- What to Expect During Ob-Gyn Visits
- Should You Choose an Ob-Gyn or a Midwife?
- The Difference Between Ob-Gyns and Midwives
- Choosing Your Caregiver: Ob-Gyn or Midwife?
- What Type of Practitioner Is Right for Your Pregnancy?
- More Postpartum Recovery Tips
- Family physician
- Certified nurse-midwife (CNM)
- Direct-entry midwife
- What about a doula?
- The SGU Pulse
- Reproductive endocrinology and infertility: Reproductive endocrinologists are OB/GYNs who evaluate and treat fertility issues for both men and women. Their expertise is also valuable for those facing reproductive health issues, such as endometriosis. What are the most important skills for OB/GYNs?
- How do you become an OB/GYN?
- How much do OB/GYNs make?
- What is the job outlook for OB/GYNs?
- Become a primary care pioneer
- Choosing Your Provider
What to Expect During Ob-Gyn Visits
When should you start seeing an ob-gyn? The American Congress of Obstetricians and Gynecologists (ACOG) recommends that girls have their first ob-gyn visit when they’re 13 to 15 years old or they become sexually active, whichever comes first. The first visit for teens may just include a talk with the doctor and no exam.
Try to avoid having sex or douching within 24 hours of your appointment. Sexual activity could irritate the tissue of the vagina and affect your Pap test results.
Your appointment will usually start with a general health check. The nurse will weigh you and take your blood pressure. You may have blood and urine tests done, too.
Then it’s time for the physical exam. The nurse will take you into the exam room and ask you to undress completely. You will be given a gown that opens to the front, and a sheet to cover your lap.
Your ob-gyn will probably start by asking you some general questions about your personal and family health history. A nurse or other health professional might stay in the room with you and the ob-gyn for the pelvic exam.
The doctor will first examine the outside of your vagina, which includes the vulva area and vaginal opening, for abnormalities. The doctor will then examine your reproductive organs from the inside. While your knees are bent and your feet are in stirrups to keep them apart, the gynecologist will use a speculum — a device that holds the vagina open — to view the inside of your vagina and cervix (the opening to your uterus). You might feel some pressure during this exam, but it shouldn’t be painful. Your ob-gyn will also examine the walls of the vagina and cervix.
A Pap test is often done during the pelvic exam. Your ob-gyn will remove a sample of cells from your cervix using a small brush. Those cells will be sent to a lab and checked for cervical cancer, possibly the human papillomavirus (HPV) and other abnormalities.
If you have been sexually active, the doctor might also test you for sexually transmitted diseases (STDs) like gonorrhea, chlamydia, syphilis, and HIV. To test for STDs, the ob-gyn will take a swab of tissue during the pelvic exam and/or check blood tests.
Should You Choose an Ob-Gyn or a Midwife?
While Ob-Gyns remain the go-to professionals for baby delivery in the United States, midwives are growing in popularity. In 1989, certified nurse-midwives delivered 3.2 percent of all U.S. babies. In 2008, that number had risen to 7.5 percent. Choosing who will deliver your baby is a highly personal decision. If you’re trying to choose between an Ob-Gyn or a midwife, here’s a look at the differences and similarities between them, plus seven questions that will help you make the final call.
The Difference Between Ob-Gyns and Midwives
“Midwives are the experts in normal pregnancies,” says M. Christina Johnson, C.N.M., director of professional practice and health policy at ACNM in Silver Spring, Md. Johnson says her profession is often best known by this saying: low tech, high touch. The majority of midwives earn bachelor’s degrees, then work as registered nurses and go back to school for a two- or three-year master’s degree program in midwifery, according to the American College of Nurse-Midwives (ACNM). The professional designation is C.N.M. for certified nurse-midwife; in Rhode Island, New York and New Jersey, it’s C.M. for certified midwife. C.N.M.s and C.M.s can prescribe drugs, including pain medication. Midwives also use technology such as fetal monitors, but rely heavily on their clinical experience.
- RELATED: Finding a Doctor or Midwife Checklist
Ob-Gyns, as a profession, have a different reputation and set of skills. “There’s the perception that the physician is more likely to intervene in the birth,” says Ob-Gyn Jennifer Niebyl, M.D., professor of obstetrics and gynecology at the University of Iowa in Iowa City. That’s partly because they can. Unlike midwives, they are trained to manage high-risk pregnancies and can perform surgeries. Midwives can’t do C-sections (though some may assist in the operating room). Ob-Gyns can also use forceps and vacuums to facilitate delivery, whereas midwives are legally prohibited from doing so.
And, indeed, research shows that Ob-Gyns are more likely to use interventions (e.g., epidural anesthesia, episiotomies, and instrument deliveries). A 1997 study published in the American Journal of Public Health compared two groups of women with low-risk pregnancies. The researchers found that C.N.M.s used 12.2 percent fewer interventions than physicians. The same study found that the women who saw midwives rather than Ob-Gyns had 4.8 percent fewer C-section births. Yet, more importantly, research has also shown that fetal and maternal outcomes are equally good when comparing Ob-Gyn and midwife births.
Another important topic: payment for service. Both Ob-Gyns and midwives are licensed and highly regulated health care providers in all 50 states – and your health insurance covers their care if you’re delivering in a hospital. Most will also cover some share of a birthing center delivery, but home births are generally not covered. More than 96 percent of births attended by C.N.M.s and C.M.s happen in hospitals, while a little more than 2 percent are in birthing centers and only about 1.7 percent at home.
- RELATED: Is There an Ob-Gyn Crisis?
Choosing Your Caregiver: Ob-Gyn or Midwife?
Niebyl and Johnson say that who you have deliver your baby boils down to what you need. If you’re grappling with the decision between an Ob-Gyn and a midwife, the best thing to do is to start by answering these seven questions:
1} Is a vaginal birth your priority?
As a profession, midwives are ardent supporters of vaginal births. Ob-Gyns may or may not be. “You should ask about the doctor’s C-section rate and philosophy,” recommends Niebyl. If it’s important to you, make sure your care provider supports vaginal birth.
2} Do you want your caregiver with you during labor?
“Nurse-midwives offer a lot of labor support. They spend more time with patients than a physician can because we get pulled in so many different directions,” says Niebyl. If you have a doula (someone trained to support and help advocate for you through labor and delivery) or other support system, though, this may not be a deal breaker for you.
3} What are your plans for pain management?
“In a hospital setting, lots of midwives’ patients ask for and get epidurals,” says Niebyl. However, midwives will likely encourage trying medication-free methods to manage pain first. “We usually look for pain management techniques that support the natural process,” says Judy Berk, C.N.M., a certified nurse-midwife at Brigham and Women’s Hospital in Boston. “That might mean showers, massage, acupressure techniques, homeopathy, switching positions, or trying a birthing ball.”
- RELATED: Essential Questions for Your Obstetrician or Midwife
4} What will happen at the hospital?
More Ob-Gyns than midwives have strict protocols. Some doctors want their patients in bed with an IV, hooked up to a continuous fetal monitor. Midwives generally encourage patients to move around and are also more likely to use intermittent rather than continuous monitoring, according to Johnson. Speak to your Ob-Gyn well before your delivery date to find out about his or her policies for childbirth in the hospital—and make sure they mesh with your expectations.
5} Do you want (or need) more support and advice for your transition to parenthood?
“Midwives do a lot of counseling for nutrition and exercise and also on the emotional changes that happen when it comes to becoming a parent for the first time or adding another child to the family,” says Berk.
6} Are you considered high-risk?
“If you have a condition that would make your pregnancy high-risk, such as diabetes, or you’re delivering twins, you should see an Ob-Gyn and deliver in a hospital,” says Michele Hakakha, M.D., an Ob-Gyn in Beverly Hills and coauthor of Expecting 411: Clear Answers & Smart Advice for Your Pregnancy. Some midwives, though, co-manage higher-risk patients alongside Ob-Gyn colleagues; that means you may see both a midwife and an Ob-Gyn during your pregnancy. Who ultimately delivers your baby will likely depend on your medical circumstances.
7} What does your gut say?
Justine Arian, a doula and birth coach in Huntington Beach, Calif., urges women to trust their instincts about whom they choose to deliver their babies and even where. “Meet different doctors and midwives and visit hospitals or birthing centers. Ask yourself, ‘Is this where I see myself giving birth?’ ” says Arian. You can be sure you’re not making decisions based on unfounded fears by taking the time to educate yourself about your options. “Women have to give birth where they feel safest and most supported,” she says.
The second time around: If you had a Cesarean section with your first child, a midwife may still be an option for your second baby—even if a C-section has been recommended. Midwives don’t perform surgery, but you can certainly discuss with your Ob-Gyn or midwife the possibility of a vaginal birth after C-section (VBAC). Right now, whether a midwife or an Ob-Gyn can offer VBACs is often dictated by a hospital’s policy. For home births, the midwife can make the call.
- By Judy Koutsky
What Type of Practitioner Is Right for Your Pregnancy?
Now that you’ve conceived, the next challenge is to pick who you want on your pregnancy team. The person(s) you choose will play a big role in your pregnancy and how your baby is brought into the world. But with so many choices — OB-GYN, midwife, family physician, doula or a combination of the above — how can you choose the perfect practitioner(s) to guide you through pregnancy and beyond? This guide can help you to assess your options so you can decide what type of practitioner is right for you.
First and foremost, reflect on your priorities. Having a clear picture of what you want out of your pregnancy and birth experience is important in helping you to pick a practitioner. A few points to consider:
- Are you at risk of any complications? Do you have diabetes or high blood pressure; are you overweight or obese; are you carrying multiples?
- Where would you like to deliver? At a hospital, a birthing center or at home?
- Would you like a natural or medicated birth? Would you like to avoid medications during birth, or do you think there’s a good chance you’ll want an epidural?
Once you’ve answered these questions, your next step is to learn a little more about the doctors who can offer the best solutions for your needs.
More than 90 percent of women choose an obstetrician-gynecologist (OB-GYN), a trained practitioner who’s had post-medical school training in only women’s reproductive and general health. OB-GYNS have experience handling every medical aspect of pregnancy (including complications like gestational diabetes, placenta previa or a multiple pregnancy), labor, delivery and the postpartum period. That’s in addition to any non-pregnancy female needs, such as pap spears, contraception and breast exams. Because your OB-GYN can function as your primary care physician, he or she can make an excellent partner even after baby arrives. And if you are among the one in three women who wind up requiring a C-section, OB-GYNs are able to perform one for you.
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An OB-GYN might be right for you if… you have a high-risk pregnancy, an awesome relationship with your current OB-GYN, or you don’t want to give birth without an epidural.
But keep this in mind: OB-GYNs are more likely than midwives to use surgical or technological interventions during labor.
If you’re considering one but aren’t sure you want to spend your pregnancy with the OB-GYN you’re already seeing, now’s a good time to start shopping around.
READ: 7 Signs It Might Be Time to Get a New OB-GYN
A one-stop shop for all your medical needs, a family physician is trained in primary care, maternal care and pediatric care. This means he or she can serve as your internist, obstetrician-gynecologist and, when the time comes, your baby’s pediatrician.
A family physician might be right for you if… you want a doctor who’s continually invested in all aspects of your health and your family.
But keep this in mind: If complications occur, he or she may have to refer you to an obstetrician.
Certified nurse-midwife (CNM)
An CNM is a medical professional who has completed graduate-level programs in midwifery and is licensed and certified by the American College of Nurse-Midwives to practice in all 50 states, as well as U.S. territories such as Puerto Rico. CNMs are thoroughly trained to care for women with low-risk pregnancies with the goal of reducing birth injury, trauma and cesarean section by providing individualized care and minimizing technological intervention during birth. They often focus on more natural approaches to labor and delivery (such as breathing techniques and hydrotherapy), and they may be more likely than MDs to offer nutritional and breastfeeding support. CNMs may provide continuing routine gynecological care and, in some cases, newborn care. Most work in hospital settings, but others are at birthing centers. Some perform home births. They can offer epidurals and prescribe labor-inducing medication (but are less likely than OB-GYNs or physicians to intervene with medication in a natural birth).
A certified nurse-midwife might be right for you if… you’re concerned about your physical and emotional wellbeing during pregnancy; having a natural childbirth is your number one priority (or you’re really opposed to cesarean delivery — CNMs tend to have much lower cesarean delivery rates and higher rates of vaginal birth after cesarean than physicians); or you’re on a tight budget (the cost of prenatal care with a CNM tends to be lower than that of an OB-GYN).
But keep this in mind: You might need a doctor in a high-risk or complicated pregnancy (most CNMs use a physician as a backup in case of complications, because they cannot perform C-sections themselves.)
If you’re considering one, be sure to select a midwife who is both certified and licensed. For more information about CNMs, check out Midwife.org.
Trained in midwifery without first becoming a nurse, direct-entry midwives are independent practitioners who perfect their practice through self-study, apprenticeship, a midwifery school, college or a university program distinct from the discipline of nursing. They’re more likely than CNMs to perform home births (although some do deliver in birthing centers).
A certified nurse-midwife might be right for you if… you are 100-percent set on having a natural birth at home and you don’t have a high-risk pregnancy.
But keep this in mind: Some (“professional direct-entry midwives”) are evaluated and certified through the North American Registry of Midwives (NARM). But others aren’t certified and are not permitted to practice legally in certain states. Where direct-entry midwives are permitted to practice, Medicaid and some private health plans will cover costs. Otherwise? No such luck.
If you’re considering one, check out the Midwives Alliance of North America at mana.org.
What about a doula?
No matter what medical practitioner you choose, you might also want to consider hiring a doula. A doula doesn’t have medical training, so she’ll work beside your OB-GYN or midwife as your head cheerleader, providing emotional support throughout pregnancy, delivery and beyond. Having one can be especially helpful if you want or need to work with an OB-GYN but are concerned about missing out on the more hands-on emotional support midwives are known to provide.
As you investigate medical practitioners, ask plenty of questions about each person’s approach to prenatal care and testing, labor and birth procedures and protocol for complications. The more information you gather, the better equipped you’ll be to make an informed decision that’s right for you and your baby.
3 things to read next:
- Delivering in a Hospital
- What You Need to Know About Epidurals
- Managing Labor Pain Naturally
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Last weekend, a woman who was eight and a half months pregnant gave birth on a New York City–bound Amtrak train in Aberdeen, Maryland. When she unexpectedly went into labor on the train, she found a “Good Samaritan” to help her until they could stop for EMT help. By then, there was no time to get to the hospital, so she had her baby on the train.
If I were that Good Samaritan, I would have been stumped. I’m a woman, and a mother, but I have no idea what to do for a woman in labor. I know CPR, including what to do if someone is drowning; I know the Heimlich maneuver; I learned how to do a tourniquet in high school; I was tested on how to make a flotation device out of my own pants. And though I’ve never used any of these skills, I value them in theory. But never once in all my travels have I been instructed, in any rudimentary sense, what to do for a woman in any stage of labor. (I gave birth to my daughter via C-section, and the likelihood of me needing a Caesarean was guessed at early enough in the pregnancy that I never did that part of the reading).
I suspect that we’re all still a little bit uncomfortable with the process of bringing life into the world, and most of us only ever learn about it when absolutely necessary. So I did everyone a favor: I investigated exactly what to do if you’re stuck on a bus with a woman who needs to have a baby right now. And I’m going to share what I’ve learned.
Step 1: Call 911 and resist the urge to panic.
The first thing to do is get some EMTs on the scene. Unless medical help is hours away, they’ll probably arrive before the baby is born. In the meantime, Rita Wagner, a certified nurse midwife with Lower Manhattan Obstetrics and Gynecology at Weill Cornell, says, “You just have to stay calm.” Sure, this is a stressful situation for you, but think about how it feels for the mother-to-be! The best thing you can do for her, Wagner says, is “be present” and “with the woman,” which, it turns out, is literally what the word midwife means.
You’ve heard this over and over: People have been having babies for thousands of years; our bodies know what to do! That is supposed to be reassuring, and most of what Wagner says is reassuring. In the year 1900, almost all U.S. babies were born outside of a hospital. By 1944, that number was 44 percent, and by 1969, 99 percent of babies were born INSIDE hospitals. Presumably, most of our common knowledge of how to birth a baby slipped our minds, but we can get it back! Even though you’re not a doctor, you will get through this. Just stay very, very calm.
A woman in advanced stages of labor — her water has broken, her contractions are very close together — often senses what to do. Wagner says there is something “instinctual” in all of this. Hopefully, in your surprise baby-delivery scenario, that will be true, leaving you with the job of keeping her comfortable and relaxed.
Step 2: Support her through early labor and gather provisions.
Labor advances largely at its own pace — for some women it moves quickly, for others, it does not. You, the helper, aren’t likely to be able to slow things down. So, if the baby really is coming, it will be very obvious. There are three stages of labor, but the first stage is unhelpfully divided further into two phases: stage one, “early labor,” which is when the pregnant woman is like, “Oh, wow, I think something is going on down there.” This is when contractions — which start pretty mild and are comparable to menstrual cramps — begin.
In the second part of the first stage, “active labor,” the contractions get more intense: They are stronger, longer, and more frequent. The second stage of labor is the part you see in movies. It ends with active “pushing” (which shouldn’t go on too long) and the baby being born. We’ll get to the third phase, but for now, let’s pretend your laboring stranger is moving into second stage, i.e, the baby is being born, imminently, even if you don’t know exactly when.
The reason that babies are sometimes born, say, en route to the hospital rather than in the hospital is because stage one is extremely variable in length. If it’s the woman’s first baby, this phase can last anywhere from six to 12 hours. Many women prefer to do a bit of this stage at home, and are even encouraged to do so by their doctors and doulas (birthing coaches). In this stage, timing contractions (timing the beginning of one to the beginning of the next gives you the frequency, while timing individual contractions from start to finish gives you the duration) is important, but so is resting and keeping hydrated. That said, stage one of labor often slides into stage two fairly rapidly, catching the mom off guard.
When active labor starts, the contractions are much more frequent and often very painful. It can last a really long time, too — sometimes eight or nine hours, but it can be as short as an hour. This is how people get caught in cars and subways: Labor is totally unpredictable. In the U.S., at this point, many hospitalized women opt for pain medication — often an epidural — at this point. In our scenario, that isn’t an option, so although it’s been said a bunch of times, your main job is to help the laboring woman breathe and manage her situation. Validation will get you a long way here: Don’t argue or disagree with her, or even try to overcalm her at this point. You know from film depictions that some women scream obscenities and lash out in anger at whoever is around. Everyone’s labor is different, but your job as the Good Samaritan is to keep your cool. This is really your last chance to get any provisions — clean towels, blankets, washcloths, and buckets of water — before things get incredibly busy.
Step 3: She’s going to push and you (yes, you) are going to catch the baby.
At some point, a laboring woman will move to the end of the transitional phase of labor. This is the hardest part, and it’s when they begin to feel the unmistakable and uncontrollable urge to really PUSH. At this point, if the woman is wearing pants, it’s definitely time to remove them. Wagner says any position that the woman feels comfortable pushing in is okay, that she should “do what feels right” — but most women opt for some sort of sitting or squatting position. “The urge to push is unmistakable,” Wagner says. Women “usually bear down uncontrollably. It is rare for someone to not know when to push when unanesthetized.” In fact, she says, some women feel this way before it’s really time, which can result in them tiring themselves out. A professional usually knows how to manage and help a woman know when to push and when not to. In a surprise scenario, just let nature guide the woman in labor. This feeling — the unmistakable urge to push — arises as the baby descends into the birth canal.
Someone — let’s say it’s you — needs to support the baby as it comes out of the mother’s vagina. If you have a full view of the proceedings, you will know the baby is coming right this exact minute when you see the top of its head. This is called crowning. At this point, if she’s not already, you should instruct the mother to push — to bear down with each contraction. Ideally, the pushes will be less short — less than ten seconds each, with a little break in between. This is the most intense part of birth, but it doesn’t usually last very long.
You should support the baby’s head as it comes out of the vagina, but you should not pull on anything, including the umbilical cord. Once the baby’s head is out, it usually rotates a bit to one side. With the next push, one shoulder will emerge, then the other. Once the shoulders are out, keep supporting the baby and lift it very slightly toward the mother’s stomach. The rest of the body will come out easily. The baby will be slippery! Be careful!
Step 4: Keep the baby warm.
As long as the baby is breathing — it should be obvious, most babies cry at least a little upon contact with their new atmosphere — it should be placed directly onto its mother’s chest immediately. Wagner says, “There is no need for routine clearing of mouth and nose at birth unless mucus or fluids are preventing baby from breathing.” The easiest thing, she says, is simply to wipe the baby’s face with a cloth. The most important thing you can do is “dry the baby and keep it warm.” This is why skin-to-skin contact is ideal. Wrapping the baby in a towel or blanket or a coat overtop of its mother will help — “babies lose A LOT of heat when wet, especially from their heads,” Wagner says, so keeping them covered is a must.
The baby, at this point, will still be attached to its mother via an umbilical cord. There’s no need to detach it, Wagner says. So in any reasonable situation — where medical help is en route, the cord can be left undisturbed.
Step 5: Do not mess with the placenta.
The third and final stage of delivery is when the placenta comes out, and it’s also the most dangerous part if you’re not a medical professional, because it can lead to hemorrhaging. You’ve already done so much: Do you really need to know about this? Well, it won’t hurt. After the baby has been born, if medical help is actually not on the way — we’re talking about a Walking Dead scenario here now, which is pretty unlikely but — why not have at least an inking of what happens next?
In the hospital, drugs are often administered to help this next part, but not always. The point is that after birthing a baby, the uterus needs to contract in order to separate the placenta from the inside of the body. The most common sign that the placenta is coming — it can happen within ten minutes after birth or take up to an hour — is a “gush of blood,” says the midwife. She also cautions more than once that placental delivery is serious business, and an “untrained professional” should not facilitate this process. But, in an end-of-the-world scenario, after the gush of blood, the woman will again have the urge to push, which is helpful to the process. The placenta will come out as she pushes. Firmly massaging the stomach after this — which will probably hurt her a little — will help to slow down the bleeding.
Congratulations! You birthed a baby!
Or maybe you just sat with the mom and helped her stay calm while help arrived! Either way, take a minute to celebrate, you Good Samaritan, you.
A word about complications: There are so many hundreds of “What if” scenarios that to even present a tiny fraction of them would make any attempt to explain the process of birth completely useless. Most babies are born without complication; many are born in unexpected circumstance and turn out fine. But there are some complications that occur all the time — like when the baby is feet first (breech) or when the umbilical cord is wrapped around its neck — and aren’t much of a threat in the presence of a professional but would be a real problem on Amtrak. So the advice above is for “standard” births, at least as “standard” as a birth on a moving vehicle/during a zombie apocalypse could possibly be.
The reality is you will probably never ever need to deliver a baby. But that doesn’t mean you shouldn’t at least try to be prepared.
You could see a range of Doctors or midwives every time you visit the hospital or your appointments. If all goes as normal you can expect to be in the hospital for 1-2 days after a vaginal delivery, longer if you are recovering from a caesarean section. There are no out of pocket costs for birthing in a public hospital, providing you are an Australian resident as it is covered by Medicare.
If you decide you’d like to have your baby in a private hospital and choose who delivers your baby, you will need to book a private Obstetrician. Obstetricians have completed all their advanced training and manage all obstetric issues by themselves. They will have delivery rights to selected private hospitals, and your bed needs to be booked ASAP as they are in high demand (your Obstetrician’s rooms will do this for you).
Patients usually have private health insurance with Obstetric cover (usually for at least a 12 month period prior to falling pregnant). Your private health insurance covers your hospital stay and part of your Obstetric fees. All appointments throughout the pregnancy are conducted in the Obstetrician’s rooms and they become more frequent as the pregnancy progresses.
Most obstetricians will utilize an ultrasound machine at each visit to monitor the growth and development of the baby. They are apt at managing any issue that arises during the pregnancy.
One of the most important things about choosing pregnancy care with a private obstetrician is that they are available to attend to your pregnancy needs 24 hours a day via a paging service. This provides you assurances that you get the best care from an experienced professional.
Sometimes there are medical reasons for a woman to deliver her baby before naturally going into labor. For example, if a week or more passes after the due date and the baby does not come, doctors may need to start, or induce, labor. Or if the woman or her baby is at risk, doctors may need to deliver the baby by Cesarean delivery, or C-section.
These types of deliveries can save lives. But to hurry a baby’s birth—just to make it convenient for you or your doctor—can increase the risk of serious problems for both you and your baby. Here’s why:
Full term is better.
A full-term pregnancy lasts at least 39 weeks. Of course, some babies naturally arrive sooner. And complications during pregnancy can make an early delivery the safest choice. But most babies need 39 weeks to develop fully. Induced or planned delivery before that time—without valid medical reason—is not in the best interest of the baby or the mother.
Between 1990 and 2007, there were fewer full-term births, and almost twice as many babies born at 37 and 38 weeks. One reason for this is that it became more common for women to be scheduled for a C-section or to have labor induced before their due date. Some hospitals have taken recent steps to reduce unnecessary early deliveries, but too many births are still being scheduled for convenience.
Carrying an infant the full 39 weeks has important health benefits for the baby and the mother. For example, during weeks 37 and 38, the baby’s lungs and brain are still developing. The baby’s body also gains fat during this time, which helps the baby keep a healthy body temperature.
Babies induced or delivered by C-section before 39 weeks are more likely to have problems breathing and feeding, have severe jaundice, and need intensive care after birth. They also have a higher chance of having cerebral palsy, which can affect movement, hearing, seeing, thinking, and learning. And, while the overall risk of infant death is low, it is higher for babies who are delivered before 39 weeks.
Women who carry their baby at least 39 weeks also have less postpartum depression. This may be because their infants are less likely to have problems than those born early.
Let nature take its course.
To prepare for birth, the cervix softens and thins. As this happens, the opening gets bigger, or dilates. But if your cervix has not changed, even if you’re in the 39th week of your pregnancy, you should not induce labor without a medical reason.
If your body is not ready, your delivery is less likely to go smoothly. For example, you are at increased risk of having a C-section, especially if you are giving birth for the first time. And your baby may be more likely to need intensive care after delivery.
Even when the cervix shows signs of being ready, there are reasons to allow labor to happen on its own. Natural labor is usually easier and shorter than induced labor. And you can usually spend the early part of your labor at home, moving around and staying as comfortable as you can.
By contrast, an induced labor takes place in the hospital. You will most likely be hooked up to medical equipment, including at least one intravenous (IV) line and an electronic fetal monitor. You will be given medicines to start your labor. You may not be able to eat or drink.
When should you induce labor?
Having a doctor start your labor is justified when there’s a medical reason, such as your water breaking and labor not starting. You may also need labor induced if you are a week or more past your due date.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
© 2016 Consumer Reports. Developed in cooperation with the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.
The SGU Pulse
Reproductive endocrinology and infertility: Reproductive endocrinologists are OB/GYNs who evaluate and treat fertility issues for both men and women. Their expertise is also valuable for those facing reproductive health issues, such as endometriosis.
What are the most important skills for OB/GYNs?
Some qualities are important for all types of physicians, but it takes a certain type of personality and skill to succeed as an OB/GYN. Effective communication skills are a good example. While this competency is important for all doctors, it’s even more crucial for those practicing obstetrics and gynecology.
“An OB/GYN doctor’s ability to place patients at ease is so important.”
“The subject matter in this field is intensely personal, so an OB/GYN doctor’s ability to place patients at ease is so important,” Dr. Richey explains.
Remaining flexible is also important. “OB/GYNs have to expect the unexpected,” Dr. Richey says. “It is part of the field. If you want to have your day planned without any deviation, this field may not be the best choice.”
Being able to roll with the punches is related to a number of other competencies, too. This is particularly true when you find yourself in the operating or delivery room.
“You will need nerves of steel and good surgical hands as well,” Dr. Richey says. “It is a procedure-driven area of medicine.”
“You will need nerves of steel and good surgical hands as well.”
How do you become an OB/GYN?
Like all physicians, OB/GYNs must graduate from a four-year medical school, complete a post-graduate residency, and successfully pass each step of the United States Medical Licensing Examination (USMLE) series. You’ll start the USMLE series in medical school, then complete the third and final portion during residency.
Matching for residency is a particularly critical step on the path to becoming a doctor. These positions provide the actual training you need to practice medicine. While it’s unlikely any OB/GYN residency that participates in the National Resident Matching Program’s Main Residency Match will be subpar, Dr. Richey does suggest doing a little bit of digging when you’re evaluating options.
“It is important to go to a program that will give you a full exposure to all the facets of the specialty.”
“It is important to go to a program that will give you a full exposure to all the facets of the specialty,” she advises. Dr. Richey says you can get a good feel for this by looking for residency programs that feature a lot of deliveries, hysterectomies, and other procedures. The more exposure you get, the more prepared you’ll be when it comes time to start practicing.
Those interested in a subspecialty will also need to complete an additional training to obtain board certification in their desired field.
How much do OB/GYNs make?
OB/GYNs are responsible for many vital health care needs. As a result, physicians who choose this field are compensated generously. According to the US Bureau of Labor Statistics (BLS), the mean annual salary for OB/GYNs is $238,320. That figure can increase for OB/GYNs who further specialize.
What is the job outlook for OB/GYNs?
A growing and aging population is driving the need for health care, so the future is bright for every type of physician. OB/GYNs are particularly well-positioned for the future.
The BLS reports employment for obstetrician/gynecologists is expected to grow 16 percent through 2026. This is more than twice the rate of the average for all other occupations in the US. The predicted OB/GYN employment growth rate even surpasses other physician occupations.
Become a primary care pioneer
So, what is an OB/GYN? You can see these doctors are invaluable in addressing the most critical female reproductive needs. While life as an OB/GYN can be hectic, it’s completely worth it for the right person.
“Even though there are hard days, nights, and fatigue, I wouldn’t change it for the world,” Dr. Richey reflects. “I am the first human hand to touch a new life and welcome it into the world. There is nothing better than that.”
If you think you could picture yourself going into obstetrics/gynecology, you might want to learn more about the primary care landscape as a whole. Perhaps you’ve heard about an impending shortage of these physicians, and you might wonder if the rumors are really true. Find out for yourself by reading our article, “Is There a Shortage of Primary Care Physicians? Evaluating the Claims.”
*This article was originally published in November 2018. It’s since been updated to reflect information relevant to 2019.
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Our experienced obstetrician-gynecologists are specially trained to provide medical and surgical care. They are affiliated with Harvard Medical School where they educate the next generation of obstetric physicians. Many of our OB/GYN doctors are bilingual and have advanced training in specialty areas. They collaborate with experts in maternal-fetal medicine, genetics, reproductive medicine and other specialties throughout BWH.
Our nurse-midwives are certified by the American College of Nurse-Midwives and licensed by the state of Massachusetts. They are skilled at providing obstetric and newborn care, family planning and wellness education. A culturally diverse group of women, our nurse-midwives work closely with obstetricians if complications occur during pregnancy, labor or delivery. The Midwifery Group at BWH is the oldest hospital-based midwifery practice in Massachusetts.
Obstetrics and gynecology physicians and nurse midwives provide services at multiple locations in Boston and surrounding communities. Babies are delivered at the state-of-the-art Center for Women and Newborns at the Mary Horrigan Connors Center for Women’s Health.
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