Who Will You Meet on Your Fertility and Pregnancy Journey?

Confused by the various practitioners you’ll meet along the way? Dr. Gleaton explains who you’ll meet, what role they’ll play, when you’ll meet them, and why they’re important. 

By Dr. Kenosha Gleaton

So, you’re just starting to TTC, and not only do you have to learn about ovulation and your fertile window, but you also have a whole new world of medical providers to understand. Depending on your story, you may interact with various knowledgeable medical team members on your path to parenthood. Let’s break down each one, including their education, where they work, and scope of care.

During your pregnancy journey:

OBGYN: An OBGYN is a doctor who practices obstetrics and gynecology. 

• Education: It takes about 12 years of education and residency training to become an OBGYN, and recertification and testing is required to maintain the high standards required for this specialization. 
• Where do they work? OBGYNs work in the inpatient hospital setting and outpatient clinic in private, public, and academic environments. 
• Scope of care: OBGYNs see adolescents to older patients for preventative gynecologic care, abnormal vaginal bleeding, family planning and contraception care, endometriosis, fibroids, and a variety of symptoms related to the reproductive organs. This means they see patients in the office, perform gynecology surgeries including hysterectomies, removal of fibroids or ovarian cysts, and also deliver babies on the Labor and Delivery unit. 

 Nurse Practitioner (NP): An NP has an advanced degree (sometimes a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) with a specialization in Women’s Health or Family Medicine. This means they may be credentialed as a Women’s Health Nurse Practitioner (WHNPs) or Family Nurse Practitioner (FNP). 

• Education: It can take as long as ten to 12 years for some to become a nurse practitioner! Many receive a bachelor’s degree (four years) in nursing (BSN) or another field, become a registered nurse and get experience (one to four years), pursue a graduate degree in nursing (one and a half to four years)
• Where do they work? Inpatient hospital setting and outpatient clinic in private, public, and academic environments. 
• Scope of care: They see adolescents to older patients for preventive gynecological care, abnormal vaginal bleeding, family planning and contraception care, endometriosis, fibroids, and a variety of symptoms related to the reproductive organs. The NP can manage patient visits and conduct ultrasounds throughout a pregnancy. They work alongside doctors. 

Physician Assistant (PA): a PA is a licensed medical professional that can diagnose and treat patients. PAs do not have a doctorate of medicine, but still perform direct patient contact, typically under supervision of a physician or surgeon. Some states and rural areas allow PAs to practice independently with little to no supervision necessary. 

• Education: A PA also has an advanced degree, usually from medical school or center of medicine (two to four years) after completing a bachelor’s degree (four years). 
• Where do they work? PAs work in hospitals, birthing centers, medical offices, nursing homes, and more. 
• Scope of care: PAs examine patients, diagnose illnesses, and provide treatment. SImilar to NP’s, some specialize in reproductive health and work with women during childbearing years. They provide preventive gynecological care, family planning and contraception, treatments for endometriosis, fibroids, and a variety of symptoms related to the reproductive organs. 
• Scope of practice can depend on the state and some PAs are able to prescribe medication as well. 

Certified Nurse Midwife: a CNM is a speciality within nursing, and it takes years of education to complete this degree. CNMs are advanced practice registered nurses (APRN) who focus on gynecological health, prenatal, and postnatal care. 

• Education: Bachelor’s degree (four years) in nursing (BSN) or another field, master’s degree (or higher) from an accredited midwifery program (two to three years). A CNM must be a Registered Nurse before becoming eligible for the CNM degree. Recertification is required to maintain the high standards required for this specialization. 
• Where do they work? Inpatient hospital setting and outpatient clinic in private, public, and academic environments. 
• Scope of care: CNMs work with women throughout their reproductive years focusing on family planning, gynecology, childbearing, and so on.   

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If you have concerns about infertility: 

• Nurse practitioner/Physicians assistants: NPs and PAs can help families going through infertility by educating them on their conditions and treatments, administer treatments, treat patients, and work with doctors on fertility research.
• Ultrasonographer: Also known as an ultrasound technician, ultrasonographers can use ultrasound to assess the shape and condition of the reproductive system, including the ovaries, uterus, and fallopian tubes. 
• Reproductive endocrinologist and infertility specialists (REI): A specialty under obstetrics and gynecology that focuses on hormones and reproductive functioning. REI’s are primarily responsible for treating patients with advanced infertility and female hormonal conditions. Similar to a general OBGYN, they complete 12 years of training followed by an additional three years of fellowship. 
• Embryologist: Highly trained medical professional who has a bachelor's degree as well as a masters and occasionally a doctorate in clinical or reproductive science. Embryologists help create viable embryos for fertility treatments.

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During labor and delivery: 

If you’re delivering in the hospital setting, you may meet any of the following:

• Labor and Delivery Nurse: Labor and delivery nurses can administer medications, help manage epidurals, and assist with labor and delivery.
• Anesthesiologist: Medical doctor who performs epidurals, spinals, and general anesthesia to assist with pain during labor, delivery, and cesarean deliveries.
• Midwife: Midwives can manage labor and perform routine vaginal deliveries in some hospitals.
• OBGYN: An OBGYN is likely to be the one delivering your baby in the hospital setting and can also perform c-sections. 
• Doula: An individual hired by the patient to provide guidance and support during pregnancy, labor and delivery.  Doulas usually attend the birth
• Lactation Consultant: A lactation consultant is likely to come around to aid you in breastfeeding and answer any questions you may have about lactation and breastfeeding.
• Pediatrician: A pediatrician is likely to assess your newborn soon after birth, and for months (maybe years) following. 
• NICU (Neonatal Intensive Care Unit): If you deliver a premature baby, or your baby has health problems or has gone through a difficult birth, you may become familiar with NICU nurses and doctors-Neonatologists. These medical professionals take care of babies that need special attention or extra care following birth. 

Throughout postnatal care:

• Pediatrician: Finding a good pediatrician is extremely important as they will be conducting your baby’s checkups from birth to 24 months up and often will see children  until 18 years of age. 
• Family doctor: Family doctors are great for primary care needs and can even help with mental health concerns like postpartum depression. 

Honestly, just thinking of the countless years of education and training for these medical professionals makes my brain hurt! However, there's a good reason. Pregnancy is a very unique and delicate time and can require significant clinical expertise. With US maternal morbidity and mortality on the rise, it's important that medical teams collaborate to ensure you and your baby have an optimal outcome. Thus, it not only takes a village to raise a kid, but also to birth and bring one home safely!

Have more questions about pregnancy or fertility? Check out our blog for more information.