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Maternity care access in the United States is in crisis. The American Congress of Obstetrics and Gynecology projects that by 2030 there will be a nationwide shortage of 9,000 obstetrician-gynecologists (OB/GYNs). Midwives and OB/GYNs have been called upon to address this crisis, yet in underserved areas, family physicians are often providing a majority of this care. Family medicine maternity care, a natural fit for the discipline, has been on sharp decline in recent years for many reasons including difficulties cultivating interdisciplinary relationships, navigating privileging, developing and maintaining adequate volume/competency, and preventing burnout. In 2016 and 2017, workshops were held among family medicine educators with resultant recommendations for essential strategies to support family physician maternity care providers. This article summarizes these strategies, provides guidance, and highlights the role family physicians have in addressing maternity care access for the underserved as well as presenting innovative ideas to train and retain rural family physician maternity care providers.

This chapter applies the lens of woman-centered care to examine the complexity of ethical decision making involving technology in contemporary reproductive health settings. It begins by situating the discussion within an international perspective, revealing that pregnancy is still a highly risky state globally for women, including risk of abuse from both within and outside healthcare. The model of woman-centered care is presented as an ethical strategy to approach a woman considering reproductive options and decisions. Using this model and a series of vignettes, ethical issues involving technology in routine reproductive care during key periods are examined, including contraception and adolescence, genetic screening, woman-centered care in childbirth, technology in labor (induction, informed consent, fetal monitoring), human rights during labor, and infant feeding. Solutions beyond technology are also offered.

PREFACE: This ‘‘In the Literature’’ column has a different genesis from previous columns. It emanates from a discussion that began on the Maternity Care Discussion Group (MCDG), an online group of more than 600 family physicians, obstetricians, midwives, nurses, and doulas that has been hosted on the College of Family Physicians of Canada website for 20 years. Although mainly a Canadian list, international participants are welcome to join in the struggle to improve maternity care and support those who provide it. To join the MCDG List, send an e-mail to mklein@interchange. ubc.ca.

Telling a pregnant woman and her family about a fetal demise is one of the greatest challenges for maternity care clinicians. In this essay, the author reflects on such an encounter in her work as a community health center clinician, maternity care teacher, and mother herself.