The Doctor / Obstetrician

For many women, the Doctor, Obstetrician/Gynecologist or OB-GYN, is the standard, socially accepted care provider for prenatal care and delivery.

OB-GYN’s receive extensive training and education, beginning with four years of college, plus an additional four years of med school. This is generally followed by four years of residency training. A sub-specialty, such as high-risk obstetrics, takes another three years; Reproductive endocrinology, another two years.

OB-GYN’s are also trained as surgeons and can perform cesareans. They can also care for women through all stages of their lives, prescribe birth control, do pap smears and other gynecologic care.

Although in the last century this area of practice was dominated by men, that has now changed. Over the last 20 years as many OB-GYN’s have reached retirement age, their positions are being filled by women. Almost 82 percent of all OB-GYN residents in the country were women in 2010, the last year for which numbers are available, according to the Association of American Medical Colleges.

Along with this has come a shift away from OB-GYN’s operating a private practice. Today more and more are employed directly by a hospital, under the heading “laborists.” The advantage for the doctor is the ability to work regular shifts, with regular, preset hours.

Still, at this time, most OB-GYN’s work in a practice with other doctors. This allows them to share costs such as maintaining an office and staff. Again, one advantage for the doctor is that they can establish regular office and working hours, and share the “after normal business hours” or on-call time with the other doctors in their practice. What this means is that if you go into labor in the middle of the night, the OB-GYN on-call to deliver your baby may not be the same one who has done all your prenatal care. Should your labor take some time to progress, it may turn out that your primary doctor will be able to arrive later and be on hand to deliver your baby.

Because the selection of a care provider and doctor is such a personal decision, this in part has led to the practice of “scheduling” the delivery, using labor inducing drugs to start contractions at an agreed point in time when the doctor has determined the baby to be “full term.” The mother is happy because she is able to give birth with the doctor she has chosen as her care provider, and the doctor is happy because he is able to have a clear schedule and commitment for his or her time.

The same organization or distribution of duties and scheduling is true for many birth centers who employ Certified Nurse Midwives. They will also distribute on-call hours or days between all of the CNM’s within their practice.

This is a distinct difference from the typical practice for the Certified Professional Midwife, who typically take fewer clients, and commits to providing your care from your initial prenatal visits, to the day of delivery and postpartum care. They may still have a practice that includes other midwives who will be in attendance and assist at your birth. Ideally you will have met the other partners in the practice and had the opportunity to develop some level of personal connection with the people who will be present at your birth.

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