September 26, 2025 • 23 mins
We dive deep into the often-misunderstood role of obstetricians during labor and birth, revealing why they're typically not present throughout the entire process despite their crucial medical expertise. Understanding the true role of each birth team member helps set realistic expectations and creates space for better collaboration.
• OBs are medical doctors with extensive training who specialize in pregnancy, birth, and reproductive health
• During labor, OBs monitor from afar, reviewing health history and making decisions about interventions when necessary
• Continuous bedside support comes primarily from nurses, partners, and doulas, not from the obstetrician
• OBs typically appear near the end of pushing stage to manage delivery, the placenta, and any complications
• The energy shift when an OB enters the room can revitalize a tired birth team at a critical moment
• OBs' expertise is most crucial during high-risk pregnancies, emergencies, and complicated labors
• Understanding your specific OB's philosophy and communication style helps create realistic expectations
• Creating a complete birth team means recognizing what each person contributes to the experience
• When birth teams collaborate with clear communication and mutual respect, birthing people feel safer
As always, I want to close with making human connection. Please make a positive human connection today. You'll need it, and somebody else will as well. The joy you bring might change someone's entire day.
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Show Credits
Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:10):
Welcome to the Ordinary Doula Podcast with
Angie Rogier, hosted by BirthLearning, where we help prepare
folks for labor and birth withexpertise coming from 20 years
of experience in a busy doulapractice, helping thousands of
people prepare for labor,providing essential knowledge
and tools for positive andempowering birth experiences.
SPEAKER_00 (00:52):
I'm the host, and today's topic um is I want to
dive into what the role of anobstetrician is during labor and
birth.
So when families, and I hearthis so, so, so many times,
right, over the years, whenfamilies picture their birth and
their birth team, they oftenthink of the OB as being there
(01:12):
every step of the way, right?
Like it's us and our doctor.
Um, but the reality of thatthroughout the process is a
little bit different than thatvision.
Obstetricians bring incrediblemedical expertise to your team.
They are an essential role inmanaging, you know, how labor
goes and managing in pregnancytoo, for that matter, especially
(01:33):
towards the end.
You know, they take up theircare and their observations and
are pretty cautious about a lotof things in all throughout
pregnancy, but especially at theend.
So they manage complications andensuring safety, right?
Medical safety, physical safety,all of that.
But they're not usually the onesthat are sitting there at
bedside.
They're not super presentthroughout the labor process.
That's where, you know, you'regonna be with your nurse a whole
(01:55):
lot more than you are yourdoctor.
Um, you're gonna be a lot oftimes with a midwife a little
bit more than a doctor.
And doulas, you know, you'regonna be with your doula a whole
lot more than a nurse or adoctor.
Um and partners, you're gonna bewith a partner a whole ton,
right?
Um, so we're gonna kind ofexplore exactly what obs do
during labor, when theirpresence is crucial, um, how
(02:16):
their role kind of fits into thebig picture of your birth team.
And whether you're expecting ababy or you're supporting
somebody else who is through thelabor process, um, or if you are
a birth worker yourself, it'sjust important to understand the
scope of an OB's role.
Kind of help set someexpectations and kind of create
a space to collaborate on thebirth team because we do want a
(02:38):
lot of collaboration there.
All right.
So, what is an obstetrician?
An obstetrician is a medicaldoctor.
They specialize in pregnancy, inbirth, and a whole lot of other
stuff like reproductive health,um, hormones, menopause.
Um, obstetricians have prettydeep training, right?
(02:58):
They're gonna, they've gone tomedical school, residency, they
are surgeons, they've hadsurgical surgical training.
Um, so this is can be quitedifferent than midwives and
maybe a family doctor, in thatum their medical training is a
bit more extensive when we getinto some of those more
complicated things.
So during the labor process, therole of an OB is to review
(03:20):
things.
There, they they uh havereviewed and are aware of health
history.
Now you meet with your OB, ifthat's who you've chosen as your
provider throughout pregnancy,right?
So you have visits in earlypregnancy, whether that's you
know, however, whatever weeksyou can get in.
Um I was talking to a very newlypregnant mom a little while ago,
and gosh, they couldn't get herin for like two months, pregnant
(03:43):
or not.
Um, so that was a very busy OBoffice, but you're gonna be
meeting with this OV OB andgetting prenatal care, right?
All throughout the pregnancy.
They review your health history,they're gonna kind of keep tabs
on things, they're gonna get abaseline early on about some
things that they're gonna wantto watch later a little bit
later.
They in little near the laborprocess are gonna be checking on
(04:05):
reasons for induction.
And you want to understandreasons for induction, right?
They're gonna monitor riskfactors that would create
reasons for induction.
Now, sometimes the quote unquotereason for an induction might
be, I'm gonna be out of town.
Or um, you are 39 weeks, or youknow, it just depends.
Like, is that legit to you?
(04:26):
And so dig a little deep withyour doc and see what your
comfort level is on.
Are these true risk factors orare they not?
Um, but they will be checking ona lot of um, that's who helps
you decide on an induction isyour OB.
Nurses don't touch that, doulasdon't touch that.
They may discuss some thingswith you, but that is a decision
you make with your doctor.
Um, during the labor process,OBs are monitoring, right?
(04:49):
Probably from afar, but theyalways have access to um what we
call the strip, like the stripof the heart baby's heart rate,
contractions.
The nurses are gonna be muchmore close to you in proximity
and doing that monitoringphysically.
Um, but the docs have access toit and they can help decide on
um interventions when they needthem.
(05:10):
That might be induction methods,augmentation methods, cesareans,
assisted delivery.
Um, so when there's a big changeand a shift, you better believe
it.
Your OB, if that's who you'reworking with, is gonna be
involved, or your midwife forthat matter.
Um, they may managecomplications such as fetal
distress, shoulder dystocia,hemorrhage, the stuff that comes
up that we don't want to, um,the stuff that sometimes comes
(05:31):
up quickly, that's where theirtraining and expertise comes in.
So if everything is supersmooth, boring, healthy, your OB
skills are set to the side,right?
They still have greatexperience.
They've done this many, manytimes, but their their deep
skill set isn't needed.
It's there for for when we needit, which a lot of the times is
(05:52):
not like anyone can deliver babyif everything is fine, right?
Babies just come on out.
Um, they need somebody to kindof have a catch pad there for
them.
But the obs are there for whenthings get a little bit
interesting, of course.
Um, and they're prepared forthat.
So during labor, they're notsuper present.
They their decisions might bepresent, but physically they're
(06:12):
not present.
They might pop in at lunchtimeduring clinic hours or before
clinic hours or after clinichours, um, before they go home
at night, whatever might thatmight be, but they are not
usually very you don't see thema whole lot.
So many times I've had um thepartner ask or the birthing mom
ask, like, hey, where's mydoctor?
Like, you know, here we aredoing this, like, where are
(06:32):
they?
When do they come in?
And it's usually a bit later.
So let's move towards deliveryand birth.
Docs, your OBs are typicallypresent near or towards the end
of the pushing stage, right?
Which sometimes comes up quicklyin labor, sometimes it takes
days to get to this point.
Um, they are responsible for thesafe delivery of the baby and
(06:54):
management of the placenta andbleeding.
So third stage is delivery ofthe placenta, that's what we
call it.
Um, that's when their skillslike start to shine, right?
I mean, if they probably havebeen already, but that's when
they get really keen on what'sgoing on, right?
The baby's born, you're holdingthe baby, you're like, awesome,
everything is great, we did it.
(07:15):
And your doc's like, you knowwhat, this we're watching for
this placenta to come.
They're gonna make sure it'scomplete.
They're assessing blood loss atthat point, any tissue
separation, whatever they needto repair.
Um, they're assessing you andyour vitals afterwards.
So they um they might just besit looking like they're sitting
there to you, but that's whentheir skills are really shining.
Um, so immediate postpartumassessment, right?
(07:36):
For mom and baby, they don't dobaby care.
A lot of them are, I mean,they're gonna do immediate, you
know, assessment of baby, butother specialists come in for
that if needed.
Um, and OBs typically addresscomplications like tears,
hemorrhage, blood pressureissues with mom afterwards.
Um, so here's kind of what OBsdon't do.
We already mentioned it.
They don't do continuous bedsidesupport, right?
(07:58):
That's your nurse will be withyou a lot more.
Hopefully, you're working with adoolobi with you a whole lot
more.
Midwives are a little morepresent as well.
Um, they don't do comfortmeasures like massage or
positioning or emotionalcoaching.
However, during that pushingstage, I've seen lots of OBs
like collaborate with theparents with me on like, hey,
what can we do to maximizepushing here in what we call
(08:20):
second stage?
They might do some emotionalcoaching insofar as they're
gonna like motivate you to pushor to push well or um whatever
that might be.
They may, if they have toaddress a real delicate
situation, say we're movingtowards a cesarean, that's some
emotional coaching too.
You know, I've seen some docs besuper uh cold, uh, you could
say, like just like, hey, thisisn't working, you gotta have a
(08:43):
C-section.
I've seen other doctors beincredibly um gentle about that
and cautious about that becausethey know how the person feels
about it.
I've seen a couple docs justlike sit right on one guy,
climbed right in the bed andjust cried with the mom.
It was super cute, actually.
Um, so sometimes there isemotional coaching.
(09:03):
Don't count on it and don't relyon it.
Um, but they they are umsometimes in emotional coaching
that way.
Um, and it's not that they don'tcare, right?
They don't care, but it's nottheir role, it's not their job.
Um, it's interesting though,because you meet with them very
regularly throughout the wholeprocess.
It would make sense they'regonna be with you through the
whole process, but just havethat really realistic
(09:25):
expectation that they're not.
Now, here's something that'svery cool that I love about OBs
and/or midwives for that matter.
Um, I think I've probably donean episode a little bit about
this, but the energy shift whensomeone enters or leaves the
room.
So a lot of times doctors comein at the end and people, the
(09:47):
team's tired at the end, right?
Whatever labor's looked like,um, we might have been working
on it for days or hours.
Maybe, maybe everybody's lostsome sleep for sure.
Um, and we've been it with eachother for a while, right?
We're all in sync with eachother, we're kind of in each
other's soup.
And then the OB comes in at theend and it's time, right?
(10:08):
Like something's shifted.
If they're coming in the room,we're pretty close to having a
baby.
And when they bring in thatenergy, I have appreciated that
so many times.
They probably look at us like, Iam the hero.
I came in and we had a baby.
Um, and while that might betrue, like a lot of work was
done without them in the room,right?
There's a lot of heroes in thisspace.
(10:28):
Um, and they all have kind ofdifferent roles.
But that shift of energy, justsomebody else come in a room.
And when we call it, I call itthe biggest nervous system in
the room.
Um, all the nervous systems,like me as a doula, the partner,
um, the birthing person, thenurse, like our nervous systems
kind of have a um, as we workand collaborate as a team,
(10:49):
there's like a little bit of ahierarchy to those as we arrange
to take care of each other.
And sometimes we'll trade aroundin that.
But um, you know, the nurse andthe doula are taking care of
this person or this couple orthis uh mom and baby, whatever
that is.
And then the doctor comes in theroom, they have just by social
contract almost, they have apretty big nervous system.
(11:10):
We could call that an ego, buthonestly, it's about the nervous
system.
They come in with a new energy.
Um, sometimes they don't readthe room and it's the wrong
energy, but they come in with anew energy and that gives energy
to other nervous systems.
So they can, it looks scripted,like they come in and they are
the hero.
But um, I love that sometimesI'm like, gosh, we just need a
(11:30):
doc to come in here and say,awesome, good job, and just
shift our nervous systems, allof us in the room.
So I do love that.
That is some weird, subtleemotional coaching.
They don't know they're doingit, but um, that is pretty
awesome.
I have seen um some providerslike do tug-a-war pushing if
we're having a long secondstage.
I've seen some probably far, farand few between, but I have seen
(11:54):
a couple OBs do a littlecounterpressure or massage, just
briefly, you know.
Again, it's not their, it's nottheir role.
It's not that they don't care,but they don't have time to do
that for everyone.
That's not where their expertiselies.
Um, that's in your supportpeople, your immediate support
person, your doula, things likethat.
Um, so we want to, you want to,um, the birth team needs to
(12:14):
collaborate.
There's a great collaborationthat goes on here as we use the
expertise of everyone in theroom.
So, doulas, nurses, and obs allwork together.
They all have, they all weardifferent hats on the team.
So ask questions as youcollaborate with your team, ask
questions before labor, askquestions at prenatal visits,
get to know what to expect, getrealistic expectations.
(12:35):
As a doula, I give my clientsseveral talking points to take
as I first meet with them.
Take these to your OB visits,see where your OB thinks about
this, says about this, how dothey support this?
And sometimes I'm like, based onwhat I'm hearing you want, you
might want to clarify this withyour OB.
So talk early and often withthem.
Um, a lot of people have saidthey kind of complain about like
(12:58):
they don't remember me fromvisit to visit.
That may be true.
They're going off a charts.
They see a lot of patients, theyrun together.
Um, again, their role is not tobe your cheerleader and your
champion, but to be to watch outfor the um medical safety of you
and your baby, right?
So don't lean on them for allthat emotional support.
It's quite not quite their role.
Some of them give it, but don'tlean on them for all of that.
(13:21):
Um, learn about your OB'sphilosophy and their style.
Some OBs are a little callous,sounding and feeling to some
people.
Um, that might be great withsome people, right?
Other people like be like, oh,it's not a good match for me.
I need somebody a little moregentle approach, a little um
tender approach.
Very recently, I um was at ahospital and somebody who knows
(13:43):
the hospital well, works on theinside of the hospital is having
a baby, and chose a provider.
Uh, and this person had a lot ofuh um complications actually to
their pregnancy.
They were having a baby, had alot of things going on, and they
chose one of my least favoritedemeanor doctors um as their
provider.
(14:04):
And and they specifically didn'tchoose one of my very favorite
demeanor doctors, demeanormeaning like how they approach
people and patients and they'rejust their warmth and their
kindness and their empathy.
Um, they chose a very uh veryfrank, very um uh curt kind of
uh a no-nonsense kind of doctor.
(14:26):
She's like, that's what I needin my situation.
I don't need, you know, thecoddling of such and such
doctor, which is reallyinteresting.
I like 10 and a half times outof nine, I would have chosen the
other doctor.
But in her situation, I couldsee she was using this doctor
for their expertise and theirexperience, not for their
emotional presence.
She had other people for that.
So um keep that in mind.
(14:47):
So learn about your OB'sphilosophies, their style, ask
other people who've been withthem, ask a doula who um has
worked with them a lot or atthat hospital.
Use your birth plan as acommunication tool.
Create that.
Whether you create that, youknow, there's great online
sources, create that with adoula.
Um, you and your partner kind oflook it over, take that in, say,
hey doc, you know, here's kindof what I'm thinking.
Um, they may just X out somethings, disagree with some
(15:09):
things.
That'll help you um get a senseof their style.
They may suggest some things toput on there.
Um, but it's important to get ina space of respectful teamwork
with all the roles before we getto the game, so to speak.
So when OB's role is mostcrucial, is in those high-risk
moments, right?
Which are really aren't verycommon.
They're also with high-riskpregnancies.
(15:30):
We have all in our country,there is a lot of people
actually deemed high risk.
Um, it's this doesn't mean lifeand death, right?
But there's co-foundingmorbidities, we call them.
That might be age, that might benumber of pregnancies, that
might be um chronic healthconditions, that might be
autoimmune things, that might beum hypertension, chronic, might
(15:50):
be obesity, it might be allkinds of things that can take a
pregnancy.
It might be multiples, you know,and may put it into a high risk
category.
So that's where we want that ummedical expertise, emergencies,
right?
We want them there inemergencies.
Um they know what to do, theyknow how to act quickly, and the
whole team does, right?
The nurses, um, the surroundingstaff, they are uh trained for
(16:13):
emergencies.
Thank goodness they don't happenvery often.
Um, at one of the hospitals Iwork at um a few months ago, we
had an emergency, you know,emergencies come up sometimes,
and there was an emergency.
I I was happened to be workingdown the hall and I saw um a
team just running towards theOR.
I'm like, oh, something's goingon, something's going down.
Um, and there was a nurse who sonurses are a huge part of the
(16:35):
team when there's an emergency.
There's a nurse who was um onthe bed, the bed that was
rushing down the hall with allthe staff are surrounding it,
um, going towards the OR.
And the nurse was kneeling onthe bed with the patient and had
it.
There was a prolapse cord.
If you know what that is, thecord comes down in front of the
baby's head.
And this nurse was kneeling onthe bed and pushing that baby's
head up off the cord.
(16:55):
Um, talk to her afterwards,like, oh my gosh, my hand was
like crushed as she held thatbaby's cord up so the baby could
get blood flow, right?
Um, we do want our OBs there inemergencies.
They know how to act quicklywith the team that they work
with.
So that could be sometimescesareans are emergencies,
usually they're not.
This particular one was inhemorrhaging situations and
(17:17):
shoulder dystocia situations,managing high-risk pregnancies,
and sometimes in a very calm andnormal way.
Um, but that's where we wanttheir expertise.
Complicated later labors,sometimes labors are just, you
know, a lot.
Um, and they are such animportant part of that team to
keep everyone safe, right?
Um, everyone, meaning even theuterus, right?
(17:38):
And that that baby, and um, theycan help with those complicated
labors or ones that requiremedical or surgical expertise,
whether that'sinstrument-assisted delivery, um
abdominal or cesarean delivery,that's where, gosh, we're so
grateful for those skills.
Um so kind of recognizing OBsfor what they are and what
(17:58):
they're not.
We love them for what they are.
Don't expect them, you know,bonus if they are a little above
and beyond that.
Um, some are phenomenal.
Some OBs I've worked with overthe years have uh an approach, a
demeanor that's much more like amidwife.
Um, and they do want to bepresent and they they are
empaths and they are emotionallyconnected and involved.
Others are not.
So um if they aren't, seek whatyou need elsewhere so you can
(18:22):
create a full birth team.
So as we wind down, um kind ofsome of our takeaways are
recognizing the Obrees, OBsbring vital expertise, right, to
ensure medical safety of allinvolved.
Um, most of the time they stepin during um the very end stages
and or actively if there'scomplications or anything um
(18:44):
prior to that, but they'reusually just there for delivery.
Keep that in mind.
Um, a lot of other support teamis is there a whole lot longer,
of course.
So as we finish up today'sepisode, hopefully you get,
hopefully, this gives you kindof a pretty clear picture of
what an obstetrician's role isduring the labor process and
what it is not.
They're just highly trainedspecialists stepping with the
(19:06):
medical skills when they'reneeded and when they're needed
most, right?
They manage complications, guideinterventions, um, and help as
as things take their own twistsand turns.
Sometimes we use a fraction oftheir skills, we hope, right?
Sometimes we're gonna be usingall their skills.
There's one um OB I worked withyears, well, I've worked with
them several times, but yearsago, we had a tough, tough case,
(19:28):
like, oh, so one of the toughestof my entire career.
And uh a long, long surgeryensued after um a primary well,
after a cesarean.
And that that OB came in hourslater to me and the dad, who we
were just waiting in the waitingroom for this.
He was hot, sweaty.
It was the middle of the nightby this point.
(19:48):
He looked terrible.
His hair was messed up, sweatingon his scrubs, and he just
plopped down right in thewaiting room with us.
And he admitted, like in hisvery human way, which I
appreciate.
Wow, guys, that was hard.
Um, and with a really trickysituation.
So remember they're people too,right?
And a lot of what they mayrecommend, they've seen a lot of
(20:10):
stuff, probably hard stuff.
Um, they've seen great stuff,but they've the the interesting
thing is they are aware ofwhat's possible and they don't
want the worst things to happen.
Sometimes the worst usuallydoesn't happen, obviously, but
they have seen it.
Um, and so that sometimes someto them, right?
We can they have traumaticexperiences too.
(20:31):
A traumatic experience thatthey've experienced will um
trickle down into their otherpatients' care.
So um take that, you know, keepthat in mind as you're working
with OBs.
If they seem stringent onsomething or strict about
something, like they've probablyseen some rough outcomes because
people, you know, uh want thingsor to make certain choices.
So um remember that they're animportant part of the birth
(20:53):
team.
There's other members too,nurses, doula's, partners, other
family members all bringdifferent kinds of support.
Um, that's physical, emotional,informational support, and obs
bring medical, medical expertiseand support.
All of that complements eachother, right?
Everybody's expertise iseverybody has a different hat to
wear, all that comes together tomake a good team.
And when people work togetherwith respect and communication,
(21:16):
the patient feels safer, right?
More supported.
They can have an empoweringbirth process.
And that's what I always wantfor people.
So as you prepare for birth,learn, take time to learn about
your particular OB or provider,whoever your prior provider is.
What's their approach?
Ask them questions, talk tothem.
You have a few minutes with themevery few weeks, probably,
(21:37):
right?
And use that time.
Go in with questions andcollaborate with your OB.
That preparation makes a worldof difference.
Hopefully, it'll make a world ofdifference for you too.
And you've chosen a really goodteam.
So I want to thank you for beingwith us today on the Ordinary
Doolow podcast.
Hopefully that gives you a clearpicture about what an OB is and
what they're not.
There's so many OBs I just sureappreciate and have worked with,
(22:00):
gosh, probably hundreds at thispoint.
Um and they're they're such ahuge important part of the birth
team, and I sure do appreciatethem and the care that they give
to all of us.
Appreciate the work they've doneto get to where they're at.
So wrap it up this episode.
Again, thanks for being with ustoday.
Um, this is Angie Roger with theOrdinary Doula Podcast.
(22:20):
And as always, I want to closewith making human connection.
Please make a positive humanconnection today.
You'll need it, and somebodyelse will as well.
Um, you never know what you'lldo for somebody else's day.
The joy you'll bring as you dothat.
Hope to see you next time andhave a great day.
SPEAKER_01 (22:56):
Episode credits will be in the show notes.
And next time, as we continue toexplore the many aspects of
giving birth.
Welcome to the Ordinary Doula Podcast with
Angie Rogier, hosted by BirthLearning, where we help prepare
folks for labor and birth withexpertise coming from 20 years
of experience in a busy doulapractice, helping thousands of
people prepare for labor,providing essential knowledge
and tools for positive andempowering birth experiences.
SPEAKER_00 (00:52):
I'm the host, and today's topic um is I want to
dive into what the role of anobstetrician is during labor and
birth.
So when families, and I hearthis so, so, so many times,
right, over the years, whenfamilies picture their birth and
their birth team, they oftenthink of the OB as being there
(01:12):
every step of the way, right?
Like it's us and our doctor.
Um, but the reality of thatthroughout the process is a
little bit different than thatvision.
Obstetricians bring incrediblemedical expertise to your team.
They are an essential role inmanaging, you know, how labor
goes and managing in pregnancytoo, for that matter, especially
(01:33):
towards the end.
You know, they take up theircare and their observations and
are pretty cautious about a lotof things in all throughout
pregnancy, but especially at theend.
So they manage complications andensuring safety, right?
Medical safety, physical safety,all of that.
But they're not usually the onesthat are sitting there at
bedside.
They're not super presentthroughout the labor process.
That's where, you know, you'regonna be with your nurse a whole
(01:55):
lot more than you are yourdoctor.
Um, you're gonna be a lot oftimes with a midwife a little
bit more than a doctor.
And doulas, you know, you'regonna be with your doula a whole
lot more than a nurse or adoctor.
Um and partners, you're gonna bewith a partner a whole ton,
right?
Um, so we're gonna kind ofexplore exactly what obs do
during labor, when theirpresence is crucial, um, how
(02:16):
their role kind of fits into thebig picture of your birth team.
And whether you're expecting ababy or you're supporting
somebody else who is through thelabor process, um, or if you are
a birth worker yourself, it'sjust important to understand the
scope of an OB's role.
Kind of help set someexpectations and kind of create
a space to collaborate on thebirth team because we do want a
(02:38):
lot of collaboration there.
All right.
So, what is an obstetrician?
An obstetrician is a medicaldoctor.
They specialize in pregnancy, inbirth, and a whole lot of other
stuff like reproductive health,um, hormones, menopause.
Um, obstetricians have prettydeep training, right?
(02:58):
They're gonna, they've gone tomedical school, residency, they
are surgeons, they've hadsurgical surgical training.
Um, so this is can be quitedifferent than midwives and
maybe a family doctor, in thatum their medical training is a
bit more extensive when we getinto some of those more
complicated things.
So during the labor process, therole of an OB is to review
(03:20):
things.
There, they they uh havereviewed and are aware of health
history.
Now you meet with your OB, ifthat's who you've chosen as your
provider throughout pregnancy,right?
So you have visits in earlypregnancy, whether that's you
know, however, whatever weeksyou can get in.
Um I was talking to a very newlypregnant mom a little while ago,
and gosh, they couldn't get herin for like two months, pregnant
(03:43):
or not.
Um, so that was a very busy OBoffice, but you're gonna be
meeting with this OV OB andgetting prenatal care, right?
All throughout the pregnancy.
They review your health history,they're gonna kind of keep tabs
on things, they're gonna get abaseline early on about some
things that they're gonna wantto watch later a little bit
later.
They in little near the laborprocess are gonna be checking on
(04:05):
reasons for induction.
And you want to understandreasons for induction, right?
They're gonna monitor riskfactors that would create
reasons for induction.
Now, sometimes the quote unquotereason for an induction might
be, I'm gonna be out of town.
Or um, you are 39 weeks, or youknow, it just depends.
Like, is that legit to you?
(04:26):
And so dig a little deep withyour doc and see what your
comfort level is on.
Are these true risk factors orare they not?
Um, but they will be checking ona lot of um, that's who helps
you decide on an induction isyour OB.
Nurses don't touch that, doulasdon't touch that.
They may discuss some thingswith you, but that is a decision
you make with your doctor.
Um, during the labor process,OBs are monitoring, right?
(04:49):
Probably from afar, but theyalways have access to um what we
call the strip, like the stripof the heart baby's heart rate,
contractions.
The nurses are gonna be muchmore close to you in proximity
and doing that monitoringphysically.
Um, but the docs have access toit and they can help decide on
um interventions when they needthem.
(05:10):
That might be induction methods,augmentation methods, cesareans,
assisted delivery.
Um, so when there's a big changeand a shift, you better believe
it.
Your OB, if that's who you'reworking with, is gonna be
involved, or your midwife forthat matter.
Um, they may managecomplications such as fetal
distress, shoulder dystocia,hemorrhage, the stuff that comes
up that we don't want to, um,the stuff that sometimes comes
(05:31):
up quickly, that's where theirtraining and expertise comes in.
So if everything is supersmooth, boring, healthy, your OB
skills are set to the side,right?
They still have greatexperience.
They've done this many, manytimes, but their their deep
skill set isn't needed.
It's there for for when we needit, which a lot of the times is
(05:52):
not like anyone can deliver babyif everything is fine, right?
Babies just come on out.
Um, they need somebody to kindof have a catch pad there for
them.
But the obs are there for whenthings get a little bit
interesting, of course.
Um, and they're prepared forthat.
So during labor, they're notsuper present.
They their decisions might bepresent, but physically they're
(06:12):
not present.
They might pop in at lunchtimeduring clinic hours or before
clinic hours or after clinichours, um, before they go home
at night, whatever might thatmight be, but they are not
usually very you don't see thema whole lot.
So many times I've had um thepartner ask or the birthing mom
ask, like, hey, where's mydoctor?
Like, you know, here we aredoing this, like, where are
(06:32):
they?
When do they come in?
And it's usually a bit later.
So let's move towards deliveryand birth.
Docs, your OBs are typicallypresent near or towards the end
of the pushing stage, right?
Which sometimes comes up quicklyin labor, sometimes it takes
days to get to this point.
Um, they are responsible for thesafe delivery of the baby and
(06:54):
management of the placenta andbleeding.
So third stage is delivery ofthe placenta, that's what we
call it.
Um, that's when their skillslike start to shine, right?
I mean, if they probably havebeen already, but that's when
they get really keen on what'sgoing on, right?
The baby's born, you're holdingthe baby, you're like, awesome,
everything is great, we did it.
(07:15):
And your doc's like, you knowwhat, this we're watching for
this placenta to come.
They're gonna make sure it'scomplete.
They're assessing blood loss atthat point, any tissue
separation, whatever they needto repair.
Um, they're assessing you andyour vitals afterwards.
So they um they might just besit looking like they're sitting
there to you, but that's whentheir skills are really shining.
Um, so immediate postpartumassessment, right?
(07:36):
For mom and baby, they don't dobaby care.
A lot of them are, I mean,they're gonna do immediate, you
know, assessment of baby, butother specialists come in for
that if needed.
Um, and OBs typically addresscomplications like tears,
hemorrhage, blood pressureissues with mom afterwards.
Um, so here's kind of what OBsdon't do.
We already mentioned it.
They don't do continuous bedsidesupport, right?
(07:58):
That's your nurse will be withyou a lot more.
Hopefully, you're working with adoolobi with you a whole lot
more.
Midwives are a little morepresent as well.
Um, they don't do comfortmeasures like massage or
positioning or emotionalcoaching.
However, during that pushingstage, I've seen lots of OBs
like collaborate with theparents with me on like, hey,
what can we do to maximizepushing here in what we call
(08:20):
second stage?
They might do some emotionalcoaching insofar as they're
gonna like motivate you to pushor to push well or um whatever
that might be.
They may, if they have toaddress a real delicate
situation, say we're movingtowards a cesarean, that's some
emotional coaching too.
You know, I've seen some docs besuper uh cold, uh, you could
say, like just like, hey, thisisn't working, you gotta have a
(08:43):
C-section.
I've seen other doctors beincredibly um gentle about that
and cautious about that becausethey know how the person feels
about it.
I've seen a couple docs justlike sit right on one guy,
climbed right in the bed andjust cried with the mom.
It was super cute, actually.
Um, so sometimes there isemotional coaching.
(09:03):
Don't count on it and don't relyon it.
Um, but they they are umsometimes in emotional coaching
that way.
Um, and it's not that they don'tcare, right?
They don't care, but it's nottheir role, it's not their job.
Um, it's interesting though,because you meet with them very
regularly throughout the wholeprocess.
It would make sense they'regonna be with you through the
whole process, but just havethat really realistic
(09:25):
expectation that they're not.
Now, here's something that'svery cool that I love about OBs
and/or midwives for that matter.
Um, I think I've probably donean episode a little bit about
this, but the energy shift whensomeone enters or leaves the
room.
So a lot of times doctors comein at the end and people, the
(09:47):
team's tired at the end, right?
Whatever labor's looked like,um, we might have been working
on it for days or hours.
Maybe, maybe everybody's lostsome sleep for sure.
Um, and we've been it with eachother for a while, right?
We're all in sync with eachother, we're kind of in each
other's soup.
And then the OB comes in at theend and it's time, right?
(10:08):
Like something's shifted.
If they're coming in the room,we're pretty close to having a
baby.
And when they bring in thatenergy, I have appreciated that
so many times.
They probably look at us like, Iam the hero.
I came in and we had a baby.
Um, and while that might betrue, like a lot of work was
done without them in the room,right?
There's a lot of heroes in thisspace.
(10:28):
Um, and they all have kind ofdifferent roles.
But that shift of energy, justsomebody else come in a room.
And when we call it, I call itthe biggest nervous system in
the room.
Um, all the nervous systems,like me as a doula, the partner,
um, the birthing person, thenurse, like our nervous systems
kind of have a um, as we workand collaborate as a team,
(10:49):
there's like a little bit of ahierarchy to those as we arrange
to take care of each other.
And sometimes we'll trade aroundin that.
But um, you know, the nurse andthe doula are taking care of
this person or this couple orthis uh mom and baby, whatever
that is.
And then the doctor comes in theroom, they have just by social
contract almost, they have apretty big nervous system.
(11:10):
We could call that an ego, buthonestly, it's about the nervous
system.
They come in with a new energy.
Um, sometimes they don't readthe room and it's the wrong
energy, but they come in with anew energy and that gives energy
to other nervous systems.
So they can, it looks scripted,like they come in and they are
the hero.
But um, I love that sometimesI'm like, gosh, we just need a
(11:30):
doc to come in here and say,awesome, good job, and just
shift our nervous systems, allof us in the room.
So I do love that.
That is some weird, subtleemotional coaching.
They don't know they're doingit, but um, that is pretty
awesome.
I have seen um some providerslike do tug-a-war pushing if
we're having a long secondstage.
I've seen some probably far, farand few between, but I have seen
(11:54):
a couple OBs do a littlecounterpressure or massage, just
briefly, you know.
Again, it's not their, it's nottheir role.
It's not that they don't care,but they don't have time to do
that for everyone.
That's not where their expertiselies.
Um, that's in your supportpeople, your immediate support
person, your doula, things likethat.
Um, so we want to, you want to,um, the birth team needs to
(12:14):
collaborate.
There's a great collaborationthat goes on here as we use the
expertise of everyone in theroom.
So, doulas, nurses, and obs allwork together.
They all have, they all weardifferent hats on the team.
So ask questions as youcollaborate with your team, ask
questions before labor, askquestions at prenatal visits,
get to know what to expect, getrealistic expectations.
(12:35):
As a doula, I give my clientsseveral talking points to take
as I first meet with them.
Take these to your OB visits,see where your OB thinks about
this, says about this, how dothey support this?
And sometimes I'm like, based onwhat I'm hearing you want, you
might want to clarify this withyour OB.
So talk early and often withthem.
Um, a lot of people have saidthey kind of complain about like
(12:58):
they don't remember me fromvisit to visit.
That may be true.
They're going off a charts.
They see a lot of patients, theyrun together.
Um, again, their role is not tobe your cheerleader and your
champion, but to be to watch outfor the um medical safety of you
and your baby, right?
So don't lean on them for allthat emotional support.
It's quite not quite their role.
Some of them give it, but don'tlean on them for all of that.
(13:21):
Um, learn about your OB'sphilosophy and their style.
Some OBs are a little callous,sounding and feeling to some
people.
Um, that might be great withsome people, right?
Other people like be like, oh,it's not a good match for me.
I need somebody a little moregentle approach, a little um
tender approach.
Very recently, I um was at ahospital and somebody who knows
(13:43):
the hospital well, works on theinside of the hospital is having
a baby, and chose a provider.
Uh, and this person had a lot ofuh um complications actually to
their pregnancy.
They were having a baby, had alot of things going on, and they
chose one of my least favoritedemeanor doctors um as their
provider.
(14:04):
And and they specifically didn'tchoose one of my very favorite
demeanor doctors, demeanormeaning like how they approach
people and patients and they'rejust their warmth and their
kindness and their empathy.
Um, they chose a very uh veryfrank, very um uh curt kind of
uh a no-nonsense kind of doctor.
(14:26):
She's like, that's what I needin my situation.
I don't need, you know, thecoddling of such and such
doctor, which is reallyinteresting.
I like 10 and a half times outof nine, I would have chosen the
other doctor.
But in her situation, I couldsee she was using this doctor
for their expertise and theirexperience, not for their
emotional presence.
She had other people for that.
So um keep that in mind.
(14:47):
So learn about your OB'sphilosophies, their style, ask
other people who've been withthem, ask a doula who um has
worked with them a lot or atthat hospital.
Use your birth plan as acommunication tool.
Create that.
Whether you create that, youknow, there's great online
sources, create that with adoula.
Um, you and your partner kind oflook it over, take that in, say,
hey doc, you know, here's kindof what I'm thinking.
Um, they may just X out somethings, disagree with some
(15:09):
things.
That'll help you um get a senseof their style.
They may suggest some things toput on there.
Um, but it's important to get ina space of respectful teamwork
with all the roles before we getto the game, so to speak.
So when OB's role is mostcrucial, is in those high-risk
moments, right?
Which are really aren't verycommon.
They're also with high-riskpregnancies.
(15:30):
We have all in our country,there is a lot of people
actually deemed high risk.
Um, it's this doesn't mean lifeand death, right?
But there's co-foundingmorbidities, we call them.
That might be age, that might benumber of pregnancies, that
might be um chronic healthconditions, that might be
autoimmune things, that might beum hypertension, chronic, might
(15:50):
be obesity, it might be allkinds of things that can take a
pregnancy.
It might be multiples, you know,and may put it into a high risk
category.
So that's where we want that ummedical expertise, emergencies,
right?
We want them there inemergencies.
Um they know what to do, theyknow how to act quickly, and the
whole team does, right?
The nurses, um, the surroundingstaff, they are uh trained for
(16:13):
emergencies.
Thank goodness they don't happenvery often.
Um, at one of the hospitals Iwork at um a few months ago, we
had an emergency, you know,emergencies come up sometimes,
and there was an emergency.
I I was happened to be workingdown the hall and I saw um a
team just running towards theOR.
I'm like, oh, something's goingon, something's going down.
Um, and there was a nurse who sonurses are a huge part of the
(16:35):
team when there's an emergency.
There's a nurse who was um onthe bed, the bed that was
rushing down the hall with allthe staff are surrounding it,
um, going towards the OR.
And the nurse was kneeling onthe bed with the patient and had
it.
There was a prolapse cord.
If you know what that is, thecord comes down in front of the
baby's head.
And this nurse was kneeling onthe bed and pushing that baby's
head up off the cord.
(16:55):
Um, talk to her afterwards,like, oh my gosh, my hand was
like crushed as she held thatbaby's cord up so the baby could
get blood flow, right?
Um, we do want our OBs there inemergencies.
They know how to act quicklywith the team that they work
with.
So that could be sometimescesareans are emergencies,
usually they're not.
This particular one was inhemorrhaging situations and
(17:17):
shoulder dystocia situations,managing high-risk pregnancies,
and sometimes in a very calm andnormal way.
Um, but that's where we wanttheir expertise.
Complicated later labors,sometimes labors are just, you
know, a lot.
Um, and they are such animportant part of that team to
keep everyone safe, right?
Um, everyone, meaning even theuterus, right?
(17:38):
And that that baby, and um, theycan help with those complicated
labors or ones that requiremedical or surgical expertise,
whether that'sinstrument-assisted delivery, um
abdominal or cesarean delivery,that's where, gosh, we're so
grateful for those skills.
Um so kind of recognizing OBsfor what they are and what
(17:58):
they're not.
We love them for what they are.
Don't expect them, you know,bonus if they are a little above
and beyond that.
Um, some are phenomenal.
Some OBs I've worked with overthe years have uh an approach, a
demeanor that's much more like amidwife.
Um, and they do want to bepresent and they they are
empaths and they are emotionallyconnected and involved.
Others are not.
So um if they aren't, seek whatyou need elsewhere so you can
(18:22):
create a full birth team.
So as we wind down, um kind ofsome of our takeaways are
recognizing the Obrees, OBsbring vital expertise, right, to
ensure medical safety of allinvolved.
Um, most of the time they stepin during um the very end stages
and or actively if there'scomplications or anything um
(18:44):
prior to that, but they'reusually just there for delivery.
Keep that in mind.
Um, a lot of other support teamis is there a whole lot longer,
of course.
So as we finish up today'sepisode, hopefully you get,
hopefully, this gives you kindof a pretty clear picture of
what an obstetrician's role isduring the labor process and
what it is not.
They're just highly trainedspecialists stepping with the
(19:06):
medical skills when they'reneeded and when they're needed
most, right?
They manage complications, guideinterventions, um, and help as
as things take their own twistsand turns.
Sometimes we use a fraction oftheir skills, we hope, right?
Sometimes we're gonna be usingall their skills.
There's one um OB I worked withyears, well, I've worked with
them several times, but yearsago, we had a tough, tough case,
(19:28):
like, oh, so one of the toughestof my entire career.
And uh a long, long surgeryensued after um a primary well,
after a cesarean.
And that that OB came in hourslater to me and the dad, who we
were just waiting in the waitingroom for this.
He was hot, sweaty.
It was the middle of the nightby this point.
(19:48):
He looked terrible.
His hair was messed up, sweatingon his scrubs, and he just
plopped down right in thewaiting room with us.
And he admitted, like in hisvery human way, which I
appreciate.
Wow, guys, that was hard.
Um, and with a really trickysituation.
So remember they're people too,right?
And a lot of what they mayrecommend, they've seen a lot of
(20:10):
stuff, probably hard stuff.
Um, they've seen great stuff,but they've the the interesting
thing is they are aware ofwhat's possible and they don't
want the worst things to happen.
Sometimes the worst usuallydoesn't happen, obviously, but
they have seen it.
Um, and so that sometimes someto them, right?
We can they have traumaticexperiences too.
(20:31):
A traumatic experience thatthey've experienced will um
trickle down into their otherpatients' care.
So um take that, you know, keepthat in mind as you're working
with OBs.
If they seem stringent onsomething or strict about
something, like they've probablyseen some rough outcomes because
people, you know, uh want thingsor to make certain choices.
So um remember that they're animportant part of the birth
(20:53):
team.
There's other members too,nurses, doula's, partners, other
family members all bringdifferent kinds of support.
Um, that's physical, emotional,informational support, and obs
bring medical, medical expertiseand support.
All of that complements eachother, right?
Everybody's expertise iseverybody has a different hat to
wear, all that comes together tomake a good team.
And when people work togetherwith respect and communication,
(21:16):
the patient feels safer, right?
More supported.
They can have an empoweringbirth process.
And that's what I always wantfor people.
So as you prepare for birth,learn, take time to learn about
your particular OB or provider,whoever your prior provider is.
What's their approach?
Ask them questions, talk tothem.
You have a few minutes with themevery few weeks, probably,
(21:37):
right?
And use that time.
Go in with questions andcollaborate with your OB.
That preparation makes a worldof difference.
Hopefully, it'll make a world ofdifference for you too.
And you've chosen a really goodteam.
So I want to thank you for beingwith us today on the Ordinary
Doolow podcast.
Hopefully that gives you a clearpicture about what an OB is and
what they're not.
There's so many OBs I just sureappreciate and have worked with,
(22:00):
gosh, probably hundreds at thispoint.
Um and they're they're such ahuge important part of the birth
team, and I sure do appreciatethem and the care that they give
to all of us.
Appreciate the work they've doneto get to where they're at.
So wrap it up this episode.
Again, thanks for being with ustoday.
Um, this is Angie Roger with theOrdinary Doula Podcast.
(22:20):
And as always, I want to closewith making human connection.
Please make a positive humanconnection today.
You'll need it, and somebodyelse will as well.
Um, you never know what you'lldo for somebody else's day.
The joy you'll bring as you dothat.
Hope to see you next time andhave a great day.
SPEAKER_01 (22:56):
Episode credits will be in the show notes.
And next time, as we continue toexplore the many aspects of
giving birth.
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