Wow. Lots and lots of opinions voiced here and lots and lots of sage advice. Read a lot of them but couldn't read even a third of them, so of course, I may be rephrasing and repeating what's already been said.
I happen to work with a couple of OB/GYN's who are in their mid 50's and are looking forward to packing it in. The OB hours are grueling, the risks are immeasurable, and if you've reached critical mass, well, there might be some less risky way to move on.
They have each hit upon the same plan, and I believe their timetables are about 1 or 2 years from now. The plan is simple: no more OB. GYN yes. OB no. But as, a lot of OB patients generate gyn patients down the road, they are each trying to come to an understanding with a physician who they will gladly give their OB patients to, so they will have the GYN connection down the road. No guarantee the OB's won't stick with the new OB doc when they become gyn patients, but it's a calculated risk.
They each have outside multiple interests, and they each feel they've had enough of the OB part of the business, considering all the changes in the way practices are managed, the EHR"s, the reimbursements, the liabilities, etc. etc.
So, they are looking for a gentler transition phase.
You might want to look into this aspect as well, as it seems like 'half a loaf' as opposed to just throwing the whole loaf away.
The other advice was something I would've mentioned as well. Go away, far far away, with someone you love, alone, whatever makes sense in your personal life, for a good long while, meaning months. This will get you to clear your head, and you will either make up your mind that you want to rid yourself of ob/gyn or some combo thereof or you will rush headlong back into it, as you may discover the original enthusiasm that led you to the specialty in the first place. Maybe you do miss those 2am c/sections for failure to progress or non-reassuring fetal pattern. Who knows? But you'll have a better idea of it if you can segregate the onus of the daily practice from the actual doctoring parts. And then you may decide once and for all that there is no segregation of the two, and that you'll either accept or reject the whole enchilada, but with a clear mind. Either way, you want to make a decision that feels 'right', and getting away from the trenches for awhile will allow you to calmly think things through. It's tough to make a good decision on week after week after month after month of sleep deprivation, right?
Maybe, as others have suggested, you get a teaching job, a consultant job, a part time coverage job, something, anything to throttle back so that you're not entirely out of the loop, however your own personal preference runs.
But 49 is a young age, and it's sort of a midlife crisis age also, so be careful that's not what's going on here. If you live another 40 years (not hard nowadays), you better have a LOT of money put away. When I was a kid, pizza was 15 cents. It's a heckuva lot more than that. You're going to either have incredibly great investments, a huge savings already in place, or some combo of the two if you just don't work at all. Of course, you may sell your (presumed) private practice for 'all the money in the world' and that may really be enough. Only you know what you expenses/income balance will be going forward. But just make sure you think about all the financial responsibilities to yourself and your loved ones that will accrue over the years. Just be sure, that's all. And then follow your heart.