartum continuity patient or maternity care pool patient is
covered under the RRC policy on at home call. This policy is copied below.
VI.G.8. At-Home Call
VI.G.8.a) Time spent in the hospital by residents on at-home call must count towards the 80-hour
maximum weekly hour limit. The frequency of at-home call is not subject to the every-third-night
limitation, but must satisfy the requirement for one-day-in-seven free of duty, when averaged over
four weeks. (Core)
VI.G.8.a).(1) At-home call must not be so frequent or taxing as to preclude rest or reasonable personal
time for each resident. (Core)
VI.G.8.b) Residents are permitted to return to the hospital while on at-home call to care for new or
established patients. Each episode of this type of care, while it must be included in the 80-hour
weekly maximum, will not initiate a new “off-duty period”. (Detail)
Residents who must spend personal time at the hospital for a continuity delivery or maternity care pool
patient should cancel clinic or take time off a required rotation if they feel it would be unsafe or
excessively taxing to do otherwise. Residents should contact each of the following if they must cancel
clinic or any clinical experience:
Residency Coordinator
A Chief Resident
Clinic Front Desk (if applicable)
Dr. Brooke Lemmen
Residents should report any work hour violations due to continuity deliveries or maternity care pool
deliveries to the program director for tracking. (i.e. when the resident must work more than 80 hours in
a week or miss one day off in 7 averaged over 4 weeks due to a continuity delivery)