Do medical students still need to attend a certain number of births?

[asIlayfrying]

Was thinking about this today as I sometimes do, because I remember having my first baby and a number of medical students traipsed in right at the end to watch.

It still bothers me that they all came in - I don't even know how many there were and can't remember their faces or anything. But I remember reading somewhere that as part of their training they 'need' to see a certain number of women give birth.

But why? I get that it's exciting and amazing to watch, and if you do go into obstetrics then you need to be there, but why do medical students - most of whom will never deliver a baby in their future careers - 'need' to be there? Surely with YouTube etc there are plenty of opportunities to see a baby being born without having to crowd into an already fraught room simply to stand around staring.

Looking back I wish I'd said can all these random strangers leave, but I was too exhausted and afterwards too busy with the baby to bring it up.

I know that many women will say they don't care who was there, but it does feel to me like an old-fashioned and somewhat entitled practice that doesn't serve birthing women and isn't that necessary from a learning perspective anyway, unless people go into that field. Or at least, should the learning value be balanced against the right to some privacy for the mother.

I know you can say no and I did for my second baby, but I did feel a pressure to be OK about students for my first, and looking back, I just don't think they would have learned much from simply watching anyway, or could have learned just as well from other sources that didn't involve me!

Midwife and med student were amazing.
Junior doctor who delivered Ds was horrendous. Tbf it was his first delivery apparently but he kept saying stuff and not letting me concentrate, and he caught Ds head when breaking my waters - he has a bald patch from it.

I had a crowd, I was asked if I consented to "a couple of medical students observing", I was in absolutely no fit state to consent to anything. There were at least 8-10.

I had been transferred in ambulance and DH had had to follow in the car, had got stuck in traffic and then behind a car crash, so it took him two hours to get there. He arrived and shortly after a large group of students, chattering amongst themselves came in, whilst the doctor was explaining what my options for birth were. DH requested the students leave.

I think(am pretty sure) they'd been there for my having the epidural sited, and my internal exam, but the fact that I can't properly recall shows me that consent wasn't given freely.

I will usually always have medical students, everyone has to learn, but to have a classfull was invasive and unnecessary. I would allow one, maybe two to observe if there is a next time.

I take issue with this in the way it’s handled, when I was having my daughter a group of six of them came in to watch me get an internal from the consultant. With the mid wife in the room I had eight people.

It was a bad labour and the walked in and all lined up at the end of the bed, I lost my temper and shouted “ what the fuck are you all looking at you bunch of perverts, get the hell out” . Not my finest moment I grant you.

They all looked mortified, the consultant asked them to leave the room and explained they were students and he should have asked first and apologised.

I’m still appalled by it. No one wants to raise their knees, drop their thighs and find seven people standing at the end of the bed looking in between their legs.

The point I am making PicouldPinet is that coming in as a group at the 'business end' of a baby being born is of limited educational benefit, or if it is educational, its benefit is at the expense of a woman feeling like she is a exhibit for a group of strangers at a very vulnerable time.

And really I do think a lot of what they saw could have been equally conveyed online, esp. as for many of them they would have gone on to do completely unrelated work and never been present at a birth again. The idea that students 'must' witness a certain number of births to qualify is worth questioning if you ask me, esp as many women who have posted here are still upset by the intrusion of strangers appearing to 'observe' to tick their training box.

Complaining at the time wasn't an option because i was unwell and delivering a baby - that is also my point - you don't have the option to give proper consent when a whole group just walks in when you are pushing out a baby.

There should be a strict maximum of two I think. That's a compromise between the need for them to learn and the dignity of the patient.

Thank you for reminding me to include ‘no students’ on my birth plan.

I can’t comment on the merits of forcing medical students to attend births but it seems like it would be worthwhile promoting a better understanding of informed consent.

Ha ! I had one one in to mine in 2008. They asked my permission and I consented. But he was so irritating. He kept asking questions and talking all the time. I put up with it for a couple of hours, then during a big contraction near the end when I needed to concentrate and he was chatting merrily, I told the midwife he had to go. Honestly it served him right and I know he’d have to try again with another patient. But seriously stop talking !!

When having dd2 I was the only one in giving birth that night. It felt like everyone was traipsing in and out because nothing eIse was going on. I remember 2 nurses in the corner discussing their plans for a night out. Was not impressed.

The idea that students 'must' witness a certain number of births to qualify is worth questioning if you ask me, esp as many women who have posted here are still upset by the intrusion of strangers appearing to 'observe' to tick their training box.

I certainly agree that there are often problems with how consent is handled but how are they meant to learn? It's not in women's best interests to prevent future doctors from learning things.

They really shouldn't be standing there as an audience - that would have been considered unusual/unnecessary/pretty useless even back in the 80s (when you did need a certain number of deliveries, not t just watching deliveries)

It should be an individual student, with consent, who is there to deliver the baby under close supervision. It is really important that doctors have experience of normal deliveries, as it really warps the system if all they learn are complex ones.

If they were just spectators, then yes you could watch on screen instead. But that was never how it used to be, and really doesn't have the value of the older system. I am somewhat staggered at the change

I went to my GP with mastitis (and a newborn baby in arms) and she had a med student working with her. I asked him to hold the baby while she examined me and the poor lad shit himself - they'd maybe watched births but certainly hadn't held babies!

I had 3 I think all mw students and I couldn’t be more greatful for the help they provided me. When I was being sick after the medicine that they had given me it wasn’t the 10yo experience doctor who was helping and cleaning me but the student.

Re your YouTube comment. Seriously ? Hope you’re never in the position where a doctor has to treat you that have learnt what needs to be done vía YouTube.

You should have been asked and can always say no (even if they don't ask, which is wrong) as you can with any part of your care.

Interesting Scaevola

Yes my point (which some have missed) is that if a student is literally just standing there a baby come out, why not watch it on a screen somewhere and spare the woman the audience?

And online learning is the future. Obviously you need actual experience as well but it's not like it was 50 years ago when you did need to physically be in the room to witness a birth. There is no difference between what the students in my room saw and what they would have seen on YouTube, it was very rushed and they were literally in and out of the room without engaging with anyone.

Individual students, throughout the process, with consent, is of course different and can't be replaced by a screen.

My sister had a roomful when she was having twins. One of the female named students made a sharp intake of breath and said in a loud whisper "Oh my god, look at those stretch marks."

[quote AmICrazyorWhat2]@SockQueen This was was in the US and they were supervised by a consultant. They were residents- not sure if it’s the same terminology in the UK.

I’m all in favor of hands-on training but these two weren’t ready to treat patients ( in my non-medical opinion). Doctors here start their residencies during the summer and DD was a summer baby...think I got some newbies.😂 Personally I think the consultant should’ve taken over when it took so long to sew me up.[/quote]
Residents are qualified junior doctors. Not med students. Not even the most junior type of doctor (those are interns in the US).

A spinal tap is a recognised complication of epidural insertion that can happen, albeit slightly less frequently, in the most experienced hands. In itself doesn't mean the procedure was "bodged." I obviously can't comment on the experience/supervision of the doctors in this case.

I do think that labour and delivery is an important experience in any med students' training, but it should be done with dignity, in small numbers and proper agreement of the women. I still remember the first delivery I saw, it was an amazing privilege to be a part of.

Massive difference between being 121 with a woman from admission right through.

That would teach you something about the progression of labour, the emotional changes, the pain "journey", the way something might go wrong fast.

Marching in as the baby is crowning and marching out again does NOT do all those things and is indeed pretty much like a YouTube video.

Consent is a massive issue still. I had a very bad time MH wise in my last pregnancy and specifically had NO STUDENTS AT APPOINTMENTS written on my notes as couldn't cope with lots of people (or really any people by that point 🤣) also used to ring before to the clinic reception to say and would get DH to say to receptionist as we arrived.

They still turned up. And I couldn't just say no because I trying not to be sick or have a panic attack.

They used my birth as some type of case study for a group of ?4/5th years when my twins were in nicu, including my history of rape ("I've just shared your story with Ollie and Harriet and they'd like to ask you some questions for a presentation they have to do").

Also random trainee GP turned up to the house with the nicu nurses on a home visit (I've just brought Mike with me today, hope that's okay, as Mike walked into my living room).

The students and Mike the trainee were all very lovely - Mike held premie DS and I could see him thinking oh shit oh shit as DS was very tiny and fragile and the nicu nurse just sort of passed DS to him

But nobody should have clinically unnecessary randoms sprung on them without warning when they're naked or vulnerable.

Hollowtalk oh that makes me so cross. Like your sister didn't have enough happening at that point, she gets insulted too. Honestly.

JohnnyMcGrath Yes that is the thing, women are so vulnerable, put on the spot, treated like case studies - it's not always like that of course and the staff that are respectful are lovely but yes it's the 'clinically unnecessary randoms' that i object to. I hope you are much better now

@JohnnyMcGrathSaysFuckOff

Consent is a massive issue still. I had a very bad time MH wise in my last pregnancy and specifically had NO STUDENTS AT APPOINTMENTS written on my notes as couldn't cope with lots of people (or really any people by that point 🤣) also used to ring before to the clinic reception to say and would get DH to say to receptionist as we arrived.

They still turned up. And I couldn't just say no because I trying not to be sick or have a panic attack.

They used my birth as some type of case study for a group of ?4/5th years when my twins were in nicu, including my history of rape ("I've just shared your story with Ollie and Harriet and they'd like to ask you some questions for a presentation they have to do").

Also random trainee GP turned up to the house with the nicu nurses on a home visit (I've just brought Mike with me today, hope that's okay, as Mike walked into my living room).

The students and Mike the trainee were all very lovely - Mike held premie DS and I could see him thinking oh shit oh shit as DS was very tiny and fragile and the nicu nurse just sort of passed DS to him

But nobody should have clinically unnecessary randoms sprung on them without warning when they're naked or vulnerable.

This angers me so much. When I was a student nurse we had it drummed into us that the patient must consent to us being in outpatient appointments and the nurse must ask permission without us being there so the patient isn't put on the spot. Its different in inpatients because we are obviously just around on the ward but even then patients had to consent to us giving direct care.

I don't understand why students are part of the process - unless they are with women all through her pregnancy - how can just turning up at the end and observing a birth be of any use? As OP states, you can watch a birth on YouTube.

How can students gain informed consent from a woman in pain and giving birth? I believe the students turn up too late to ask and hope to get away with it.

Yes my point (which some have missed) is that if a student is literally just standing there a baby come out, why not watch it on a screen somewhere and spare the woman the audience?

Because this not what they are doing. They are not just watching the baby come out. Among other things the medical students are watching:

• how the team works together (including midwifes, doctors, anaesthetists, birth partners AND the mother)
• the decisions made, at what point, why, who by
• the observations and monitors - heart rate, blood pressure, how many cms etc
• what medication is given, when, why etc
• what interventions are given and how (from palpation to C sections)

Really they just could not experience all this watching videos and I honestly don't think most women would be happy about giving birth with a qualified doctor who'd never seen a birth in real life before.

Just asked dh and I had about 8 in the room for my c section. Full term elective c section of twins.

I vaguely remember being asked but I sort of turned in on myself (my epidural was very difficult and they had to get the consultant in to do it so I sort of shut down and just cuddled the mid wife for a bit god love her).

A few came in post birth to see us - girls were quite big and very healthy. They told me it was nice to see a straight forward multiple birth as there was a lot of focus on the difficult ones. In fact I had a few in my consultant appointment once where the consultant said - 'and this is Mrs Frank who has no complications and there is nothing really to discuss' and they just left.

I have said no to students in the room when discussing sensitive mh issues when I just wanted my gp. I also had a young male gp student do a breast exam when I found a lump. He was a total poppet and warmed up his hands.

I said no to all students, they have to learn, but one was so unprofessional during an antenatal check I thought nope.

No idea but I had a few students at my forceps delivery 18 years ago. TBH by that point I had lost all dignity and capacity for rational thought and I would have agreed to anything😫 It was a case of this baby needs to come out now and do you mind if these students watch🥺

I still don't really care, the delivery caused health issues I still suffer from which are far more important but I think with hindsight, they should ask beforehand. In that moment of panic, pain and fear of losing my baby, I couldn't make an informed decision.