Specialist Q&A: What Can an Obstetrician-Gynecologist Do for You?

Gaither: I'm a maternal-fetal medicine specialist, and what that means is I have done extra training to take care of women that have complicated pregnancies. Either they have some underlying medical issue like diabetes, hypertension [high blood pressure], HIV, or surgical issue, or their baby has an anomaly of some sort. I'm trained to perform detailed obstetrical ultrasounds and genetic amniocentesis; in short, prenatal diagnosis, which I absolutely love.

What I love about being a maternal-fetal medicine specialist is the ability to focus on what and how you like to practice. For me, I'm interested in prenatal diagnosis. I love the genetic analysis aspect and I love the research. I also love teaching.

Other maternal-fetal medicine specialists might focus on other aspects, such as fetal surgery or engaging in bench research, meaning you're in the lab doing X, Y and Z with either cells or animal models, looking to see or come up with new research/novel treatments to help progress medicine. I still do clinical research and did bench research when I was in fellowship training on placental function in diabetes.

Well, certainly, the specialist needs to be an M.D. or a D.O. Then you should look to see that they are board certified in whatever subspecialty you need. So they will be double board certified in obstetrics and then in whatever specialty it is that you've selected, too.

For example, I'm double board certified in obstetrics and maternal-fetal medicine. So who would be coming to me? Diabetics. Hypertensives, patients with HIV/AIDS [or] sickle cell disease. Babies with anomalies; cardiac anomalies or brain anomalies. You know, any type of really complicated pregnancy issues.

• Gynecologic oncologists deal with cancers of the female genital tract: the vagina, the cervix, the uterus, the fallopian tubes and the ovaries.
• Minimally invasive gynecologic surgeons deal with a lot of laparoscopic techniques and gynecologic surgery that doesn't necessarily require a laparotomy—for example, opening up the patient's abdomen—even though they do that type of surgery, too.
• Reproductive endocrinologists deal with infertility. So I have an alignment with a reproductive endocrinologist due to all the multiple gestations that I contend with. The infertile patients get pregnant with the help of the reproductive endocrinologist and then come over to me with twins, triplets, quads, etcetera.
• Urogynecologists deal with things like urinary incontinence and pelvic organ prolapse.

It's vital for you to take family information and history with you and share that with your doctor. For instance, it's really important for your OB-GYN to know if your mom and sister have breast cancer, because they're going to do genetic screening to ensure you don't have a risk of developing breast cancer.

Please know your medications when you come. Many people describe their medication to their doctor, saying something like, "I take the blue pill," but there are thousands of blue pills. You don't have to know all the names. If you can't remember them, then just take the boxes/bottles with you to the appointment to show your doctor or keep a list you can take with you.

When you see an OB-GYN, you're going to get an exam in triage where the nurse will take your vitals, dip your urine and do a pregnancy test, if you're coming to ascertain whether or not you're pregnant. Then your provider will take a history, which will ask questions like:

• Why are you here?
• What symptoms are you having?
• What is your medical and surgical history?
• What is your family history?
• Tell me about your social history: Do you drink alcohol or take drugs? Have you had any issues with substance use in the past?

The clinician will review all of the body systems from head to toe, asking about headaches, your heart, gut problems and every concern. This is followed with a complete body examination of your eyes, mouth, thyroid, breasts and abdomen. They're going to do a pelvic exam and Pap smear, too.

It's also likely you'll have a rectal-vaginal exam where one finger is inserted in the vagina and one finger in the rectum to ensure there are no abnormal findings, such as nodularity. There's a band of tissue there where you can develop cancer, endometriosis, etcetera, so they're going to do a rectal-vaginal [exam] to make sure there are no issues at hand. If necessary, they'll screen you for sexually transmitted diseases, too.

Depending on what your issue is, they might get some other labs—like blood tests—and maybe an ultrasound to see what's going on internally. Certainly, if you're going to a reproductive endocrinologist for infertility or because you want to get pregnant, they're going to draw hormone levels to see where you are "chemically," so to speak, and determine whether there is a problem with premature ovarian failure.

Each specialist will then have further lab tests to complete depending on what they're looking for. A gynecologic oncologist looking for ovarian cancer will do certain labs that are markers of cancer. If it's an urogynecologic evaluation, they might use a machine to assess whether or not you're having bladder problems.

With me, certainly I'm going to do the history and physical, an ultrasound, and take a look at the baby and then take it from there, depending on what I see.

All these examinations, tests and history taking can then be pieced together to help make a diagnosis.

Everybody practices differently. When I meet a patient, I talk to them like they're my friend. I want to talk to them in a manner they readily understand. I've got plenty of medical books in my office to do a show and tell. I talk to them, for instance, about how diabetes impacts mommy and how diabetes impacts the baby. I'm going to talk about what they can expect as they go through their pregnancy and why. It's always important not to just say we're going to do this and we're going to do that. There is a reason why; that must be explained as well.

The patient has to take ownership and offer input into their care as well, because it's not just me involved in the pregnancy care, it's them, too. They have to show up. They have to check their finger sticks. They have to follow the diet. They have to come for fetal testing. Their input is just as important to ensure a good outcome for both of them, mother and baby. So we have a frank discussion as to the what, when, where, how and whys. And the why is really important, more so than anything else. Why are we doing this?

Make sure you get early prenatal care. Actually, if you're thinking of getting pregnant, even in the preconceptual period, go and see your doctor, particularly if you have underlying comorbidities like diabetes or hypertension. It's important you get your health, like your blood sugars, under control because everything you are as a human being forms within the first six weeks of pregnancy.

If you are an out-of-control diabetic, you have a markedly increased risk for congenital anomalies, specifically, of the baby's brain, heart and lower limbs. So I would really have my patients in the preconceptual period go to their doctor and get their comorbid conditions optimized. Start taking your prenatal vitamins with folic acid as soon as you start trying to get pregnant or find out you are pregnant if you are not actively trying. Folic acid helps to prevent CNS [central nervous system] abnormalities. If you can't get care at the preconception point, as soon as you find out you're pregnant, come on in.

The best recommendations of who to go to for prenatal care will come from your family and friends. I think that's the best way to get somebody you can relate to. I think the basis of a good patient-doctor relationship begins there.

Certainly, there are going to be technological advancements as far as a sonogram is concerned, and prenatal diagnosis, because we already have 3D and 4D scans. At some point, we're going to get beyond that.

I think we will reach the point where pregnancies can occur outside the body, because they're already doing so with sheep. Fetal sheep are being gestated in fluid-filled plastic bags. I think the technology is going to get to the point where that's going to happen for humans.

Say, for instance, a woman has had a hysterectomy or she's had cancer of the uterus, and the uterus is no longer there, but she's got ovaries. So the possibility—the scientific possibility—which I'm sure is going to come to fruition, is to harvest eggs and sperm and get the embryo, and then put the embryo in a plastic bag with the fluid/nutrients and let that bag be the gestating womb. I think we're going to see that come to fruition quite soon.

With the genome projects going on, I think there will be more technological advancements in genomic development/manipulation. They will be able to look at your genome—your specific DNA—to see what types of issues you might have throughout your lifetime and be able to genetically manipulate or fix whatever defects you have at that point in time. I believe that's coming down the pipeline in the future.