With this issue of Alberta Doctors’ Digest, we are pleased to continue our series on the Foundation Stones of Medicine.
When walking across the floor of a building, we may not be aware of the foundation stones that keep it in place. Similarly, patients travelling across the health care system are usually unaware of the intricate structure of specialty care that lies beneath what they see on their individual journeys.
So we are featuring an ongoing series of articles highlighting some foundational specialties. We think the perspectives of these colleagues will be illuminating for the public and perhaps even for members of the medical profession.
For the current issue, we introduce OBGYN.
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Obstetrics and gynecology involves caring for everything in a woman’s reproductive health care. Dr. Cameron Sklar, President of the Section of Obstetrics and Gynecology for the Alberta Medical Association, explains that OBGYN involves the main areas of obstetrics and gynecology and includes multiple sub-specialities in the field. A main component of the specialty of obstetrics includes looking after women who are pregnant and caring for them in their prenatal period, up to the delivery of their babies.
“You’d be the one providing expertise in the delivery of the newborn children, either vaginally or by doing Cesarean sections,” says Dr. Sklar. “You’d be consulted by family doctors, who are also doing low-risk obstetrics. You’d be consulted by midwives in the community who need your expertise for high-risk pregnancies. We care for all of the health conditions a woman may have during their pregnancy.”
The other main area of OBGYN is the specialty of gynecology, which Dr. Sklar notes is a wide-ranging specialty. “We’d be dealing with a woman’s reproductive health, screening for gynecological cancers such as cervical cancer. Some gynecologists perform colposcopy, so they’re specialists who perform specialized techniques to screen and treat cervical cancer.”
Dr. Sklar further describes that women would see gynecologists if they are experiencing menstrual issues, including heavy menstrual bleeding or dysmenorrhea, or if there are any fertility issues. Additionally, he explains that the role of a gynecologist extends to when a woman's reproductive life cycle has stopped, and the woman begins entering menopause.
“We’d be the experts in managing their journey into menopause,” Dr. Sklar says, “so we’d be prescribing hormone replacement therapy and helping them through their menopause journey and any other issue they have through their reproductive life cycle.”
Dr. Sklar explains that the specialty of OBGYN is more than delivering babies; it’s considered a surgical specialty. “We spend the great majority of our time in the operating theatre, either performing Cesarean sections or wearing our gynecology hats and performing hysterectomies, operating on women’s ovaries, performing surgeries to help women conceive, or dealing with other emergency surgeries such as ectopic pregnancy, or helping women who have unfortunately suffered a spontaneous abortion or miscarriage and require treatment for that.”
Dr. Sklar says one of the main challenges of practicing OBGYN in Alberta is the demanding lifestyle. The field of OBGYN has the tendency to be physically, mentally and emotionally draining. Additionally, Dr. Sklar states that other major challenges for many obstetricians and gynecologists include the lack of people entering the workforce, recent struggles with government, and the overall work hours adding to the burnout of the profession.
“Definitely, babies don’t tend to just come after lunch. They tend to be delivered 24 hours a day,” says Dr. Sklar. “One of the biggest challenges with this specialty is the sacrifices that you make to your personal life and your family life. You spend a couple nights a week on call at the hospital away from your family, and it’s incredibly draining.”
As for solutions, Dr. Sklar does see hope. “The AMA is doing a lot of great work to stabilize primary care, and without a doubt, that’s the foundation of our health care system. But I think another solution is what the AMA is already working and drilling towards – trying to stabilize the acute care workforce. I think that obstetrics and gynecology stands to benefit from the solutions that the AMA will hopefully find for the acute care workforce.”
Continuing a hopeful look into a future, Dr. Sklar wants to see OBGYN receive recognition from the government through added investment into aftercare hours and acute care. He would also like to see a reduction in the time-consuming paperwork and administrative burden required by Alberta Health Services. The result would be a more stabilized specialty.
Dr. Sklar explains that people in the community don’t fully understand the complexity of OBGYN. Therefore, an issue facing the field is the overall perception that it’s easy to deliver babies and care for pregnant women. Dr. Sklar describes how social media adds to challenges in the specialty, which is a highly specialized and complex field.
“We feel as a specialty that it’s really difficult when you have people with their own thoughts and beliefs based on what they’ve seen on social media posts about what they think their pregnancy, labour and delivery should look like,” says Dr. Sklar, “when really myself and my colleagues are looking at evidence-based literature. We’re trying to give patients the safest outcome, and sometimes that’s not what people envision based on social media exposure.”
Dr. Sklar says the social media issue can interfere with the specialists’ ability to provide the safest and highest quality care for patients. However, the core foundations of obstetrics and gynecology are to provide high quality care for women and everything in a woman’s reproductive health care cycle, and that’s exactly the work that Dr. Sklar and his colleagues provide for Albertans.
Banner image: Dr. Cameron Sklar (Photo credit: Marvin Polis)