You may be seeing headlines about declining birth rates in the United States, but what’s often overlooked is that every pregnancy is deeply personal. Having an OB-GYN who understands your wishes, listens to your concerns, and supports your choices makes all the difference as you welcome a baby — or if you choose not to have one.
While 710,000 fewer babies were born in 2025 than two decades ago, many families are choosing to start later. No matter your path or concerns, a strong relationship with your OB-GYN ensures care built on listening, respect, and partnership, says SSM Health’s Dr. Karyn Fowler, a general OB-GYN and faculty member at Saint Louis University School of Medicine. She is also a co-principal investigator for the Maternal Health Innovation Grant from HRSA.
We asked Dr. Fowler to share insights on some of the most common questions about pregnancy — and why regular care with an obstetrician-gynecologist matters.
Q: Statistics show that the birth rate in America is declining. What reasons do your patients share for delaying or choosing not to have children?
Dr. Fowler: "There are a variety of personal and practical reasons that lead women to delay childbearing. What I have heard from my patients is threefold.
"One is that women often tell me that the current state of the world is not conducive to wanting to bring new life into the world. I also would posit that women have been saying that for centuries. But if you’re waiting for that perfect time, I'm not sure that exists either.
"The second is finances. Historically, we do know that birth rates drop when there is fear that a recession is coming or when we have financial times that are not predictable. That understandably leads many people to delay childbearing, as they consider the financial realities and how they want to provide for their families.
"Third, as we’ve seen over time, more women are entering the workforce than ever before. Many want not only to control when they have children, but also to align that timing with the right stage in their careers. Often this means waiting until they’ve established stability and feel more comfortable taking leave and returning to a supportive workplace."
Q: What is one of the biggest misconceptions people have about fertility? What do you wish more people understood about fertility and timing?
Dr. Fowler: "One of the biggest misconceptions about fertility is the belief that we can control how and when it will work for us.
"While some factors are within our control, many are not. Over the years, I've cared for women who are ready to become pregnant and have done everything “right” — taking really good care of themselves, tracking their cycles and their ovulation, yet pregnancy doesn’t happen.
"In some cases, when something shifts in their lives and overall well-being, pregnancy may follow. But there are some aspects of fertility you simply can't control."
Q: When should women start seeing an OB-GYN?
Dr. Fowler: "I always recommend starting preventive care in the early teen years. Establishing a relationship with an OB-GYN can be incredibly beneficial for young women as they begin to understand and manage their health.
"As an adolescent, female health is more focused on the start of menstrual cycles: What is normal? What is appropriate self-care? How does mental health factor into your physical care? All of those things can be established with a thorough OB-GYN.
"Young women can be educated in generalities around sexual health. What is okay and what's not? What is birth control and what are the reliable forms available to them? What can the pill be used for beyond the prevention of pregnancy?
"And, quite honestly, I think the most important thing that early preventive care does is help women understand that they're in control of their health and that early prevention means lifelong health and overall well-being."
Q: What are some reasons that women should regularly see an OB-GYN?
Dr. Fowler: "There are many important reasons for women to access gynecologic care. It often begins in adolescence, when young women start their periods and menstrual cycles, which can feel irregular or unpredictable. While this may seem concerning, it’s actually a normal part of development.
"Understanding that these changes are typical can be very empowering. As women move through different stages of life, having knowledge about their bodies helps them make informed decisions, establish healthy boundaries, and feel a greater sense of control over their health and well-being. This foundation is incredibly important.
"A woman needs to understand how to protect herself from things like sexually transmitted diseases — the incidence of syphilis, for example, has tripled in the past six years.
"If you become pregnant, it's important to get early care so that you can have great outcomes and healthy babies. Early care also helps reduce the risk of conditions like chronic hypertension, excessive weight gain and diabetes, which can have long-term effects on your health.
"After childbearing, women enter the season of perimenopause and menopause, bringing new changes to the body. We have a big gap to fill there, yet it’s just as important for women to stay connected to their care — so they can understand what's happening and feel supported through the transition.
"Even symptoms that may seem minor can significantly affect a woman’s quality of life — and addressing them can make a meaningful difference. As women move beyond menopause, conversations around bone density and the risk for osteoporosis and fractures become especially important.
"Finally, good breast health and mental health are also key considerations as we age, and these are all areas where a gynecologist can provide support and care."
Q: What are some things that women can do now to support their long-term reproductive health?
Dr. Fowler: "There are a few key priorities. First, make sure your physical health is in a strong place. Are you living an active lifestyle? Are you moving your body in ways that support a healthy weight? Do you have a good understanding of nutrition? If not, building those habits early and making them part of your daily routine is essential. A healthy lifestyle is the foundation not only for your own well-being, but also for the example you’ll one day set for your children.
"For me, healthy lifestyle is about more than a healthy weight or practicing good nutrition. It also means supporting both your healthy mind and body. This includes staying active and moving regularly, but also staying well-connected with others. It’s about building healthy relationships and making time for what helps you feel grounded and supported. We know that mental health plays a significant role in long-term health — both physically and emotionally. The two are closely connected and should be cared for together.
"These are the cornerstones of healthy fertility. Just as important is the ability to create and maintain a healthy environment for yourself.
"If you are working outside the home, finding a supportive workplace — one that values pregnancy, leave, and your transition back — can make a meaningful difference in striving for a healthy work-life balance.
"I often say that I'm not sure a perfect work-life balance truly exists. Instead, it’s about being aware and doing the best you can in each moment with what you have.
"That sense of everything being perfectly balanced isn’t realistic — not just for mothers or fathers, but for any of us. What matters most is the environment and support systems you choose for yourself."
Q: Do you have patients who delay coming to you for care? And if so, what reasons do they give?
Dr. Fowler: "I think women often delay seeking care for many reasons, especially those who are very active in their careers and family lives. They may be juggling different seasons, from raising children to caring for aging parents while managing their careers.
"When all of this comes together, it’s easy to think: “I don’t have time to go to the doctor for something I can't feel, that isn’t bothering me right now, and can probably wait.”
Q: What about women’s mental health?
Dr. Fowler: "We're talking about mental health more openly these days, but care in this area is still often delayed.
"When we’re able to have these conversations, it’s not uncommon to find that a woman has been living with depression, anxiety, or other struggles for a long time. In some cases, she may have come to see those feelings as normal until they’re named and addressed. For these reasons, access to mental health care often gets delayed."
Q: When you do get a chance to care for a woman who has been putting off care, what are the results? Do you have a memorable story?
Dr. Fowler: "There are many powerful stories of early detection — cervical cancer identified through routine pap smears And breast cancer detected early through regular mammograms.
"But one patient’s experience has stayed with me. She had recently lost twins and was referred to me for mental health support. Her depression screening was positive, understandably so.
"As we began talking, I asked when her depression first started.
"She shared, 'I think it really started when my daughter was murdered 13 years ago. And I've never talked to anyone about that.'
"It took my breath away. I wasn’t expecting that but, in that moment, she was able to say it out loud for the first time and begin the process of getting help.
"It’s a reminder of how often people carry deep pain without feeling they have a safe place to share it. Not every story is this traumatic, but it underscores the importance of creating space and encouraging women to speak openly about their mental health."
