Your Physician or Midwife During Pregnancy

Oct 08 2007

The majority of the child births in the United States today are managed by specialists in obstetrics. The American Academy of Family Physicians reports that about 20 percent of births are attended by family physicians. Midwives currently attend about 9 percent of the vaginal births in this country, approximately 7 percent of all births. Many physicians and midwives offer one visit, either before pregnancy or during its early weeks, just to talk. There often is no fee for this visit. Sometimes it is conducted as a group orientation or a telephone conversation. Take advantage of such offers to “shop around” if you are undecided about a provider during the pregnancy planning stages or at the beginning of the pregnancy.

Obstetricians

There are about thirty-nine thousand members of the American College of Obstetricians and Gynecologists (ACOG). Obstetricians have graduated from medical school and then completed four or more years of residency in obstetrics and gynecology. At the conclusion of this training program they are authorized to take a more-than-three-hour written examination on the factual basis of the practice of this specialty. Those who pass the examination may represent themselves as Boardeligible. This means they have met the qualifications set by the American Board of Obstetrics and Gynecology (ABOG).

The American Board of Obstetrics and Gynecology is one of more than twenty member-Boards of the American Board of Medical Specialties. It was established in 1927, making obstetrics the third oldest medical specialty in the United States. The Board is sponsored by the American College of Obstetricians and Gynecologists, the Association of Professors of Gynecology and Obstetrics, the American Gynecological and Obstetrical Society, and the American Medical Association.

After two or more years of practice as Board-eligible physicians, the candidates submit to the ABOG a list of all the women they have cared for and all procedures they have performed during the last full year of practice for review by the Board. If this review indicates that the quality and quantity of practice are sufficient to meet the standards of the Board, the individuals are invited for a three-hour oral examination. This is intended to scrutinize the level of their knowledge and the style of their practice. If all this is completed successfully, the individuals are authorized to identify themselves as Fellows of the American Board of Obstetrics and Gynecology. Most Fellows are required to be re-certified by examination at regular intervals so that the Board can be certain that they have kept themselves up-to-date with the changing standards of practice.

Some obstetricians and gynecologists become subspecialists. ABOG currently certifies physicians in four subspecialties gynecologic oncology (care of women with reproductive-related cancers), maternal and fetal medicine (care of women and fetuses with obstetrical problems or risks), reproductive endocrinology and infertility (care of women with problems related to the chemical or hormonal component of reproduction. with a particular emphasis on infertility), and female pelvic medicine and reconstructive surgery (care of problems of the urinary tract and disorders resulting from loss of muscle support of organs in the pelvis. Physicians who become subspecialists have completed an advanced educational program in one of these areas. If you have a serious medical orobstetrical problem complicating your pregnancy, you may choose to have a subspecialist in maternal and fetal medicine care for you, or your regular obstetrician may consult with a maternal and fetal medicine sub-specialist. Sometimes these subspecialists are called perinatologists.

Family Practitioners

Family practice is the medical specialty that provides care to all members of a family. Family physicians have not spent nearly as much Lime on their education in obstetrics, although they have done work in me field in the course of their training. The American Academy of Family Physicians, known until October, 1971, as the American Academy of General Practice, has more than eighty-five thousand members. Since 1969, examinations have been conducted in this specialty to certify and re certify practitioners. The Academy also requires continuing education of all its members.

Your Physician or Midwife During Pregnancy Approximately 25 percent of family practitioners provide maternity care. Most hospitals that are accredited by the Joint Committee on the Accreditation of Hospitals authorize such practitioners to take care of normal pregnant women and their births. Most often, the hospitals specify that major problems and operative obstetrics be referred to physicians with obstetrical qualifications. Approximately two thousand family pracitioners, however, are credentialed to perform cesarean births in hospitals in the U.S. today. Such credentialing is determined on an individual basis. Some family practice residency programs include preparation in cesarean section. Most family physicians take an advanced training program or fellowship to learn this skill. Once again, local sources of information :an be used to indicate a particular doctor’s experience and credentials.

Why would somebody choose a general or family practitioner to attend a birth? There are a number of reasons. Perhaps the physician has been your family’s doctor for a number of years-taking care of you and other family members. This is a distinct advantage; the physician with whom you already have an ongoing and trusting relationship can provide your maternity care and then care for the newborn. He or she can follow your children throughout their lives. Because, like midwives (see below), they often don’t care for women with serious complications, and generally need to call in an obstetrician for a complication or for a forceps or cesarean birth, family physicians generally are less likely to utilize technological interventions, which may carry the risk of causing one problem while correcting another. Finally, in some communities, the only obstetrical provider is the general or family practitioner. This may be especially true in rural areas.

Midwives

Midwifery is a growing profession in the United States. It has evolved over time and continues to evolve as a variety of educational pathways have developed in recent years for professional midwives. Of course, the roots of the profession can be traced back through human history. Midwifery can make a claim as the oldest profession-or perhaps the second oldest, following motherhood. Indeed, the term obstetrics is derived from the Latin obstetrix, which means midwife. Early midwives were not necessarily educated in the art or science of maternity care, they were community women who were called upon to help other women in childbirth. Oftentimes, such women passed on their acquired knowledge to younger women-perhaps a daughter, niece, or grand daughter.