What is an obstetrician?
It is not unusual to be asked: “What is an obstetrician?” An obstetrician is a specialist medical doctor who looks after (manages) women who are pregnant. An obstetrician also manages a woman and her unborn baby in labour and delivers her baby and looks after her in the postnatal (immediately after delivery) period. Obstetric care is usually considered to end at the six-week postnatal visit.
An obstetrician also manages complications of pregnancy, labour and delivery, and in the immediate postnatal period. This includes medical complications of the woman in pregnancy and labour, the baby’s size, position and wellbeing while in the womb, and multiple pregnancies. The obstetrician should be skilled in all aspects of antenatal (pregnancy), all aspects of labour management, doing normal vaginal deliveries, doing operative vaginal deliveries, dealing with perineal, vaginal, cervical and uterine trauma with birth, doing Caesarean section deliveries and other pregnancy and delivery surgery related concerns and procedures.
The obstetrician may request other doctors to assist in management as relevant. Such other doctors may be endocrinologists (diabetes and thyroid disease), renal physicians (renal problems, severe hypertension and pre-eclampsia), haematologists (blood disorders), surgeons (surgical problems), urologists (ureteric or kidney stone, compressed ureter), anaesthetists (epidural and general anaesthetic), surgical assistant (to assist with Caesarean section delivery), etc. Once the baby is delivered, it is no longer the responsibility of the obstetrician. A paediatrician will be asked to manage the newborn baby.
In Australia, the specialist medical training (beyond that of becoming a medical doctor) to enable a doctor to be an obstetrician is through the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).
Training to become an obstetrician
The training and study to become and remain an obstetrician is considerable. Someone wanting to be an obstetrician needs a sufficient result in the Higher School Certificate (HSC) to enter a suitable university degree course. For many Australian universities, the medical training program is now a graduate training program, meaning the aspiring doctor first needs to pass a suitable undergraduate degree before being considered for enrolment in medical school. This undergraduate course usually takes three years to complete. The graduate medical school training program is usually for four years. Some universities have an undergraduate medical school entry with the course being longer (five to six years). In my case, I went straight from high school to the Sydney University School of Medicine. The medical course was six years.
Having passed the university medical training program, the junior doctor needs to be successful in achieving a suitable hospital resident appointment. Then the aspiring obstetrician needs to be accepted into the RANZCOG specialist training program. After years of study and hospital work and passing all necessary RANZCOG examinations and other criteria, the aspiring obstetrician qualifies as a Member of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (MRANZCOG). It usually takes six years of training with the RANZCOG.
After a number of years of working as a MRANZCOG obstetrician, and after fulfilling all necessary RANZCOG criteria, the junior MRANZCOG obstetrician can apply to become a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (FRANZCOG).
After my junior doctor residency years in Sydney, I started my specialist obstetrician training in Sydney and completed it in the United Kingdom. I am a Fellow of the Royal College of Obstetricians and Gynaecologists (United Kingdom) (FRCOG) as well as being a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (FRANZCOG).
In my case, it took 14 years of work, study and passing examinations and other criteria after I finished high school before I became an obstetrician (MRANZCOG and MRCOG).
The RANZCOG requires all obstetricians to continue study and training so they are up to date with knowledge and so the RANZCOG has a formal Continuing Education Program that all obstetricians need to re-pass every three years to remain qualified as an obstetrician.
Obstetrics and gynaecology
The RANZCOG training is in both obstetrics and gynaecology. While obstetrics is about the care of the pregnant woman, gynaecology is about the care of the non-pregnant woman. Gynaecologists don’t do breast surgery though. Most obstetricians also practice as gynaecologists. Some gynaecologists have stopped doing obstetrics.
There is an opportunity for a graduate obstetrician gynaecologist to enrol in further training in a specific craft (subspecialty) in obstetrics or gynaecology and so he or she becomes a RANZCOG accredited subspecialist. The large majority, if not all, of a subspecialist’s work, will be in this subspecialty. Subspecialties are in gynaecological oncology, maternal and foetal medicine, obstetrical and gynaecological ultrasound, reproductive endocrinology and infertility (CREI) and urogynaecology.
While over the years I have gained considerable training and expertise in most areas of obstetrics and gynaecology, I have now deliberately chosen to focus on the area of work I love the most – pregnancy care. So, the majority of my patients are pregnant women.