When you are planning to breastfeed, there are few roles more important than a supportive obstetrician (also called an OB). But terminology can be dense and confusing. Let's shed some light on the situation by explaining the roles and requirements of OBs and how those compare to a gynecologist and a midwife. Before it's over, you'll have better insight into choosing the best practitioner to support you and nurture your desire to breastfeed.
Obstetricians are specially trained physicians who monitor the health of mother and baby throughout pregnancy, during childbirth, and in the immediate postpartum and postnatal period. When it’s time to deliver, or if an induction or cesarean delivery are needed, your obstetrician will be there to oversee the procedure. If you choose, your OB will be the doctor to circumcise your son the day after his birth.
Obstetrician: Education and Requirements
After graduating from an accredited university with an undergraduate or bachelor’s degree, an aspiring obstetrician will attend medical school for four years to obtain an MD or Doctor of Medicine degree. In medical school, your OB sat through many hours of lectures in anatomy, physiology, laboratory science, and healthcare before gaining practical experience by participating
in clinical rotations at an affiliated hospital. After graduating from medical school, prospects apply for licensing by taking a test called the USMLE.
Newly licensed interns enter a residency program. These clinical programs are experiential and hospital-based. Residency programs may last from one to four years. During this time of intensive training, future obstetricians work closely with practicing physicians and surgeons to learn new skills and techniques while diagnosing and treating patients in a wide variety of general medicine, surgery, and obstetric settings. During residency, your future obstetrician will begin to work with breastfeeding moms during the crucial postpartum period.
Next, medical residents desiring to become board certified obstetricians will apply to a competitive training program called a Fellowship. Medical “fellows” receive comprehensive training in gynecology, infertility, pregnancy monitoring, surgical and non-surgical delivery, maternal-fetal medicine, oncology (cancer treatment), and reproductive endocrinology.
Finally, the last step in becoming an obstetrician is to demonstrate competency through a board certification in obstetrics and gynecology. Certification by the American Board of Physician Specialties includes clinical, oral, and written components. To maintain their certification and licensure, all OBs must participate in a specified number of continuing education training hours each year.
What Conditions Do Obstetricians Treat?
Women wishing to become pregnant will usually first see an obstetrician for routine prenatal care shortly after they become pregnant. OBs monitor the health of both mother and baby from conception until birth. Also, obstetricians treat pregnancy complications, conditions related to infertility, and events associated with high-risk pregnancies. These can include:
- Previous ectopic pregnancy, miscarriages, and stillbirths
- Previous cancer treatment
- Infectious diseases (sexually transmitted, autoimmune related, etc.)
- Fetal distress
- Preeclampsia or high blood pressure during pregnancy
- Placenta previa
- Placental abruption or detachment
- Uterine rupture
- Breast abnormalities or difficulty breastfeeding
Infertility is the inability to become pregnant, maintain pregnancy, or experience a successful birth. Early indications of infertility can be subtle or non-existent. In fact, many couples have no reason to suspect infertility until they try to get pregnant. This fact is why it’s important that women see an obstetrician if they have been unable to conceive within one year of attempting or if they are over the age of 35 and trying to become pregnant.
A board-certified obstetrician can treat infertility. However, there is also a designated sub-specialty of obstetrics called reproductive endocrinology. Endocrinology is the study of hormones and their effects on the body. Consequently, reproductive endocrinologists seek to understand how hormones impact your ability to achieve, maintain, and complete a healthy pregnancy.
Maternal-Fetal Medicine Specialists
Maternal-fetal medicine specialists (MFM) are OB physicians who have finished two to three years of training in high-risk pregnancies. If you’re a pregnant woman with a chronic health problem, a maternal-fetal specialist will work hard to keep you healthy while your body changes and as your baby grows. MFMs also take care of pregnant women who face unexpected problems like early labor, abnormal bleeding, and high blood pressure. If you are carrying multiple babies, you’ll likely need a referral to a Maternal-fetal medicine specialist for the term of your pregnancy.
Differences Between Obstetrics, GYN, and Midwifery
Have you ever wondered what the difference between a midwife and an obstetrician is? Or thought “what is a GYN?” If so, you're not alone. Here is a breakdown of what distinguishes these three practitioners so that you can make the best choice for you.
What is an OB/GYN?
GYN is short for “gynecologist,” a physician or surgeon who specializes in treating issues with the female reproductive system. Today, gynecology is focused largely on disorders of these organs. Often, you will see the abbreviation OB/GYN. Therefore, this a physician who cares for pregnancy and also manages reproductive and breast health.
What is a Midwife?
A midwife is a specially trained practitioner who assists in the delivery of babies. Certified Nurse Midwives (CNM) are registered nurses, RNs, with an advanced degree and licensure through the American Midwifery Certification Board.
CNMs do more than deliver babies, though. They also aid their patients to manage labor -- naturally and with medication, and they actively monitor both mothers and babies during pregnancy and throughout delivery to ensure a safe and successful birth.
Generally, a midwife is a staunch advocate of a natural birthing process and breastfeeding. Midwives are trained in alternative pain management methods such as breathing techniques and warm water therapy. They often supervise and direct home births. However, in some states, home births are not sanctioned by state laws and may require CNMs to operate from a birthing center instead.
How to Choose an Obstetrician
If you're already under the care of a gynecologist with whom you have an established relationship and who practices obstetrics, you may choose to have this doctor manage your pregnancy, especially if you like the hospital facilities where they practice.
However, if you need a referral, you may ask a trusted healthcare provider to recommend someone. Alternatively, talk to friends and relatives who’ve recently delivered or ask someone who works in healthcare. Local childbirth educators and breastfeeding advocates are excellent sources for referrals, as well.
How To Background Check Your Obstetrician
Due diligence is an essential responsibility for all consumers especially when it comes to your health. As a patient, you should feel empowered to decide for yourself if an obstetrician meets your high standards. Start by using the search engine at Doc Info, a federal organization dedicated to transparency in healthcare. Here, you’ll learn where your doctor is licensed and for how many years. Also, you can find out if there are any disciplinary actions or reports.
Additionally, you can check for disciplinary actions by searching your state’s medical licensing board. There are also many peer-supported review sites that rank and rate doctors based on patient experience. Thank you, Internet!
Three Important Considerations
Aside from general compatibility and philosophy, there are a few situations when you will want to give more significant attention to your choice of a practitioner. First and foremost, check with your insurance company. Likely, they will have a list of participating providers for you to choose from. Most physicians offer a free consultation. Here are a few questions to keep in mind when you are selecting the perfect provider.
1. Are you high-risk?
You may be considered high-risk if you’re pregnant and answer "yes" to any of the following questions.
- Do you have any chronic health conditions?
- Are you over the age of 35?
- Are you carrying twins or more babies?
- Have you had previous miscarriages?
- Do you have a history of preterm labor?
- Have you had a prior cesarean or c-section delivery?
- Do you have a recent or remote history of tobacco, drug, or alcohol use?
2. How do you intend to manage pain?
If you are planning to have a natural birth, without the aid of pain medications like epidurals, it’s essential to find an obstetrician who will be supportive of these choices. Conversely, if you have a low pain tolerance, you’ll want to make sure your chosen doctor understands and is attentive to your concerns.
3. Do you need support while transitioning?
Transitioning into motherhood can be daunting. For example, breastfeeding is not always a natural or instinctual process. Many new mothers struggle with anxiety or need help developing good habits and proper techniques. Because breastfeeding is so vital to the health and well-being of mom and baby, most large hospitals and most birth centers offer support from breastfeeding coaches or visits from a lactation consultant nurse. Additionally, there are many outside resources like the La Leche League and helpful online guides to breastfeeding. Be sure to ask your prospective caregiver about access to these resources.
Preparing for Your First Obstetrician Appointment
The first time seeing a new doctor can be nervewracking. Don’t worry, though, before you enter the examination room (and put on that awful gown), you’ll be able to meet your doctor face to face. Arrive early, prepared to fill out paperwork with details like insurance, and medical history for yourself and your partner. Here is a quick checklist of the information you will most likely need.
- History of medical problems including hospitalizations and surgeries
- Mental health history
- Date of your last menstrual period (LMP)
- Any birth control methods you have used
- Account of prior attempts to become pregnant
- List of previous pregnancies including abortions or miscarriages
- List of medications you are taking or have taken recently
- Allergies to food and medicine
- Your family’s medical history including the father’s medical and mental health history
- List of questions and concerns regarding pregnancy, delivery, and breastfeeding
If you are already pregnant, schedule your first prenatal eight weeks after your last menstrual period. If you are visiting an obstetrician before you become pregnant, be prepared to have a pelvic examination, manual breast exam, and annual screening tests such as a pap smear and routine bloodwork. Your first visit will be one of the longest, so plan accordingly.
Your Obstetrician Is Key to Prenatal Health, Successful Pregnancy, and Positive Breastfeeding Experience
In the U.S., obstetricians are well-educated and highly-trained medical doctors who’ve met the strict standards required by law. OBs are an important part of your pregnancy journey. That is true if you are planning natural childbirth at home or a more traditional birth in the hospital. OBs utilize their vast knowledge and experience to help you navigate the journey of pregnancy. And even if you’re not a first-time mom, prenatal visits with an obstetrician are still crucial because each pregnancy is different.
Choose a doctor who shares your same values and philosophy to ensure a solid foundation on which to build. Share openly any observations, feelings, and concerns about your pregnancy to alleviate unneeded stress. Remember that obstetricians are experts are handling both the ordinary and unforeseen events that occur in pregnancy. However, they are also adept at predicting and preventing these same issues. This factor makes building an open and honest relationship with your OB paramount to a successful pregnancy and childbirth.
Check in with us regularly to learn about all things breastfeeding! Milk Chicks intends to be your go-to resource and an everpresent help during your pregnancy and beyond.