The obstetrician’s role in begins at conception and usually ends in
the weeks following birth. Obstetricians provide prenatal care to
pregnant women with the goal of reducing the risk of prenatal
complications, overseeing the health of both the mother and the fetus,
and educating patients about nutrition, health and safety during
Prenatal care begins with the confirmation of pregnancy – usually
using a urine test that screens for elevated levels of the pregnancy
hormone, hCG. A physical exam and blood testing may follow, as well as a
doctor-patient interview about past pregnancies and family history.
Often, routine check-ups to monitor the growth and health of the fetus
and the mother continue once every four weeks for the first two
trimesters and once every two weeks for the final trimester.
Obstetricians provide “due dates” as estimations only. Some children
are born prior to their due date, and others are born after their due
date. Few are born on their original estimated dates of arrival. In some
cases, complications or pre-term labor can lead to an early delivery.
A routine vaginal delivery is usually performed once a pregnancy
becomes full term. This is usually between the 37th and 42nd weeks of
pregnancy. In most cases, the cervix begins to dilate and efface in the
days and weeks leading up to delivery. Labor may begin on its own, or an
obstetrician may induce labor by rupturing the amniotic sac or
administering labor-inducing drugs. Labor may last from a few minutes to
many hours, during which time a laboring woman’s obstetrician can offer
pain management options.
When labor begins, uterine contractions help the cervix rapidly
dilate and also move the baby into the birth canal, usually in a
head-down position. Once the cervix reaches approximately 10 centimeters
in diameter, the obstetrician may instruct a laboring mother to push
intermittently until the baby’s head crowns, followed by the remainder
of the body. Following birth, a few additional contractions may follow
to expel the placenta.
Caesarean section births, also known as c-sections, are used to
surgically remove a baby from a mother’s uterus, bypassing the birth
canal. There are a number of reasons why an obstetrician may order a
c-section birth, either for concern of the mother or baby’s health, or
complications of vaginal delivery. Some of the most common reasons for
c-section births include breech presentation, a multiple birth,
difficulty during labor and complications of the placenta.
A mother may or may not be awake during a caesarean birth, depending
on the nature of pain management used during the procedure. Either a
transverse or vertical incision will be made into the uterine wall, out
of which the obstetrician will deliver the baby and placenta. The
incision is then repaired, and a hospital day of approximately three
days will follow.
Women who undergo caesarean section births may be at risk for
complications of the procedure, such as infection of the surgical site
and blood clots. Obstetrical care will continue in the weeks following a
c-section to monitor recovery and manage any complications that may
arise from the procedure.
Postpartum (Care or Hemorrhage)
The postpartum period includes the weeks immediately following
delivery. Usually, women are monitored by an obstetrician and nurses
consistently for the first two to three days, after which one or two
follow-up appointments may occur. However, in a very small percentage of
women, postpartum recovery can be complicated by hemorrhaging.
Although it is normal for women to experience some blood loss after
the placenta detaches from the uterine wall, hemorrhaging can occur due
to excessive bleeding. Treatment for most cases of postpartum
hemorrhaging includes administration of IV fluids, iron supplementation
and medications. Only a small number of women experience hemorrhaging
that requires blood transfusion.
High Risk Pregnancy
When either a mother or baby’s health is at risk during gestation,
the pregnancy is referred to as “high-risk.” Pregnant women and their
unborn babies who are labeled high-risk may be required to make more
frequent visits to the obstetrician for check-ups and exams.
Additionally, obstetricians may make more restrictive recommendations
for high-risk pregnancies regarding diet, nutrition, activity,
medications, immunizations, tobacco-use and consumption of alcohol.
There are a number of conditions and circumstances that determine
whether a pregnancy is considered high-risk. For example, certain
complications of pregnancy such as placenta previa may make a pregnancy
high-risk. Other complications include maternal age under 17 or over 35,
as well as a multiple birth, history of multiple miscarriages, or
certain medical conditions like preeclampsia or autoimmune diseases.
According to the U.S. Department of Health and Human Services, as
many as 10 percent of pregnancies result in the development of
gestational diabetes. The condition is prevalent among pregnancy women –
especially those over age 25 – because of increased difficulty for the
body to produce insulin when pregnancy hormones are present. Gestational
diabetes screenings are standard during the second trimester of
pregnancies in the U.S., although some women may be screened sooner if
determined high-risk for developing the condition.
Diagnosis of gestational diabetes places mothers at an increased risk
for other pregnancy complications and is more likely to lead to a
caesarian section delivery. The disease also leads to higher birth
weights and requires careful oversight of diet, nutrition and activity
levels during pregnancy. In some cases, diabetes medicine and/or insulin
may be necessary to regulate blood glucose levels.
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