For many obstetricians, it is the excitement of bringing new life into the world that first attracts them to the specialty. "There are still many situations where nature is not a good midwife" Dr Rupert Sherwood, president Dof the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), says one of his favourite parts of his job is seeing the first ultrasound images of a growing embryo.
"After 2526 years [as an obstetrician–gynaecologist] I still get a buzz when I see that first ultrasound image of an embryo at 89 weeks, with a heartbeat ... it's a story that you can watch together with the parents", he says.
The excitement of delivering a baby is also something many obstetricians continue to find stimulating after many years of practice (eg, see Medical Mentor, page C5). Intrapartum care can range from a supervisory role to hands-on involvement, especially in complicated labour or caesarean deliveries. Before the pregnancy, obstetricians are also involved in pre-pregnancy medical care, and after the birth they provide postnatal care, which is defined as care up to around 6 weeks after the birth.
Dr Sherwood says most specialist obstetricians also practise as gynaecologists. "Unlike some other fields where the degree of subspecialisation is quite high, we still have a fairly large generalist workforce and we aim to keep it that way, particularly in rural and regional Australia", he says.
Dr Sherwood, who practises in Hobart, says that obstetrics allows doctors to use an appealing mix of medical and surgical skills.
"I describe myself as an operating physician. [The specialty suits] people who don't want to do the technical thing all day, but enjoy consulting and medicine as well."
Junior doctors who are considering a career in obstetrics need to be empathetic, with good communication skills."Because you are dealing with people at a difficult emotional time in their lives, you need to be supportive and have good interpersonal skills ... you can't survive on technical excellence only", says Dr Sherwood. "I still get a buzz when I see that first ultrasound image of an embryo at 8-9 weeks"
Professor Ian Fraser, professor of reproductive medicine at the University of Sydney, says would-be obstetricians also need to have a real enthusiasm for the field so they can handle the often antisocial working hours.
"They need to find the wonder of reproduction and pregnancy and birth and new life something that excites them, because it's a demanding specialty in terms of time and commitment."
Obstetricians also need to be able to project an air of confidence, which will inspire confidence in other staff, such as nurses and midwives, as well as their patients -- particularly when things go wrong.
"There are still many situations where nature is not a good midwife", says Professor Fraser. "You need a personality which doesn't freak out when something unexpected happens. You have to have confidence in yourself, and a calmness in your personality that will extend to the people around you."
Obstetricians, particularly those in the private sector, often have long-term relationships with their patients over many years, or even over generations. As well as the close care provided during a pregnancy, many obstetriciangynaecologists will also provide gynaecological care between pregnancies.
"Getting to know your patients and their children and their families over the years, and seeing the children of the women you delivered, or, when you get to my stage, the grandchildren -- that aspect can be particularly satisfying. We find that in few other specialties", says Professor Fraser.
- Sophie McNamara