Society for Maternal-Fetal Medicine (SMFM) Special Report: the maternal-fetal medicine subspecialists' role within a health care system

Published:October 16, 2014DOI:
      A maternal-fetal medicine (MFM) subspecialist has advanced knowledge of the medical, surgical, obstetrical, fetal, and genetic complications of pregnancy and their effects on both the mother and fetus. MFM subspecialists are complementary to obstetric care providers in providing consultations, co-management, or transfer of care for complicated patients before, during, and after pregnancy. The MFM subspecialist provides peer and patient education and performs research concerning the most recent approaches and treatments for obstetrical problems, thus promoting risk-appropriate care for these complicated pregnancies. The relationship between the obstetric care provider and the MFM subspecialist depends on the acuity of the maternal and/or fetal condition and the local resources. To achieve the goal of promoting early access and sustained adequate prenatal care for all pregnant women, we encourage collaboration with obstetricians, family physicians, certified midwives, and others, and we also encourage providing preconception, prenatal, and postpartum care counseling and coordination. Effective communication between all obstetric care team members is imperative. This special report was written with the intent that it would be broad in scope and appeal to a diverse readership, including administrators, allowing it to be applied to various systems of care both horizontally and vertically. We understand that these relationships are often complex and there are more models of care than could be addressed in this document. However, we aimed to promote the development of a highly effective team approach to the care of the high-risk pregnancy that will be useful in the most common models for obstetric care in the United States. The MFM subspecialist functions most effectively within a fully integrated and collaborative health care environment. This document defines the various roles that the MFM subspecialist can fulfill within different heath care systems through consultation, co-management, and transfer of care, as well as education, research, and leadership.

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        • Clark S.L.
        • Meyers J.A.
        • Frye D.K.
        • Perlin J.A.
        Patient safety in obstetrics: the Hospital Corporation of America experience.
        Am J Obstet Gynecol. 2011; 204: 283-287
        • Simpson K.R.
        • Kortz C.C.
        • Knox G.E.
        A comprehensive perinatal patient safety program to reduce preventable adverse outcomes and costs of liability claims.
        Jt Comm J Qual Patient Saf. 2009; 35: 565-574
        • Wagner B.
        • Meirowitz N.
        • Shah J.
        • et al.
        Comprehensive perinatal safety initiative to reduce adverse obstetric events.
        J Healthc Qual. 2012; 34: 6-15
        • Tu H.T.
        • Lauer J.R.
        Word of mouth and physician referrals still drive health care provider choice.
        Res Brief. 2008; 9: 1-8
      1. Association of Maternal Fetal Medicine Management. 40 Years of leading maternal and fetal care. 2013. Appendix C: AMFMM Benchmarking Data, 2010-11. Available at: Accessed Oct. 1, 2014.

      2. Schwatz R. Creating successful maternal fetal medicine partnerships; the Chartis Group Management Consultants 2011. Available at: Accessed June 5, 2014.

        • Rayburn W.F.
        • Klagholz J.C.
        • Elwell E.C.
        • Strunk A.L.
        Maternal-fetal medicine workforce in the United States.
        Am J Perinatol. 2012; 29: 741-746
        • Eden R.D.
        • Penka A.
        • Britt D.W.
        • Landsberger E.L.
        • Evans M.I.
        Re-evaluating the role of the MFM specialist: lead, follow, or get out of the way.
        J Matern Fetal Neonatal Med. 2005; 18: 253-258
        • Britt D.W.
        • Eden R.D.
        • Evans M.I.
        Matching risk and resources in high-risk pregnancies.
        J Matern Fetal Neonatal Med. 2006; 19: 645-650
        • Manuck T.A.
        • Henry E.
        • Gibson J.
        • et al.
        Pregnancy outcomes in a recurrent preterm birth prevention clinic.
        Am J Obstet Gynecol. 2011; 204: 320.e1-320.e6
        • Luke B.
        • Brown M.B.
        • Misiunas R.
        • et al.
        Specialized prenatal care and maternal and infant outcomes in twin pregnancy.
        Am J Obstet Gynecol. 2003; 189: 934-938
        • Johnson D.
        • Mauldin J.
        • Chang E.
        • et al.
        Maternal-fetal medicine coverage improved perinatal outcomes in a rural area.
        Am J Obstet Gynecol. 2014; 210: s197
        • Sullivan S.A.
        • Hill E.G.
        • Newman R.B.
        • Menard M.K.
        Maternal-fetal medicine specialist density is inversely associated with maternal mortality ratios.
        Am J Obstet Gynecol. 2005; 193: 1083-1088
        • Centers for Disease Control and Prevention
        Recommendations to improve preconception health and health care–United States: a report of the CDC/ATSDR preconception care work group and the select panel on preconception care.
        MMWR Recomm Rep. 2006; 55: 1-23
        • Acherman R.J.
        • Evans W.N.
        • Luna C.F.
        • et al.
        Prenatal detection of congenital heart disease in southern Nevada: the need for universal fetal cardiac evaluation.
        J Ultrasound Med. 2007; 26: 1715-1719
        • Ogunyemi D.
        • Buskye S.
        Prenatal diagnosis of fetal anomalies in a regional tertiary center: the role of a maternal fetal medicine unit–a review of 6,877 deliveries.
        J Matern Fetal Med. 2000; 9: 219-223
        • Mari G.
        • Deter R.C.
        • Carpenter R.L.
        • et al.
        Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization; collaborative group for Doppler assessment of the blood velocity in anemic fetuses.
        N Engl J Med. 2000; 342: 9-14
        • Squires D.A.
        Explaining high health care spending in the United States: an international comparison of supply, utilization, prices, and quality.
        Issue Brief (Commonw Fund). 2012; 10: 1-14