Obstetrical care is the medical specialty dedicated to the health and well-being of a person during pregnancy, childbirth, and the immediate postpartum period. This branch of medicine focuses on two patients simultaneously: the expectant parent and the developing fetus. The goal is to monitor physiological changes during gestation and manage risks, ensuring a safe outcome for both. Care spans routine monitoring for uncomplicated pregnancies to specialized interventions for higher-risk situations.
Primary Care Providers in Obstetrics
Care during pregnancy is delivered by a variety of trained professionals who collaborate to meet diverse patient needs. Obstetricians (OBs) are physicians (MD or DO) who complete a specialized residency in Obstetrics and Gynecology. They manage both routine and complicated pregnancies and are surgical specialists qualified to perform Cesarean sections and other necessary procedures.
Certified Nurse Midwives (CNMs) are advanced practice registered nurses with graduate-level education in midwifery. CNMs manage low-risk pregnancies, focusing on a holistic, patient-centered approach, and typically attend births in hospitals or birth centers. Family Practitioners, who are also physicians, often provide comprehensive maternity care, including prenatal visits and delivery, especially in areas where specialist access is limited. These providers often consult or refer patients to an obstetrician if risk factors develop.
Routine Care Across the Pregnancy Timeline
The standard obstetrical journey is divided into three phases: prenatal, labor and delivery, and postpartum.
Prenatal Monitoring
Prenatal care involves a structured schedule of regular appointments, beginning monthly, progressing to bi-weekly around 28 weeks, and becoming weekly from 36 weeks until birth. At these visits, the provider monitors the expectant parent’s weight, blood pressure, and checks a urine sample for signs of infection or preeclampsia. Fetal health is assessed by measuring the uterine fundal height and listening to fetal heart tones using a Doppler.
Prenatal Screening
Routine screening tests are performed throughout the pregnancy. These include blood tests in the first trimester to check blood type and screen for infectious diseases. An anatomy scan ultrasound is performed around 20 weeks to evaluate fetal development and placental location. Screening for gestational diabetes occurs between 24 and 28 weeks, and a swab for Group B Streptococcus bacteria is done near 36 weeks to guide antibiotic use during labor.
Labor and Delivery
During labor and delivery, obstetrical care manages the progression of contractions and fetal well-being while offering various pain management options. Neuraxial anesthesia, such as an epidural, is the most effective pharmacological method used in hospital births. Non-pharmacological techniques, including hydrotherapy, massage, and breathing exercises, are also supported to help manage the intensity of labor. Providers are prepared to manage a vaginal birth or intervene with an operative delivery, such as a Cesarean section, if complications arise.
Postpartum Care
Postpartum care begins immediately after birth and extends for up to 12 weeks, focusing on maternal recovery and newborn adjustment. Initial hospital care involves monitoring the patient’s vital signs and checking for excessive bleeding or infection. The provider assesses the physical healing of any perineal tears or surgical incisions and supports initial infant care, such as feeding and safe sleep practices. A comprehensive follow-up visit is recommended by 12 weeks postpartum, including screening for emotional health concerns like postpartum depression and discussing family planning.
Addressing High-Risk Pregnancies and Complications
A pregnancy is classified as high-risk when a pre-existing condition, maternal age (under 17 or over 35), or a complication during gestation increases the chance of adverse outcomes for the parent or the fetus. Conditions like chronic hypertension, pre-existing diabetes, or a history of preterm birth require intensive management.
Specialized care often involves a Maternal-Fetal Medicine (MFM) specialist, an obstetrician with three additional years of training in high-risk conditions. These pregnancies receive enhanced monitoring, including more frequent prenatal visits and targeted fetal surveillance. Monitoring tools include biophysical profiles (BPP) and non-stress tests (NST), which use ultrasound and fetal heart rate tracking to assess fetal well-being.
Specific complications like preeclampsia, characterized by new-onset high blood pressure and organ damage after 20 weeks, require close management, sometimes including medication or planned early delivery. Specialized monitoring is also essential for multiple gestations, such as twins or triplets, to track fetal growth and manage the higher risk of preterm labor.
The Distinction Between Obstetrics and Gynecology
While often practiced together by the same physician, obstetrics and gynecology are distinct medical fields. Obstetrics focuses on the care of the patient during pregnancy, labor, and the period immediately following childbirth. The obstetrician’s expertise centers on the unique physiology and potential complications associated with carrying a fetus.
Gynecology, by contrast, is concerned with the health of the female reproductive system across the lifespan, independent of pregnancy. This includes routine wellness exams, managing menstrual disorders, treating infections, and addressing conditions of the uterus, ovaries, and fallopian tubes. The specialties are often bundled because they require a shared understanding of the female reproductive system, but they address fundamentally different health states.