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What is an Obstetrician-Gynecologist?

What is an Obstetrician-Gynecologist?
September 14, 2019AGNES JOSEPHStudy abroad

The medical specialties of obstetrics and gynecology are closely related and often practiced together. Obstetrics is concerned specifically with childbirth and the care of women giving birth. Gynecology deals with the functions and diseases specific to women and girls, especially those affecting the female reproductive tract. When practiced together, the specialties are commonly referred to as OB/GYN or OB-GYN.

Postgraduate training programs will combine the two disciplines so that practitioners are adept in dealing with women’s health issues as well as managing the stages of pregnancy.

According to the Bureau of Labor Statistics (BLS), around 18,500 OB/GYN doctors are actively practicing in the United States. The vast majority work in medical offices, while roughly 4,300 are employed by hospitals or outpatient clinics.

Concentrations

The fields of obstetrics and gynecology are distinct but invariably interlinked, in part to ensure a continuity of care if and when a woman becomes pregnant.

Obstetrics

Obstetrics involves care during preconception, pregnancy, childbirth, and the weeks following childbirth. The stages are defined as follows:

  • Preconception involves the counseling of women and couples who intend to get pregnant. It aims to optimize the chances of a safe pregnancy by identifying and modifying risks to a woman’s health. A fertility specialist may be also be involved to aid in the treatment of male or female infertility.
  • Prenatal care is delivered during pregnancy and involves monthly scheduled visits from week 4 to 28, twice monthly visits from weeks 28 to 36, and weekly visits from week 36 to birth.
  • Neonatal care refers to the care given to newborns immediately following childbirth. The level of care is directed by the health of the baby, classified as level I (well newborn delivery), level II (special care nursery), or level III (neonatal intensive-care unit).
  • Postpartum care begins immediately after birth for both the mother and child and continues with regular checkups for six weeks or more.

Gynecology

Gynecology deals specifically with the health of the female reproductive organs (including the ovaries, fallopian tubes, uterus, and vagina) and the breasts. Gynecologists provide both preventive services and medical or surgical interventions when needed.

In the United States, some states and health insurance companies will allow gynecologists to function both as a specialist and a woman’s primary care physician.

Preventive wellness screenings vary by age and may include a pelvic exam, mammography, Pap smears, HPV vaccination, STD screening, and bone mineral density screening.

In terms of treatment, gynecologists will commonly treat or manage conditions such as:

  • Amenorrhea (absent periods)
  • Cancer (including breast, cervical, ovarian, and uterine cancer)
  • Dysmenorrhea (painful periods)
  • Endometriosis (overgrowth of uterine tissue)
  • Infertility (including ovarian insufficiency, menstrual irregularities, and structural uterine abnormalities)
  • Menorrhagia (heavy vaginal bleeding)
  • Osteoporosis (bone loss common in postmenopausal women)
  • Pelvic inflammatory disease (the spread of a sexually transmitted bacteria from the vagina to other reproductive organs)
  • Pelvic organ prolapse (when the muscles and tissues supporting the pelvic organs become weak or loose)
  • Premenstrual syndrome (PMS)
  • Sexually transmitted infections (including chlamydia, gonorrhea, syphilis, HPV, genital herpes, and trichomoniasis)
  • Urinary tract infections (UTI)
  • Urinary incontinence
  • Uterine fibroids (noncancerous growths in the uterus)
  • Vaginal infections (including yeast infections and bacterial vaginosis)

Many of these conditions are characterized by pelvic pain, cramps, vaginal discharge, abnormal bleeding, the frequent need to urinary, pain with urination, genital bumps, sores, vaginal itching or burning, or pain with intercourse.

Procedural Expertise

Obstetrics is devoted solely to conception, pregnancy, childbirth, and postpartum care. Gynecology involves all other aspects of a woman’s health, although certain conditions may overlap during pregnancy.

Obstetrics

For the obstetrician, patient care is largely directed by the stage of the pregnancy, known as trimesters. By definition:

  • The first trimester is from week 1 to the end of week 12.
  • The second trimester is from week 13 to the end of week 26.
  • The third trimester is from week 27 to the end of the pregnancy.

During the first trimester, the woman will undergo a battery of tests to ensure that there are no medical conditions that might complicate the pregnancy. These may include an STD screen, Pap smear, urinalysis, and genetic testing for Down syndrome and other congenital disorders. Your OB/GYN will also estimate the due date for delivery.

During the second trimester, your OB/GYN would continue to monitor your condition to ensure that pregnancy proceeds safely. During this time, the doctor would track the baby’s growth, check for a fetal heartbeat, and screen for gestational diabetes and neural tube defects. An amniocentesis may be performed if you are over 35 or there is an abnormal genetic test result.

During the third trimester, you’ll be assessed for any signs of premature contractions, vaginal bleeding, or placental leakage. You would also be screened for group B streptococcus (GBS), a common bacterial infection that can harm the baby. As the delivery nears, your OB/GYN would check that the baby’s position in the womb is correct or provide you the necessary vaccinations (like the Tdap and flu shot) to avoid infection.

Labor and delivery may be induced or natural and involve either a vaginal birth or a cesarean section (C-section). Your OB/GYN would also be involved in delivering the appropriate pain relief, including epidural, spinal, or combined spinal-epidural (CSE) anesthesia.

Postpartum care is focused on optimizing care for both the mother and newborn. This includes assessing the baby’s health, screening for defects or diseases, and delivering preventive medications. Health and wellness checks would be routinely scheduled. The mother’s physical, social, and psychological well-being would also be monitored during the postpartum period.

Gynecology

Gynecologists employ both surgical and non-surgical therapies to treat or manage conditions affecting a woman’s health. These a wide range of medications used to treat menstrual pain (including Cox-2 inhibitors and nonsteroidal anti-inflammatory drugs), heavy periods (tranexamic acid), vaginal dryness (propylene glycol and topical anesthetics), and vaginal infections (oral antibiotics, antifungals, and probiotics).

Gynecologists will also use hormone-modulating therapies to treat conditions ranging from menorrhagia and endometriosis to infertility and menopause. It also includes oral and injectable hormonal contraceptives to prevent pregnancy.

Non-hormonal contraceptives include intrauterine devices (IUDs), cervical caps, diaphragms, contraceptive sponges, spermicides, and male and female condoms.

Surgery is also a mainstay of a gynecological practice even though gynecologists are not considered surgeons. Some of the more common surgeries used in gynecology include:

  • Adhesiolysis (the cutting to scar tissue to relieve pain from endometriosis and other conditions)
  • Cervical excision (removal of the surface of the cervix if precancerous cells are found)
  • Cervical cone biopsy (use to obtain cervical tissue samples)
  • Colporrhaphy (surgical repair of the vaginal wall)
  • Colposcopy (insertion of a scope through the cervix to view the uterus for diagnostic and treatment purposes)
  • Cystoscopy (insertion of a narrow scope into the urethra to view the urinary tract for both diagnostic and treatment purposes)
  • Dilation and curettage (a procedure to remove tissue from inside the uterus following a miscarriage or for diagnostic purposes)
  • Endometrial ablation (removal of uterine tissue overgrowth)
  • Hysterectomy (removal of the uterus))
  • Oophorectomy (removal of the ovaries)
  • Pelvic laparoscopy (insertion of a scope through the abdominal wall to view the pelvic organs)
  • Suburethral sling (a surgery used to support the pelvic organs)
  • Tubal ligation (the “tying” of the fallopian tubes to prevent pregnancy)

Although the gynecologist can aid in the diagnosis of breast cancer and other cancers, the removal of tumors would be performed by a surgeon or surgical oncologist.

Subspecialties

While many OB/GYN doctors will maintain a general practice, others will pursue a range of subspecialties that allow them to focus on a specific field of practice. These include:

  • Family planning (involving contraception and abortion)
  • Female pelvic medicine and reconstructive surgery (surgical and non-surgical treatment of pelvic floor disorders)
  • Fetal therapy (treating fetal diseases before birth)
  • Gynecologic oncology (involving gynecological cancers)
  • Laborists (specialists in managing labor and delivering babies)
  • Maternal-fetal medicine (involving pregnancy complications)
  • Reproductive endocrinology and infertility (fertility specialists)
  • Urogynecology (concerned with the female urinary tract)

Training and Certification

Obstetricians and gynecologists typically need a bachelor’s degree, a degree from a medical school, and the completion of internship and residency programs to obtain a medical license. All told, you would expect to spend no less than 12 years in training and education.

Medical School

Medical schools are highly competitive. Most require you to pass the Medical College Admission Test (MCAT) and to complete prerequisite courses in advanced math, chemistry, biology, physics, and social science.

Medical students spend most of the first two years in laboratories and classrooms. During the last two years, you would work in different medical facilities, rotating through different fields of practice including internal medicine, family practice, obstetrics and gynecology, pediatrics, psychiatry, and surgery.

Residency

Upon graduating as either a doctor of medicine (MD) or doctor of osteopathic medicine (DO), you would need to complete both an internship and a residency in a hospital-based obstetrics and gynecology program. An internship is usually a year long, while a medical residency generally lasts for four years.

After the completion of your residency, you would need to be licensed in the state in which you intend to practice.

To obtain a license, you would need to pass a national exam—either the United States Medical Licensing Exam (USMLE) for MDs or the Comprehensive Osteopathic Medical Licensing Exam (COMLEX) for DOs—and occasionally a state exam.

Board Certification

Once you have met the educational and training requirements, you can obtain board certification from the American Board of Obstetrics and Gynecology (ABOG).

The ABOG board exam consists of two parts. The written exam is only offered once yearly on the last Monday in June. The oral exam is conducted by a panel of experts and covers the same topics as the written exam.

Some OB/GYN doctors will embark on fellowship training after completing their residency. This could involve anywhere from two to four years of additional training to focus on specific aspects of obstetrics and/or gynecology.

In Conclusion,

A career in obstetrics and gynecology can be incredibly rewarding. Not only do you have the opportunity to participate in childbirth, but you are involved as much in the prevention of disease as the treatment of disease—arguably more than any other medical profession.

But there are downsides. OB/GYNs often work long hours and have to deal with the stress of miscarriage, pregnancy complications, and conditions for which there are limited treatment options.

Another downside is the high liability that comes with delivering babies. This liability results in higher malpractice insurance costs for many practitioners, even those with an otherwise clean practice record.

With that being said, nearly three out of every four OB/GYN doctors expressed high to very high satisfaction with their job, according to a survey published in the American Journal of Obstetrics and Gynecology. Job autonomy, physician-patient relationship, and financial compensation were among the positive attributes of the profession.

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