I am asked from time to time: What is an obstetrician? What is the difference between an obstetrician and a gynaecologist? What is the difference between an obstetrician and a midwife?
What is an obstetrician?
An obstetrician is a specialist medical doctor. An obstetrician has had specialist doctor training in the management of women during pregnancy, childbirth and the postnatal period.
The training to become a doctor is through a university with an undergraduate medical school. In my case it was six-year undergraduate medical course.
The extra training to become an obstetrician is postgraduate and in Australia through the Royal Australians and New Zealand college of Obstetricians and Gynaecologists (RANZCOG). This is usually another six years. This specialist training commences at least one to two year after graduating from university as doctor.
It was 16 years from when I left school before I started working a specialist obstetrician doctor.
The practical specialist obstetrician training is at a teaching hospital with a maternity department. There are obstetrician supervisors for the trainee obstetricians. Clinical training and experience comes through supervised activities such as deliveries (normal and operative) and operations (such as Caesarean sections) on public patients.
What is the difference between an obstetrician and a gynaecologist?
The RANZCOG training is in both obstetrics and gynaecology. So when a specialist starts working they see patients for both obstetrics and gynaecology reasons.
An obstetrician manages pregnant women (both normal and abnormal) while a gynaecologist manages non-pregnancy women who have problems to do with their female reproductive system or for well-women check-ups, contraception, etc. Both obstetricians and gynaecologists are trained to do surgery as is appropriate.
Some specialist obstetrician gynaecologists become subspecialists in particular field of work. That requires extra training through the RANZCOG. You can check if someone is a qualified subspecialist by the extra qualifications after their name. The RANZCOG subspecialty disciplines are in gynaecological oncology (cancer) (CGO), maternal and foetal medicine (CMFM), obstetrical and gynaecological ultrasound (COGU), reproductive endocrinology and infertility (IVF, etc.) (CREI) and in urogynaecology (pelvic floor and bladder problems) (CU). To maintain their subspecialty qualification the large majority of patients the subspecialist sees must have problems in be in their subspecialty discipline. That mean such doctors should see usually these doctors see few (if any) patients who don’t have problems related to their subspecialty. I only use subspecialists who confine their work to their subspecialty as I have found over years that those who don’t have tried to poach patients who don’t need their subspecialty expertise to try to increase their general patient workload.
As well there are some gynaecologists who focus on a gynaecological problem or particular gynaecological surgical area, which is not recognised by the College as a subspecialty. This includes difficult advanced laparoscopic surgery, the surgical treatment of endometriosis, etc. This gives them greater expertise in treating patients with gynaecological problems related to their field of interest.
All obstetricians and gynaecologists can see patients with a full range of issues but they will usually involve in patient care a subspecialist or a colleague with a business focus in an area of work when appropriate.
As there are some obstetrician gynaecologist doctors who focus on gynaecology and don’t do obstetrics. There are others who focus on obstetrics.
I focus on obstetrics. I enjoy it and I am very experienced at it.
I do see gynaecology patients. I am very happy to provide office gynaecology services and I have patients who have been seeing me for decades for their well-women checks. I do gynaecological surgery. Over more recent years with the advent of subspecialties and colleagues with a business focus in a gynaecological problem I consider it logical to refer a patient on to a colleague who has a business focus in the relevant gynaecological area of work. This means I can focus on my business focus of work (pregnancy) and patients who has a problem outside my business focus of work will be attended by a colleague who has a business focus in their problem. GPs often don’t have the knowledge base to know who is the right person for a patient to see. I do. So I am happy to assess a patient and decide about this, knowing that I am not going to try and be the ‘jack of all trades’.
What is the difference between an obstetrician and a midwife?
The Australian College of Midwives on their website states ‘a midwife is a qualified health professional, trained and committed to providing care, education, advice and support to women during pregnancy, labour and delivery and the initial six week postnatal period.’
Midwives are members of the nursing profession who express their midwifery skills in a variety of ways.
As a Director of Hamlin Fistula Australia in my visits to Ethiopia I have met midwives working alone in remote rural areas (sometimes without electrical and running water) who do the most amazing and highly skilled procedures in supporting women in childbirth.
In Australia midwives are not trained in the same range practical skills as midwives in Ethiopia. Midwifery training in Australia primarily equips midwives in management of uncomplicated pregnancy, uncomplicated childbirth, uncomplicated postnatal period and in lactation problems.
There is a small number of midwives in Australia who work independently and who focus on home births. They are usually unsupervised. They are expected to refer a patient to the local public hospital when there are abnormal developments or the patient is a ‘high risk’ of pregnancy and/or childbirth complications.
Most midwives in Australia are employed by a hospital as members of the nursing staff. The relationship between the patient, obstetrician and midwife in Australia in the hospital context varies depending on whether the patient is to be confined as public or private patient.
The midwife is usually the primary care provider for public patients. The midwife is expected to contact the hospital obstetric medical staff when there is a need. While a public patient is ‘nominally’ admitted under the care of the ‘on take’ obstetrician for that day, that obstetrician usually is not involved in the patient’s care and all the care is usually done by the midwifery staff supported by the junior medical staff. This is with the exception of high-risk patients and in country hospitals if there are no junior medical staff.
For private patients the obstetrician is the primary care provider and the midwife supports the obstetrician in the management of the private patient. Both private or public hospitals have private care patients.
Midwives are employed as members of the nursing staff by the hospital. Obstetricians working in public hospitals may be employed as members of the medical staff by the hospital. A fully qualified obstetrician doctor employed by the hospital is called a ‘staff specialist’. Some staff specialists have the right to admit a certain number of their own private patients. There are also private obstetricians working in public hospitals.
An obstetrician working in a private hospital (e.g. me) is not employed by that private hospital and receives no financial renumeration from the hospital. Obstetricians looking after private patients in a public hospital are not reimbursed by the public hospital for management of their private patients.
In summary obstetricians are primarily trained to look after the abnormal developments of pregnancy, labour and childbirth, to do Caesarean sections and other obstetric related operations and procedures and in the management of complications of the postnatal period. They are though the primary care provider for their private patients when there is normal pregnancy, normal childbirth, uncomplicated postnatal care. Midwives are trained in the management of pregnant women with uncomplicated pregnancy, uncomplicated childbirth, uncomplicated postnatal care and in lactation problems. They are usually the primary care provider of uncomplicated public patients and are expected to involve obstetric trainee or trained doctors in patient management when there are abnormal developments.
