OB is short for obstetrics, or an obstetrician. An obstetrician is a physician who is responsible for the delivery of a baby. However, obstetrics does not stop at delivery, but the entire process of ensuring a woman remains healthy throughout her maternity. Obstetrics includes pregnancy, labor, childbirth, and the postpartum period.
GYN refers to the field of gynecology. A gynecologist is a physician who focuses on the treatment of diseases associated with female reproductive organs. This includes diagnosis, treatment, and care of the vagina, uterus, ovaries, and fallopian tubes. Gynecologists also screen and treat problems relating to women's breasts. Gynecologists focus on women's health from puberty to adulthood.
Quite literally, the word gynecology actually means "the study of women" from the Greek "gyno," or "gynaikos," to mean woman and "logia" meaning the study. Today, gynecology specifically refers to the treatment of reproductive organs.
The term OB-GYN can refer either to the specific doctor, an obstetrician-gynecologist, or to the general study of obstetrics and gynecology.
What is an OB-GYN?
Put together, OB-GYNs, or obstetrician-gynecologists, are physicians who are responsible for both the delivery of babies and treating diseases that occur in female reproductive organs. OB-GYNs care for women's health throughout many different stages, from menstruation, to childbirth, to menopause, and practically everything in between.
Obstetrician-gynecologists are highly trained in female reproductive health, pregnancy, and childbirth; however, they vary on their focuses. Certain OB-GYNs are available for general health services, much like your primary care doctor, while others focus solely on specifics of the female reproductive system.
What do OB-GYNs do?
Some OB-GYNs offer general health services and information on the female reproductive system, while others focus exclusively on reproductive health and wellness.
On top of routine medical appointments, OB-GYNs also offer preventative screenings for diseases related to the reproductive system.
Some of the most common reasons for visiting an OB-GYN include abnormal bleeding, infertility, pelvic pain, hormonal disorders, genital itching, breast disorders, urinary incontinence, endometriosis, and urinary tract or vaginal infections. However, there is a wide array of services offered by OB-GYNs, so a patient's age, health, and reproductive goals will impact their motives for visiting an OB-GYN.
History of OB-GYNs
In only the third century, Greek physician Metrodora is believed to have written the oldest medical text by a woman, called "On the Diseases and Cures of Women." It was used for centuries by doctors in the treatment of women, discussed sexually transmitted infections, gynecological examinations, and more.
In Switzerland in around the year 1500, Jakob Nufer was the first person to successfully complete a cesarean delivery with the mother living. It just so happened that the mother was his wife, and she went on to have five more children.
Around 1700, the first successful ovariotomy was completed by Robert Houston. There is debate over whether it was truly the first successful ovariotomy or the first ovarian cyst drainage. Despite a vagueness surrounding the specifics, Houston made history by being the first to drain a large ovarian cyst.
In 1795, Alexander Gordon put forward that puerpal sepsis could occur from an infectious contagion. He came to this conclusion from an observational, epidemiological study that took place in Aberdeen, Scotland.
In 1809, Ephraim McDowell conducted the first successful ovarian cystectomy. The patient was Jane Todd Crawford, who was a cousin of Mary Todd Lincoln. She decided to go forward with the procedure after her physician informed her of his belief that she was suffering from a "post-term pregnancy." Formerly, patients of this sort would die slowly and painfully, so she opted for an experimental surgery, and fortunately made a complete recovery.
Shortly after, in 1812, the first modern vaginal hysterectomy was completed; however, it was partially an accident. G.B. Paletta aimed to extract a cancerous tumor from a patient's cervix. Afterward, he realized that he actually removed the entire uterus. Unfortunately, the patient died three days later, rendering the surgery unsuccessful. In following years, more hysterectomies would occur intentionally but not one was successful until 1853, over forty years later.
In 1846, ether was first administered to a woman giving birth, marking the beginning of numbing the pain during delivery. The next year, chloroform was first used as an anesthetic.
In 1849, vesicovaginal fistula was successfully treated with surgery for the first time.
The 1860s brought many advances; in 1866 came the first case of artificial insemination. Three years later, the first operative hysteroscopy was conducted.
Robert Lawson Trait is one of the biggest names in the history of OB-GYN. In 1872, he administered the first oophorectomy for sepsis. In the same year, he also conducted the first bilateral oophorectomy for menorrhagia. Seven years later, he conducted the first successful cholecystostomy. In 1880, he was responsible for the first removal of a hydatid cyst and the first appendectomy for acute appendicitis. He also completed the first successful salpingectomy for ectopic pregnancy.
In 1882, Max Sänger first described the classical Cesarean Section technique, including the closing myotomy, that would go on to be a pillar in the field.
In 1900, spinal anesthesia was first used in labor, introduced by obstetrician Oskar Kreis. The next year, obstetrician Walter Stoeckel first used an epidural anesthesia.
In the early 1900s, Marie Stopes came on to the scene, and changed the OB-GYN field forever. Her largest and most famed contribution was the book "Wise Parenthood," which came out in 1918. She gave it away for free, and although it was only 16 pages, it was full of information on contraception, and advice on how women could take control of their fertility - and therefore, their lives. Along with her book, she would offer advice to women who would write her letters about marriage, sex, and birth control.
In 1941, George Nicholas Papanicolau introduced the first screening test for cancer, specifically for cervical cancer.
In 1942, penicillin was first successfully administered to a human patient to treat septic abortion.
In 1944, the modern laparoscopy technique was introduced by gynecologist Raoul Palmer.
Virginia Apgar was an obstetrical anesthesiologist at the top of her field, and she also dedicated much of her life to research. In 1953, she created what is now referred to as the Apgar score, which is a way to rank the health of newborn babies. Apgar went on to fight against mothers transmitting rubella to their children whilst pregnant during the rubella pandemic. She also promoted Rh testing, which was significant in identifying women's risk for miscarriages.
In 1958, Ian Donald developed the Ultrasound, originally with the intent of being used for obstetrics, which would go on to change not only the OB-GYN field, but numerous other medical areas.
In 1978, Patrick Christopher Steptoe was responsible for the first successful in vitro fertilization.
More breakthroughs in the OB-GYN field occur daily, as it is constantly evolving. Women are now strengthening their reproductive systems more than ever before, taking control of their own bodies, and carrying out pregnancies at an older age than previously considered possible.
Procedures Offered by OB-GYNs
OB-GYNs are often trained in certain major and minor surgeries, such as biopsies, dilations and curettages, laser surgeries, tubal ligations for female sterilizations, hysterectomies, and myomectomies. Certain procedures are inpatient while others are outpatient.
Common procedures that OB-GYNs offer during pregnancy, childbirth, and postpartum include in vitro fertilization, vaginal delivery, cesarean delivery, forceps and vacuum deliveries, and amniocentesis to determine the sex and any potential abnormalities of the baby.
As mentioned, OB-GYNs also often offer preventative tests and screenings, which are important especially if you are at a heightened risk for a certain disease. These screenings normally include, but are not limited to, pelvic exams, pap smears, clinical breast exams, mammographies, and cancer screenings.
Where can you find OB-GYNs?
OB-GYNs are often available through private practices, while others are involved in medical groups or hospitals.
Subspecialties of OB-GYNs
While the vast majority of OB-GYNs are generalists, at approximately 90 percent, others specifically offer services in subspecialties instead of a wide umbrella of services. Here are a few of the most common subspecialties.
Reproductive endocrinology and infertility
OB-GYNs who focus on reproductive endocrinology and infertility treat problems that are associated with either infertility or the glands and hormones within the endocrine system. These OB-GYNs are often who you would visit if you were having struggles conceiving when attempting to become pregnant. Reproductive procedures they normally offer include in vitro fertilization, gamete intrafallopian transfer, zygote intrafallopian transfer, and embryo transfer.
Female pelvic medicine and reproductive surgery
OB-GYNs who specialize in female pelvic medicine and reproductive surgery primarily treat women who are suffering from urinary tract disorders. They also often specialize in disorders associated with the muscle and connective tissue of the pelvic floor, which is the located directly underneath the pelvis. Such problems associated with the pelvic floor normally revolve around weakness that comes with specific medical problems, pregnancy, or age.
OB-GYNs with the subspecialty of female pelvic medicine and reproductive surgery treat pelvic organ prolapse, urinary or fecal incontinence, bladder pain, overactive bladder, vaginal or urinary tract infections, and more.
Gynecologic oncology
OB-GYNs with a subspecialty in gynecologic oncology focus on the diagnosis and treatment of cancers that occur within the female reproductive system including the cervix, uterus, ovaries, vulva, and more.
Maternal-fetal medicine
OB-GYNs who specialize in maternal-fetal medicine focus on the treatment of those with high-risk pregnancies and medical conditions that are associated. These include chronic or gestational high blood pressure, blood-clotting disorders, gestational diabetes, premature labor, and more.
Why should I see an OB-GYN?
In general, both in your reproductive health and other areas of your wellbeing, the best approach is preventative care as opposed to waiting for a problem to arise and treating it. Therefore, even if you are feeling perfectly healthy and have not experienced any signs of problems relating to your reproductive health, you should still visit an OB-GYN annually for a preventative checkup. During such visits, evaluations, immunizations, and lab tests may be done, largely depending on your age group and risk factor. Pelvic exams will also be conducted.
You should see your OB-GYN whenever you undergo a noticeable change in your reproductive cycle, even if you have already visited them within a year. Even if these changes are expected, normal, or even planned, you should visit if you experience your first menstrual cycle, pregnancy, perimenopause, or menopause. Of course, if alterations to your reproductive cycle are abnormal or unexpected, then it is especially important to visit your OB-GYN. Such changes include pain during urination, pain during intercourse, heavier or lighter menstrual bleeding than normal, more or less frequency of menstrual bleeding than usual, and unusual cramping.
If you are sexually active, it is important to visit your OB-GYN for birth control, contraception, sterilization, urinary tract infections, abnormal vaginal discharge, vaccination against the human papilloma virus, treatment and prevention of pain during sex, advice on preventing or treating sexually transmitted infections or HIV, as well as general advice on safe sex. OB-GYNs can act as more than just doctors, but figures who can offer guidance when it comes to decisions regarding sex and pregnancy.
If you are pregnant, or trying to become pregnant, OB-GYNs can offer assistance regarding the planning of your pregnancy, infertility treatment, postpartum depression, labor and birthing options, genetic testing and screenings, advice on breast-feeding, prenatal care, and even advice on how to alter your diet.
If you have noticed pain either before or during menstruation, OB-GYNs are there to assist you in questions you might have regarding easing cramps, cysts and fibroids, premenstrual syndrome, mood swings, irregular or abnormal bleeding, and pelvic support problems.
For those who are going through menopause, or who have already been through menopause, OB-GYNs can offer assistance regarding low libido, incontinence, vaginal dryness, hot flashes, bone loss, and hormone replacement therapy.
How do I choose an OB-GYN?
Some women actually have an OB-GYN instead of a primary care physician; however, not all OB-GYNs offer such robust services. If you already have an OB-GYN, you can discuss with them whether or not they are comfortable serving in that capacity.
If you do not yet have an OB-GYN, you should take the decision very seriously. The OB-GYN you choose may vary on what stage of your life you are in.
You should decide on what qualities you want in your doctor beforehand, which will make the research and eventual decision far easier. For example, some women specifically desire a certain gender, or require specific credentials and track record. For some, after-hours availability and accessibility within a certain hospital is crucial. So, if you know that you have any such-deal breakers, find out this information first to rule out OB-GYNs who are not a fit for you.
You may also want to start out with seeing which OB-GYNs are included in your insurance plan, as this could rule out many potentials and make your decision easier. Stephanie McClellan, M.D. is an OB-GYN based in California, and she explains the importance of choosing someone who is in-network for many who are making the decision, "for some women, minimizing any out-of-pocket expenses is their number one priority." However, that does not mean you have to choose someone covered by insurance. If you believe you can afford it, and are absolutely set on a certain doctor, then go for it!
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You should also listen to recommendations from your friends, as well as your regular gynecologist, if you have one. In conversation, bring up the fact that you are looking for a good OB-GYN, you never know who will have some advice that will change your life! Recommendations are extremely important, and, if possible, you should never make a choice without one. Normally, your regular gynecologist, or even your primary care doctor, will be able to recommend specific doctors. If you have a specific hospital in mind, you could acquire a list of doctors who operate there.
Online reviews can also be extremely helpful. Maybe you are interested in someone that none of your friends have visited, but you do not want to go in without any information - so look them up! You may find that practically everyone who has visited the doctor has loved them, or that you should probably make an appointment with someone else. Websites like Health Grades, Vital, and Share Care are quick and easy places to get started on your internet detective work. Online, you can also visit each doctor's website where you will be able to also find their credentials, services, philosophy, and testimonials.
Of course, you may fall in love with an OB-GYN only to find that they are not taking new patients, or that it is extremely difficult to get an appointment. For some, a doctor with very little availability is not a problem, while others find it off-putting. If it is an issue for you, make sure to ask about their availability when you have an introductory visit.
During this introductory visit, you should also have a few questions in mind to see if they are the right fit for you. Normally, they should be three or four questions about some deal-breakers you might have in deciding on a doctor. McClellan explains why these are crucial to ask, "the point of the questions aren't necessarily the answers but to find out how easily you're able to dialogue with your doctor. Are you having a conversation that's bidirectional, effective, and open? Can you picture entrusting your pregnancy this person?" If not, don't be afraid to take them off the list of possibilities.
There are also some questions you should ask yourself while you are there. Do you feel welcome in the office? Did you have to wait longer than you are comfortable with? Do you feel they communicate with you well? Are the staff there helpful? Be honest with yourself in answering questions that are important to you, and do not opt for a doctor that makes you feel as if you might be settling. After all, it's a very important decision, and they will have a large role to play in your life.
Finally, you have decided on your OB-GYN. But before you throw that list of back-ups away, keep in mind that just because they nailed the first visit does not mean that everything will always go perfectly in the future. So, don't forget about the other doctors that you liked when you visited them, as you never know when they might prove to be a better fit. If you do make the decision to change doctors, explain to your new doctor why you made the decision. McClellan explains why this improves care, "from a doctor's perspective, it's difficult to switch practices mid-care because you're always worried that you're not getting the whole story. You don't want to jump into something extreme and not be able to please the patient because what they want isn't clear - not even to them."
So, think of your relationship with your OB-GYN a bit like a relationship with a potential partner. Make sure that you're comfortable and respect them, but be positive that they are listening to you and fulfilling your needs in return. Of course, open communication from both sides is key.
How do you become an OB-GYN?
To become an OB-GYN, a candidate must have successfully been awarded a bachelor's degree, and completed four years of medical school training. Upon the conclusion of medical school, a four-year graduate-level education as a resident in the field of obstetrics and gynecology is required. During residency, candidates get first-hand experience learning about everyday reproductive problems, including diagnosis, treatment, management, and prevention. Residencies occur under the management and direction of a doctor within a medical institution, often hospitals.
After residency, a three-year training period of specialty is required. Then, the candidate must pass a specialty board certification exam, under the supervision of the American Board of Obstetrics and Gynecology.
Upon successful completion and the award of a certification, a "maintenance exam" is required every six years.
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