The Ordinary Doula Podcast

E92: Role of an OB on a Birth Team

• Angie Rosier • Episode 92

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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

SPEAKER_01:

Welcome to the Ordinary Doula Podcast with Angie Rogier, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.

SPEAKER_00:

I'm the host, and today's topic um is I want to dive into what the role of an obstetrician is during labor and birth. So when families, and I hear this so, so, so many times, right, over the years, when families picture their birth and their birth team, they often think of the OB as being there every step of the way, right? Like it's us and our doctor. Um, but the reality of that throughout the process is a little bit different than that vision. Obstetricians bring incredible medical expertise to your team. They are an essential role in managing, you know, how labor goes and managing in pregnancy too, for that matter, especially towards the end. You know, they take up their care and their observations and are pretty cautious about a lot of things in all throughout pregnancy, but especially at the end. So they manage complications and ensuring safety, right? Medical safety, physical safety, all of that. But they're not usually the ones that are sitting there at bedside. They're not super present throughout the labor process. That's where, you know, you're gonna be with your nurse a whole lot more than you are your doctor. Um, you're gonna be a lot of times with a midwife a little bit more than a doctor. And doulas, you know, you're gonna be with your doula a whole lot more than a nurse or a doctor. Um and partners, you're gonna be with a partner a whole ton, right? Um, so we're gonna kind of explore exactly what obs do during labor, when their presence is crucial, um, how their role kind of fits into the big picture of your birth team. And whether you're expecting a baby or you're supporting somebody else who is through the labor process, um, or if you are a birth worker yourself, it's just important to understand the scope of an OB's role. Kind of help set some expectations and kind of create a space to collaborate on the birth team because we do want a lot of collaboration there. All right. So, what is an obstetrician? An obstetrician is a medical doctor. They specialize in pregnancy, in birth, and a whole lot of other stuff like reproductive health, um, hormones, menopause. Um, obstetricians have pretty deep training, right? They're gonna, they've gone to medical school, residency, they are surgeons, they've had surgical surgical training. Um, so this is can be quite different than midwives and maybe a family doctor, in that um their medical training is a bit more extensive when we get into some of those more complicated things. So during the labor process, the role of an OB is to review things. There, they they uh have reviewed and are aware of health history. Now you meet with your OB, if that's who you've chosen as your provider throughout pregnancy, right? So you have visits in early pregnancy, whether that's you know, however, whatever weeks you can get in. Um I was talking to a very newly pregnant mom a little while ago, and gosh, they couldn't get her in for like two months, pregnant or not. Um, so that was a very busy OB office, but you're gonna be meeting with this OV OB and getting 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 a baseline early on about some things that they're gonna want to watch later a little bit later. They in little near the labor process are gonna be checking on reasons for induction. And you want to understand reasons for induction, right? They're gonna monitor risk factors that would create reasons for induction. Now, sometimes the quote unquote reason for an induction might be, I'm gonna be out of town. Or um, you are 39 weeks, or you know, it just depends. Like, is that legit to you? And so dig a little deep with your doc and see what your comfort level is on. Are these true risk factors or are they not? Um, but they will be checking on a lot of um, that's who helps you decide on an induction is your OB. Nurses don't touch that, doulas don't touch that. They may discuss some things with you, but that is a decision you make with your doctor. Um, during the labor process, OBs are monitoring, right? Probably from afar, but they always have access to um what we call the strip, like the strip of the heart baby's heart rate, contractions. The nurses are gonna be much more close to you in proximity and doing that monitoring physically. Um, but the docs have access to it and they can help decide on um interventions when they need them. That might be induction methods, augmentation methods, cesareans, assisted delivery. Um, so when there's a big change and a shift, you better believe it. Your OB, if that's who you're working with, is gonna be involved, or your midwife for that matter. Um, they may manage complications such as fetal distress, shoulder dystocia, hemorrhage, the stuff that comes up that we don't want to, um, the stuff that sometimes comes up quickly, that's where their training and expertise comes in. So if everything is super smooth, boring, healthy, your OB skills are set to the side, right? They still have great experience. They've done this many, many times, but their their deep skill set isn't needed. It's there for for when we need it, which a lot of the times is not like anyone can deliver baby if everything is fine, right? Babies just come on out. Um, they need somebody to kind of have a catch pad there for them. But the obs are there for when things get a little bit interesting, of course. Um, and they're prepared for that. So during labor, they're not super present. They their decisions might be present, but physically they're not present. They might pop in at lunchtime during clinic hours or before clinic hours or after clinic hours, um, before they go home at night, whatever might that might be, but they are not usually very you don't see them a whole lot. So many times I've had um the partner ask or the birthing mom ask, like, hey, where's my doctor? Like, you know, here we are doing this, like, where are they? When do they come in? And it's usually a bit later. So let's move towards delivery and birth. Docs, your OBs are typically present near or towards the end of the pushing stage, right? Which sometimes comes up quickly in labor, sometimes it takes days to get to this point. Um, they are responsible for the safe delivery of the baby and management of the placenta and bleeding. So third stage is delivery of the placenta, that's what we call it. Um, that's when their skills like start to shine, right? I mean, if they probably have been already, but that's when they get really keen on what's going on, right? The baby's born, you're holding the baby, you're like, awesome, everything is great, we did it. And your doc's like, you know what, this we're watching for this placenta to come. They're gonna make sure it's complete. They're assessing blood loss at that point, any tissue separation, whatever they need to repair. Um, they're assessing you and your vitals afterwards. So they um they might just be sit looking like they're sitting there to you, but that's when their skills are really shining. Um, so immediate postpartum assessment, right? For mom and baby, they don't do baby care. A lot of them are, I mean, they're gonna do immediate, you know, assessment of baby, but other specialists come in for that if needed. Um, and OBs typically address complications like tears, hemorrhage, blood pressure issues with mom afterwards. Um, so here's kind of what OBs don't do. We already mentioned it. They don't do continuous bedside support, right? That's your nurse will be with you a lot more. Hopefully, you're working with a doolobi with you a whole lot more. Midwives are a little more present as well. Um, they don't do comfort measures like massage or positioning or emotional coaching. However, during that pushing stage, I've seen lots of OBs like collaborate with the parents with me on like, hey, what can we do to maximize pushing here in what we call second stage? They might do some emotional coaching insofar as they're gonna like motivate you to push or to push well or um whatever that might be. They may, if they have to address a real delicate situation, say we're moving towards a cesarean, that's some emotional coaching too. You know, I've seen some docs be super uh cold, uh, you could say, like just like, hey, this isn't working, you gotta have a C-section. I've seen other doctors be incredibly um gentle about that and cautious about that because they know how the person feels about it. I've seen a couple docs just like sit right on one guy, climbed right in the bed and just cried with the mom. It was super cute, actually. Um, so sometimes there is emotional coaching. Don't count on it and don't rely on it. Um, but they they are um sometimes in emotional coaching that way. Um, and it's not that they don't care, right? They don't care, but it's not their role, it's not their job. Um, it's interesting though, because you meet with them very regularly throughout the whole process. It would make sense they're gonna be with you through the whole process, but just have that really realistic expectation that they're not. Now, here's something that's very cool that I love about OBs and/or midwives for that matter. Um, I think I've probably done an episode a little bit about this, but the energy shift when someone enters or leaves the room. So a lot of times doctors come in at the end and people, the 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 lost some sleep for sure. Um, and we've been it with each other for a while, right? We're all in sync with each other, we're kind of in each other's soup. And then the OB comes in at the end and it's time, right? Like something's shifted. If they're coming in the room, we're pretty close to having a baby. And when they bring in that energy, I have appreciated that so many times. They probably look at us like, I am the hero. I came in and we had a baby. Um, and while that might be true, like a lot of work was done without them in the room, right? There's a lot of heroes in this space. Um, and they all have kind of different roles. But that shift of energy, just somebody else come in a room. And when we call it, I call it the biggest nervous system in the room. Um, all the nervous systems, like me as a doula, the partner, um, the birthing person, the nurse, like our nervous systems kind of have a um, as we work and collaborate as a team, there's like a little bit of a hierarchy to those as we arrange to take care of each other. And sometimes we'll trade around in that. But um, you know, the nurse and the doula are taking care of this person or this couple or this uh mom and baby, whatever that is. And then the doctor comes in the room, they have just by social contract almost, they have a pretty big nervous system. We could call that an ego, but honestly, it's about the nervous system. They come in with a new energy. Um, sometimes they don't read the room and it's the wrong energy, but they come in with a new 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 sometimes I'm like, gosh, we just need a doc to come in here and say, awesome, good job, and just shift our nervous systems, all of us in the room. So I do love that. That is some weird, subtle emotional coaching. They don't know they're doing it, but um, that is pretty awesome. I have seen um some providers like do tug-a-war pushing if we're having a long second stage. I've seen some probably far, far and few between, but I have seen a couple OBs do a little counterpressure or massage, just briefly, you know. Again, it's not their, it's not their 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 expertise lies. Um, that's in your support people, your immediate support person, your doula, things like that. Um, so we want to, you want to, um, the birth team needs to collaborate. There's a great collaboration that goes on here as we use the expertise of everyone in the room. So, doulas, nurses, and obs all work together. They all have, they all wear different hats on the team. So ask questions as you collaborate with your team, ask questions before labor, ask questions at prenatal visits, get to know what to expect, get realistic expectations. As a doula, I give my clients several 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 do they support this? And sometimes I'm like, based on what I'm hearing you want, you might want to clarify this with your OB. So talk early and often with them. Um, a lot of people have said they kind of complain about like they don't remember me from visit to visit. That may be true. They're going off a charts. They see a lot of patients, they run together. Um, again, their role is not to be your cheerleader and your champion, but to be to watch out for the um medical safety of you and your baby, right? So don't lean on them for all that emotional support. It's quite not quite their role. Some of them give it, but don't lean on them for all of that. Um, learn about your OB's philosophy and their style. Some OBs are a little callous, sounding and feeling to some people. Um, that might be great with some people, right? Other people like be like, oh, it's not a good match for me. I need somebody a little more gentle approach, a little um tender approach. Very recently, I um was at a hospital and somebody who knows the hospital well, works on the inside of the hospital is having a baby, and chose a provider. Uh, and this person had a lot of uh um complications actually to their pregnancy. They were having a baby, had a lot of things going on, and they chose one of my least favorite demeanor doctors um as their provider. And and they specifically didn't choose one of my very favorite demeanor doctors, demeanor meaning like how they approach people and patients and they're just their warmth and their kindness and their empathy. Um, they chose a very uh very frank, very um uh curt kind of uh a no-nonsense kind of doctor. She's like, that's what I need in my situation. I don't need, you know, the coddling of such and such doctor, which is really interesting. I like 10 and a half times out of nine, I would have chosen the other doctor. But in her situation, I could see she was using this doctor for their expertise and their experience, not for their emotional presence. She had other people for that. So um keep that in mind. So learn about your OB's philosophies, their style, ask other people who've been with them, ask a doula who um has worked with them a lot or at that hospital. Use your birth plan as a communication tool. Create that. Whether you create that, you know, there's great online sources, create that with a doula. Um, you and your partner kind of look it over, take that in, say, hey doc, you know, here's kind of what I'm thinking. Um, they may just X out some things, disagree with some things. That'll help you um get a sense of their style. They may suggest some things to put on there. Um, but it's important to get in a space of respectful teamwork with all the roles before we get to the game, so to speak. So when OB's role is most crucial, is in those high-risk moments, right? Which are really aren't very common. They're also with high-risk pregnancies. We have all in our country, there is a lot of people actually deemed high risk. Um, it's this doesn't mean life and death, right? But there's co-founding morbidities, we call them. That might be age, that might be number of pregnancies, that might be um chronic health conditions, that might be autoimmune things, that might be um hypertension, chronic, might be obesity, it might be all kinds 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 um medical expertise, emergencies, right? We want them there in emergencies. Um they know what to do, they know how to act quickly, and the whole team does, right? The nurses, um, the surrounding staff, they are uh trained for emergencies. Thank goodness they don't happen very often. Um, at one of the hospitals I work 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 working down the hall and I saw um a team just running towards the OR. I'm like, oh, something's going on, something's going down. Um, and there was a nurse who so nurses are a huge part of the team when there's an emergency. There's a nurse who was um on the bed, the bed that was rushing down the hall with all the staff are surrounding it, um, going towards the OR. And the nurse was kneeling on the bed with the patient and had it. There was a prolapse cord. If you know what that is, the cord comes down in front of the baby's head. And this nurse was kneeling on the bed and pushing that baby's head up off the cord. Um, talk to her afterwards, like, oh my gosh, my hand was like crushed as she held that baby's cord up so the baby could get blood flow, right? Um, we do want our OBs there in emergencies. They know how to act quickly with the team that they work with. So that could be sometimes cesareans are emergencies, usually they're not. This particular one was in hemorrhaging situations and shoulder dystocia situations, managing high-risk pregnancies, and sometimes in a very calm and normal way. Um, but that's where we want their expertise. Complicated later labors, sometimes labors are just, you know, a lot. Um, and they are such an important part of that team to keep everyone safe, right? Um, everyone, meaning even the uterus, right? And that that baby, and um, they can help with those complicated labors or ones that require medical or surgical expertise, whether that's instrument-assisted delivery, um abdominal or cesarean delivery, that's where, gosh, we're so grateful for those skills. Um so kind of recognizing OBs for what they are and what 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 over the years have uh an approach, a demeanor that's much more like a midwife. Um, and they do want to be present and they they are empaths and they are emotionally connected and involved. Others are not. So um if they aren't, seek what you need elsewhere so you can create a full birth team. So as we wind down, um kind of some of our takeaways are recognizing the Obrees, OBs bring vital expertise, right, to ensure medical safety of all involved. Um, most of the time they step in during um the very end stages and or actively if there's complications or anything um prior to that, but they're usually just there for delivery. Keep that in mind. Um, a lot of other support team is is there a whole lot longer, of course. So as we finish up today's episode, hopefully you get, hopefully, this gives you kind of a pretty clear picture of what an obstetrician's role is during the labor process and what it is not. They're just highly trained specialists stepping with the medical skills when they're needed and when they're needed most, right? They manage complications, guide interventions, um, and help as as things take their own twists and turns. Sometimes we use a fraction of their skills, we hope, right? Sometimes we're gonna be using all their skills. There's one um OB I worked with years, well, I've worked with them several times, but years ago, we had a tough, tough case, like, oh, so one of the toughest of my entire career. And uh a long, long surgery ensued after um a primary well, after a cesarean. And that that OB came in hours later to me and the dad, who we were just waiting in the waiting room for this. He was hot, sweaty. It was the middle of the night by this point. He looked terrible. His hair was messed up, sweating on his scrubs, and he just plopped down right in the waiting room with us. And he admitted, like in his very human way, which I appreciate. Wow, guys, that was hard. Um, and with a really tricky situation. So remember they're people too, right? And a lot of what they may recommend, they've seen a lot of stuff, probably hard stuff. Um, they've seen great stuff, but they've the the interesting thing is they are aware of what's possible and they don't want the worst things to happen. Sometimes the worst usually doesn't happen, obviously, but they have seen it. Um, and so that sometimes some to them, right? We can they have traumatic experiences too. A traumatic experience that they've experienced will um trickle down into their other patients' care. So um take that, you know, keep that in mind as you're working with OBs. If they seem stringent on something or strict about something, like they've probably seen some rough outcomes because people, you know, uh want things or to make certain choices. So um remember that they're an important part of the birth team. There's other members too, nurses, doula's, partners, other family members all bring different kinds of support. Um, that's physical, emotional, informational support, and obs bring medical, medical expertise and support. All of that complements each other, right? Everybody's expertise is everybody has a different hat to wear, all that comes together to make a good team. And when people work together with respect and communication, the patient feels safer, right? More supported. They can have an empowering birth process. And that's what I always want for 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 to them. You have a few minutes with them every few weeks, probably, right? And use that time. Go in with questions and collaborate with your OB. That preparation makes a world of difference. Hopefully, it'll make a world of difference for you too. And you've chosen a really good team. So I want to thank you for being with us today on the Ordinary Doolow podcast. Hopefully that gives you a clear picture about what an OB is and what they're not. There's so many OBs I just sure appreciate and have worked with, gosh, probably hundreds at this point. Um and they're they're such a huge important part of the birth team, and I sure do appreciate them and the care that they give to all of us. Appreciate the work they've done to get to where they're at. So wrap it up this episode. Again, thanks for being with us today. Um, this is Angie Roger with the Ordinary Doula Podcast. And 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. Um, you never know what you'll do for somebody else's day. The joy you'll bring as you do that. Hope to see you next time and have a great day.

SPEAKER_01:

Episode credits will be in the show notes. And next time, as we continue to explore the many aspects of giving birth.