Obstetrics

Obstetrics is the branch of medicine that deals with assisting and monitoring women during pregnancy, childbirth and puerperium (the period immediately after the birth). The area of obstetrics also includes the pathologies that may occur in the mother and the foetus.

The role of the midwife during pregnancy

The main task of the midwife involves promoting the well-being of the woman and providing the necessary support and guidance so that the expectant mother can approach the duration of her pregnancy and the experience of childbirth in as relaxed a way as possible.

It often happens that women, especially if it is their first pregnancy, are plagued by worries and concerns once they find out that they are pregnant. The task of the midwife is to reassure these women, to help them to understand the processes during pregnancy, to prepare them for the changes that their bodies will undergo and to provide them with support and advice, not just on a physical level but also mentally and emotionally.

In the very first stage of the pregnancy, the body of the expectant mother changes in order to be able to accommodate the foetus. However, it is not always easy for women to accept the physical and emotional changes associated with this stage. The tasks of the midwife include making this adjustment process easier by helping the expectant mother to understand how the various mechanisms work to create the ideal conditions to accommodate the baby. It is in fact extremely important that the changes in the body in the first trimester of the pregnancy take place under the best possible conditions as this can help to reduce the risk of gestosis and the occurrence of high blood pressure in the last trimester of the pregnancy. In the second and third trimesters of the pregnancy, the placenta becomes fully formed and the foetus starts to move actively, something that helps to strengthen the close bond between mother and child. The midwife also plays a fundamental role during these particularly important stages in supporting the expectant mothers and preparing them for the unique experience of childbirth.

What are the tasks of the midwife?

The assistance provided by the midwife includes:

• antenatal training and preparation for becoming a parent, not just for women but also for couples/families;
• promoting a physiological birth by helping events to unfold in as natural a way as possible;
• preventing morbid conditions that mother and child may encounter during pregnancy;
• identifying complications for mother and child by recording potentially pathological situations that require medical intervention and taking the relevant emergency measures where necessary;
• guiding and supporting the woman during labour and childbirth and avoiding all aspects and interferences that could have a negative impact;
• supporting the brand-new mother when they meet their baby for the first time.

The associated professions

As a general rule, representatives of two different medical specialisations work within this department.

• The first of these are doctors who have completed their specialist medical training in gynaecology and obstetrics. In the area of pregnancy and childbirth, gynaecologists are the only ones who can intervene if complications occur during labour and surgical interventions such as a caesarean sections have to be carried out. Gynaecologists take a medical approach during pregnancy and intervene in the event of problems in order to prescribe the necessary medical treatment. However, the responsibility of gynaecologists is not limited to pregnancy, it includes all diseases and disorders of the female internal and external genitalia of women at all stages of their lives.
• The second of these are midwives. These are the healthcare professionals who look after the patient during pregnancy, childbirth and the postpartum period. They are not permitted to carry out surgical interventions or to prescribe medication. In the case of high-risk pregnancies or where the pregnant woman has health issues, the midwife’s area of activity may therefore be limited to requesting medical and pharmacological assistance, such as in the case of heart conditions, epilepsy or diabetes.

There is no clear separation between these, as a woman may generally be under the care of both a gynaecologist and a midwife at the same time. From an ethical perspective, the doctor (the gynaecologist) deals with the pathological aspects due to their role as a physician. The midwife, on the other hand, is an expert in the physiological processes during pregnancy and childbirth. If you wanted to identify a fundamental difference between these two roles, you could say that the main task of a doctor who is a specialist in gynaecology and obstetrics is to provide treatment, while the main task of the midwife is to provide assistance. However, this assistance also includes having the specialist expertise to identify when this support is no longer enough and somebody else is needed who is able to intervene to provide treatment. The midwife is therefore able to not only recognise when a doctor is required during pregnancy and birth but also has the necessary skills to avoid the need for intervention by a doctor as far as possible.