How Obstetrics and Gynecology Became One Specialty

Contents

1. Midwives held the birthing room for centuries
2. Forceps shifted the work toward surgeons
3. Early cesarean operations were rare events
4. Two societies merged into one
5. One board certifies both halves
6. Subspecialties grew inside the field
7. Women returned through the universities
8. A small minority became a clear majority
9. What changed and what did not

Candace Cooley is a board certified obstetrician and gynecologist, and the makeup of her specialty is a question the researcher William F. Rayburn of the University of New Mexico set out to measure. MDedge reported that his team’s cross sectional study of 190,379 physicians found that women made up almost 62 percent of obstetricians and gynecologists in 2014, making the field the only one of the five largest adult outpatient specialties with a female majority.⁵ That majority is recent. The specialty itself is younger than the two crafts it joined, and its story runs from the birthing room to the examination hall.

Midwives held the birthing room for centuries

In early modern Europe, roughly 1400 to 1800, a history published by the International Museum of Surgical Science explains that midwives attended women in labor at home and were responsible for the safe delivery of babies, calling in barber surgeons and their instruments when labor was delayed or an emergency arose.² Most midwives trained by apprenticeship, a few attended formal schools, and for centuries they were refused the advanced knowledge taught at the medical universities. City councils also moved to control their duties and their pay, which narrowed their independence as a profession.²

Forceps shifted the work toward surgeons

The same account traces the turn to an instrument. Barber surgeons were at first associated with death, because they were summoned only when a delivery had gone badly. Forceps let them deliver babies successfully, and male surgeons took control of labor and delivery, their standing lifted by the Enlightenment’s regard for science and reason.² Men then held the field for as long as they were the only ones admitted to formal medical education and training.

Early cesarean operations were rare events

Two operations from the nineteenth century show how dangerous surgical birth still was. James Barry, a military surgeon who lived as a man and was found after his death to have been assigned female at birth, performed the first successful cesarean section in South Africa in 1826.² In 1844 the Colombian physician Jose Ignacio Quevedo performed the first successful one in Latin America, a scene later painted with a priest present in case the patient died, since the risks of the operation were well known.²

Two societies merged into one

In the United States the two halves of the field organized separately at first. The foundation of the American Association of Obstetricians and Gynecologists records that the American Gynecological Society was founded in 1876 and the American Association of Obstetricians and Gynecologists in 1888, and that both pursued the same aims: advancing knowledge in the field, passing current knowledge on, and recruiting talented people to obstetrics and gynecology.¹ The two merged in 1981 as the American Gynecological and Obstetrical Society. The foundation, incorporated in 1929, now puts its resources mainly into research training scholarships for people pursuing an academic career in the specialty, and since 2002 has jointly sponsored one for obstetrician gynecologists doing research in maternal fetal medicine.¹

Figure

Two societies, one field

1. 01
   1876The American Gynecological Society is founded.
2. 02
   1888The American Association of Obstetricians and Gynecologists is founded with similar goals.
3. 03
   1929The association's foundation is incorporated to support an annual oration and a manuscript prize.
4. 04
   1981The two societies merge as the American Gynecological and Obstetrical Society.

One board certifies both halves

Certification brought the two fields under one roof well before the societies merged. The American Board of Obstetrics and Gynecology dates its work to 1927 and describes itself as a national nonprofit that offers voluntary certification, and continuing certification, to obstetricians and gynecologists in the United States and Canada.⁴ In a 2024 statement on the meaning of certification, the board called itself a founding member of the American Board of Medical Specialties and said that certification signals a diplomate has achieved and maintained the knowledge, skills and professionalism to practice in the specialty.³ Its examinations are set by subject experts, built on psychometric methods and revised as practice in women’s health care changes; they are not meant to test teaching or administrative ability.³ The years of training that lead to that examination are covered in the entry on OB/GYN residency.

Subspecialties grew inside the field

The combined specialty then branched. The board has certified subspecialists in gynecologic oncology and maternal fetal medicine, among others, for about fifty years, and since 2018 it has certified urogynecology and reconstructive pelvic surgery, once called female pelvic medicine.³ It now administers certification in five subspecialties and offers focused practice designations in pediatric and adolescent gynecology and in minimally invasive gynecologic surgery.⁴ Imaging became part of the same toolkit, a thread followed in the entry on Ian Donald and obstetric ultrasound.

Women returned through the universities

The museum’s history places the turning point in education. Only in the late 1800s could women attend medical universities, schools to train women were founded, and the labor shortages of the First World War drew more women into the professions, though quotas and other restrictions kept the path narrow.² As women entered medicine in larger numbers, obstetrics and gynecology saw more women physicians and fewer men choosing the field.² The trend in schooling continued. The Association of American Medical Colleges reports that women became a majority of United States medical students for the first time in 2019, at 50.5 percent, and accounted for 54.6 percent in the 2023 to 2024 academic year.⁶

A small minority became a clear majority

The change among trainees was steep. The museum’s history cites figures showing that women were 16 percent of residents and physicians in training in the field in 1975, and that by 2015, 85 percent of its residents were women.² Among practicing physicians the shift came later. The AAMC comparison found women rose from 38 percent of active obstetricians and gynecologists in 2004 to 62 percent in 2022, when the specialty joined pediatrics and dermatology as the largest specialties with a female majority.⁶ The study Rayburn led also found the field had the largest share of underrepresented minority physicians of the five specialties compared, at 18.4 percent.⁵

Figure

Women as a share of active physicians

	2004	2022
Pediatrics	52%	66%
Obstetrics and gynecology	38%	62%
Dermatology	35%	53%
Pathology	32%	44%
All active physicians	26%	38%

What changed and what did not

Much changed. Delivery moved from the home and the apprentice to the hospital and the university, two societies became one, and a single board came to certify both halves of the work. The people doing that work changed most visibly, from a profession closed to women to one in which they predominate. Some things held steady. Certification is still voluntary, as it was designed to be.³ Why men have moved away from the field is still unclear, and the museum’s history notes that research suggests a physician’s gender is not a primary factor in how patients choose.² An older pattern also persists: the AAMC cites a study in which, within six years of finishing training, 22.6 percent of women physicians were not working full time, against 3.6 percent of men.⁶ What kind of specialist suits any one woman, and what her care should include, remain matters for her and her own clinician to settle.