The Life Raft for ob/gyn

December 17, 2008 at 8:00 pm (Life Raft)

Along with surgery, the obstetrics and gynecology rotation is one of the most fear-inducing clerkships that a medical student will encounter. It, too, is filled with long hours in which lots of patients have to be seen, prepped for surgery, and then operated on. I took my ob/gyn rotation after family medicine. Making the switch from getting up at 8:00 a.m. to getting up at 4:00 a.m. hit me pretty hard.

The inpatient gyn section of the rotation is very similar to surgery. The attending yelled at residents for not knowing minutia. The residents in turn yelled at the intern for not anticipating the desires of the superiors. And the medical students got ignored and were forced to stand in the back of the room when examining a patient. While a simple hysterectomy can be performed in under two hours, some of the oncology surgeries would go well beyond the eight hour mark as we removed the entire pelvic anatomy of a woman stricken with ovarian cancer. And I use “we” in a loose sense. In reality, I sterilely stood to the side and watched as an attending muttered profanity under his breath with each blood vessel and ligament encountered. So long as you remember the details and advice from the Life Raft for surgery article, you should be fine on the gynecology section.

The real highlight and breakaway comes when you do obstetrics. Obstetricians have vast medical knowledge regarding drug effects on fetuses, the day-by-day timing of embryonic growth, and carry with them enormous patience for a woman in labor to finally hit the delivery point. At my hospital, medical students are required to deliver at least one baby during the rotation. Unfortunately, there is a turf war going on between midwives and obstetrics residents for delivery time. I may spend an evening on call working with a patient in labor in the hopes that I might get to perform the delivery, only to have a midwife shove me out of the way and tell me, “She’s mine, bitch!”

It’s kind of like when I’m at a party and trying to pick up the attractive girl, only to have her fat friend show up and say, “We’re leaving! No one wants to talk to me.” And just like that, all of the work on my behalf is gone. But so long as you are persistent, you should eventually get to catch a baby on your own.

Some advice:
First, never examine a patient on your own, even if you are female. There are lots of nutty people who come to the hospital with their own expectations. You might be performing an internal exam to check for STDs, positioning of a baby’s head, reasons for vaginal bleeding, or whatever else you can think of—only to have the patient accuse you of sexual assault. Find a nurse for another medical student and have that person chaperone you when you are performing a physical.

Second, when you find a patient that you want to perform the delivery on, introduce yourself many hours in advance. Granted, some women who choose to go to county hospitals for delivery don’t care who delivers her baby, much less who knocked them up, but it’s still the polite thing to do.

Finally, make sure everything is ready to go for the delivery—even if the baby isn’t due for another six hours. I had everything laid out on a table in case of an imminent delivery because there really is no way to predict when the baby will arrive.

Some previous artcles:
Was that my alarm clock making that noise?
Birthing: the miracle of life or “don’t drop it”?
The fake surgeons

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2 Comments

  1. Scrub Notes said,

    Heh, can’t reiterate that ‘be prepared’ point enough. I finished ob/gyn a few months ago, and I remember a high parity mother (like G4P3) that I had. She was close to delivering, and we were in the room getting ready. However, by the time we had gotten the kit set up and our gloves on, the baby had already popped out on its own! Of course, the nurse assisted, but in essence, it was an “auto delivery.” Sometimes, I think we forget that nature took care of a lot of this stuff long before there was formalized “medicine.”

  2. nadia said,

    Hi im interested in Doing OBgyn residency and I wanted to know as a pg1 what should I do or know before hand… any physical exam advice (like you mentioned in your post) medication advice? note taking advice? what books do the residents use. will i always be supervised and told what to do or will i be expected to know already? anything you can tell me will be helpful or even if you know a place i can look to for more info. thank u

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