A helping hand
An obstetrician is a doctor who specialises in the care of women in pregnancy, labour and after birth. Your obstetrician has many roles throughout your pregnancy – they may be an adviser, an observer, a physician, a surgeon and a counsellor – as is appropriate to your needs to ensure that your pregnancy and birth is as stress-free as possible. This may include providing expert advice, practical care and a hand to hold pre-conceptually, throughout your antenatal stage, in labour and after your delivery.
If you have a pre-existing medical condition such as diabetes, epilepsy or high blood pressure, you should see an obstetrician before you become pregnant or as soon as you know that you are. A specialist will discuss the impact of pregnancy on your condition, how your condition might affect pregnancy and review the suitability of your medication. Speak to an obstetrician if you are at risk of specific genetic disorders (such as cystic fibrosis), so that a diagnosis can be made and information offered concerning the risk of inheritance.
Once you are pregnant your health status will be risk assessed. If there is a particular concern, your midwife or GP will refer you for an appointment with an obstetrician, such as previous complications in pregnancy or chronic illness. You can ask to see an obstetrician if you have any concerns that you want to discuss. Obstetricians assess the health of your baby by monitoring the fetal heart rate and through ultrasounds for growth. In some hospitals, obstetricians specialising in fetal medicine perform all ultrasound scans in complex high risk pregnancies, or where problems have been identified. In some cases, especially high-risk pregnancies, your obstetrician may offer genetic testing and testing of the amniotic fluid.
You may be sent to a hospital antenatal clinic at certain points of your pregnancy – for example, if you have had a caesarean in the past, if you are expecting twins or if a midwife has detected a possible problem, such as high blood pressure or the baby not moving.
If labour comes on naturally, is uncomplicated and at full term, many women will not need an obstetrician. However, should problems develop obstetricians, in addition to midwives, may be present. As well as monitoring your progress in labour, your obstetrician will review your baby’s condition and respond to changes – for example, if your baby’s heartrate alters.
If you go into labour prematurely your specialist may try to stop it, prescribe drugs to help the baby’s lungs, or arrange for you to be transferred to another hospital for extra care.
If you bleed heavily during pregnancy or labour, an obstetrician will make sure that you don’t have a serious condition such as a low-lying placenta or placental separation.
Your obstetrician will be called if there are signs your labour is complicated. Two common reasons include:
• Your baby’s heart rate is causing concern because they are not coping well. In this case, your doctor may take a small sample of blood from your baby’s scalp and test it to see whether your baby has the strength to continue with labour.
• Your contractions are not dilating your cervix enough. Here, your doctor may recommend breaking your waters, as this helps to speed up labour, or start an oxytocin (hormone) drip to improve your contractions.
If your obstetrician is still concerned about your labour, they will consider an emergency caesarean or deliver your baby vaginally by using either forceps or a ventouse (vacuum) cup for your safety and baby’s.
WHAT ABOUT AFTER DELIVERY?
As with antenatal care and labour, if your postnatal period is uncomplicated, you will be looked after by midwives. Your obstetrician will manage any complications that occur, such as infection, heavy bleeding, high blood pressure, blood clot formation, wound or breast problems. If you needed an obstetrician during your pregnancy or labour, it’s likely that you will see one after delivery, to debrief you on the specialist attention you received during labour and advise you on future pregnancies. If you developed high blood pressure during pregnancy or labour your specialist will monitor and control it after the delivery. Women who experienced lots of bleeding during labour or after delivery will be seen to ensure that they don’t need a transfusion, iron supplements or to drain a haematoma (collection of blood) if developed. If you are still bleeding heavily after giving birth, your specialist will need to see you. An obstetrician will also counsel you if you experienced difficult problems in your pregnancy or labour, such as losing the baby.
Your obstetrician will be on hand in the event of an emergency:
SHOULDER DYSTOCIA – when the baby’s shoulder gets caught on your pubic bone during delivery.
CORD PROLAPSE – when the umbilical cord comes out before the baby. This can cut off the oxygen supply to the baby.
Eclamptic fit, heavy bleeding, retained placenta, haemorrhaging, severe perineal tears or trauma are other examples of emergencies.
Shree Datta, RCOG, is a Consultant Obstetrician and Gynaecologist at King’s College Hospital, London
Q What are my choices for birth after a caesarean delivery?
A Both a vaginal delivery or caesarean may be safe in any future pregnancy. You and your obstetrician or midwife will consider your chance of a successful vaginal birth, your personal wishes and future fertility plans when making a decision about vaginal birth or caesarean delivery.
Q If I need to be induced, how will this be done?
A You will only be induced into labour if this is best for you and your baby and the method used will depend on your needs. There are three steps to being induced – prostaglandin gel or tablets are inserted into the vagina to soften and open the cervix, your waters can be broken, or you will be given an oxytocin hormone drip.
Q Why do some women have a ventouse or forceps delivery?
A There are several reasons for needing an assisted vaginal delivery, for example, if there are concerns about the baby’s wellbeing during birth or if the baby is not moving out of the birth canal as would normally be expected. Additionally, if you are unable to or have been advised not to push during the birth, you may be offered a ventouse or forceps delivery.