Obstetrician-gynecologists (ObGyns) are trained to care for women experiencing medically complex or high-risk pregnancies. Obstetrics and Gynecology is a surgical specialty. Obstetricians are surgeons. If you have a medically complex pregnancy, such planning a repeat cesarean section, or have an unstable chronic illness that could affect your pregnancy, an obstetrician is best equipped to provide your pregnancy care.

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Where do they attend births?

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Obstetricians attend births in the hospital. 

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Do I need a referral? 

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For most hospitals, yes, you will need a referral from a family doctor in order to be followed by an obstetrician for your pregnancy. This is because obstetricians are specialized in high-risk pregnancy, so most pregnancies do not need to be followed by an obstetrician. 

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What is their approach to care?

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Obstetricans are specialized in high-risk pregnancy. In this specialty, pregnancy is viewed as a medical condition to be “managed” or treated, rather than a normal physiologic process. 

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Prenatal appointments are typically brief and cover the essential physical assessments to ensure your pregnancy is progressing well and your baby is doing well. Opportunities for discussions about your options for your birth can be difficult during these brief appointments, so exploring topics of interest independently and preparing your questions and notes on your concerns to discuss before visits can be helpful to ensure you get the essential information you need. 

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What care will I receive during labour?

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Nurses will care for you and your baby throughout your labour. They will advise the obstetrician on-call of your arrival and labour progress. Obstetricians work in teams, so your doctor may not be the one on-call when you are in labour or when you give birth. 

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Depending on the hospital where you give birth, there may also be medical residents (and students) working with the staff doctor on duty. The medical resident and/or staff doctor on-call may introduce themselves at some point during your labour before leaving you in the care of the nurses. 

The nurses will communicate with the doctors periodically throughout your labour.

The obstetrician may come to evaluate your cervix and assess your labour progress. They will likely offer certain medical interventions to speed up your labour, such as artificially rupturing your membranes (AROM) or prescribe synthetic oxytocin given intravenously, to increase the intensity of your contractions. These are also known as “active management of labour”. Each of these interventions has risks and benefits depending on your particular circumstances. One of the risks to consider is the cascade of interventions, where one intervention leads to another which leads to another. Sometimes these interventions are needed for a specific medical reason, other times, it is the usual “routine” of “actively managing labour”. You can ask questions in order to make an informed choice about whether or not you want to accept these interventions. 

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When you are ready to give birth, especially if it is your first time, you will typically begin pushing with the nurses, and the physician will arrive when your baby’s birth is more imminent. You may be able to begin pushing with the nurses in various positions that are comfortable and instinctive for you. However, when the obstetrician arrives, they will most likely encourage you to move into a position lying on your back (lithotomy), as this is the position that obstetricians are most familiar with. This is the position in which they were trained to perform assisted deliveries (forceps and vacuum assisted deliveries) and other birth interventions (ex. episiotomy). You are also more likely to be instructed to use coached closed-glottis (obstetrical pushing technique similar to valsalva maneuver) rather than pushing spontaneously with open-glottis. The nurses continue to provide care to you throughout labour and birth. 

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Note: In Quebec, obstetricians are the only medical care provider authorized to assist breech vaginal births; however, many do not have adequate training and experience, so it is left to chance whether the obstetrician on-call for your birth is willing to assist a breech vaginal birth or if they will do a cesarean section.

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What can I expect as postpartum care for me and my baby after I give birth?

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After you give birth, the doctor will ensure that you and your baby are well. They will perform any perineal repair (stitches) as needed. Nurses will continue to provide postpartum care. 

Your doctor or one of their colleagues on duty will assess you and a pediatrician will assess your baby before you are discharged from the hospital 24-36 hours after giving birth. They will give you instructions to make an appointment for follow-up in 6 weeks for you. You will need to find a family doctor or pediatrician (ped. only if your baby needs specialist care) to do follow-up for your baby.  

Once you are home, a nurse will call you from the CLSC within the first week home to do a phone assessment. If this is your first time coming home with a baby, the CLSC will offer you a home visit; otherwise, they may only offer phone assessment and support.