Medical student doing Obs/Gyn placement

[amandine07]

Hi everyone, I'm a medical student and will be undertaking my Obs/Gyn placement early next year. Just looking for some advice & information on here...it's a part of the course that many students feel anxious about (especially the blokes!)

Personally, I don't have any children yet- I was wondering if you lot could give me any pointers about what you would like from a student who is present during the birth of your baby? I feel that it is a privilege when a patient agrees to you being present during a consultation/procedure, even more so during childbirth which can be a scary experience, not knowing exactly what to expect etc.

Therefore, I'd really appreciate any info about what you have experienced, whether good/bad etc. I really want to approach the placement with the mindset of- what would I want if it were me in the patient's place, giving birth to my baby? many thanks in advance!

'The midwives treated him like shit. felt sorry for him'

I'm rather more sorry someone that goofy is now unleashed on an unsuspecting public to practice medicine, tbh.

Read the woman's notes before you enter the room to make sure you familiarise yourself with her maternal history. Try and avoid the 'is this your first' conversation unless you know for sure it is. There are many women who have gone through miscarriages/neonatal deaths etc and this needs to be handled with sensitivity.
Make friends with the midwives. Don't run off in the middle of a labour because it is 5pm. See some 'normal' deliveries.

Really good point about seeing 'normal' deliveries.

Go out and see a homebirth. I was talking to one of the doctors in the hospital and she was saying that she had only ever seen medicalized births which was a bit of a slanted view of child birth.

Whilst a woman is having a contraction, it's really not helpful to say... 'I know it hurts' unless you have given birth yourself.

I had a medical student observe me in (induced) labour. It took quite a lot for me to agree because it was a youngish man and I didn't especially feel like being observed naked on a birthing ball, bleeding and moaning. However I do think people need to learn so I agreed. He was clearly a bit uncomfortable (understandable) but dashed out at 5, just as things were getting interesting, saying he had a meeting with his supervisor! I felt a bit like I'd really done him a favour and he couldn't be bothered to hang around and actually see a baby being born.

Not that annoyed obviously as I had better things to worry about but I thought a small amount of gratitude would be nice! So my advice is to acknowledge the fact the woman is actually doing you a favour. She doesn't have to let you observe the birth.

Stay for the 3rd stage. A baby popping out is not the end of childbirth, the placenta needs to come out, the woman needs to recover. It can still go pear shaped after a healthy baby has been born, you need to stay and learn about this very important part of the birth process.
Agree about seeing a 'normal' birth, most of the docs I've seen have a very skewed view of childbirth because they only become involved when something is going outside 'normal'. Remember more babies are born in 'normal' deliveries than not.

Make sure the mum gets the baby (if he's fine) to hold before he's wrapped up. One of mine was carted off, given a wipe and swaddled before I got to cuddle him and I was furious.

Following on from MrsBadger, don't discuss a high-risk/tricky case outside the room unless you are absolutely sure the mother can't hear you. "hhm, yes, you might want to see this one, it's a transverse lie and the chances of getting it out vaginally are pretty damn slim" is sooooo not what a labouring, frightened woman wants to overhear ...

Don't stick the TV on, like the MW did with my first labour. Suddenly heard the theme tune to "Calamity Jane" .
Listen to the woman in labour. If she uses her exorcist voice to yell, "I want to push now" - she ain't joking.

Good luck.

Don't mislead. It's lying, near as damn it. I was "misled" by my medical team with DD3 and it has left me bloody furious and seriously considering freebirthing next time.

I had a medical student present during my first homebirth. It was her first birth. I think it was good for her to see a natural, physiological birth, without any medical intervention. She was not far enough along in her course to do anything clinical with me.

She cried when DS was born.

Thank you so much for your responses everyone- hope you all had a lovely christmas!

There's a lot of good advice that I'll definitely take with me on my placement (I'm female by the way)- I know in hospital maternity units they see births day in day out, but for each women it's a different experience & one that is etched on the memory forever.

I really hope I can help make a positive difference for the women I see & that this goes some way to helping them have the experience that they want!

please do not be offended if a patient refuses to have you in, it is not personal but may stem from previous bad experiences. I would not have a student midwive at my next delivery due to this. We reserve the right to be totally selfish at this time of our lives and not be thinking of the greater good of womankind! Please read histories, at least to find out about miscarriages etc as very distressing to have to have explain yet again to each person. I had a very sensitive medical student when in triage for suspected miscarriage on gynae ward. He just chatted away about other stuff when nurse had to go out of room to see consultant. Just be natural even though said woman is proabably on verge of tears! Do not be like horrible doctor on ward when kept in overnight for miscarriage to happen who refused to use the term baby, would only say fetus or product of conception - be senstive to how women wish to deal with these terms. Horrible doctor balanced out by lovely registrar though! You sound like you will be a very thoughtful student and a good doctor!

Good luck - I remember O&G placements as the most stressful bit of medical school. Do you still have to get a certain number of assists?

It's easier to be a medical student where there are complications as at that point there are more people in the room so you don't stand out so much (not suggesting this is a good thing, it's just a fact) and the parents are expecting things to become more medicalised.

Attending a normal delivery that is completely managed by midwives is something I found much harder, but is an unforgettable experience. Ask questions about how it feels, rather than telling people about stuff you've read in a book, and don't try to muscle in on any of the real sleeves rolled up stuff without being asked and you'll learn loads.

And well done coming on here to ask

I had a (male) medical student with DC3. I nicknamed him "silly questions boy" as he asked the midwife such stupid basic questions about what was going on. I had put in my notes that I would only allow a student if they would be there for the whole labour and delivery, and he was. But I felt a bit resentful at times that the midwife couldn't concentrate on me as she was constantly having to answer his silly questions. Wish now that I'd asked him to be quiet.

With DC4 I wrote "no students" on my notes, but the midwife said she had a midwifery student with her, who was already a mum, and I agreed to her. She was lovely; I really liked her, and she visited me each day for the week I was in hospital.

A surgeon friend of DH's said he was partly terrified and partly bored silly during his obs rotation, years ago. He told me he got through it by bringing chocolates for the midwives on the first day and learning their names.

I see you've already been recommended some books; I personally wish it was mandatory for every medical professional in the country to read "The Politics of Breastfeeding" by Gabrielle Palmer.
I can't recommend it highly enough.

Good luck! (You clearly care, so you'll be fine!)

I totally agree with all the posts on here and am really glad that OP has asked for advice.
One question though, will OP be getting her fellow med students to read this?

OP, well done for caring enough to start this thread and ask the questions!

Hi everyone, I've not popped by here for ages. I had an amazing time on my obs & gyn placement; it was funny how people on my course either loved it or hated it, not really much in between!

I saw loads of births, all sorts from the straightforward with no interventions to the full-on EMCS. On a personal level, I'm 30 and it really made me think a lot about when I'm going to have kids- it's really not something I've thought deeply about until now.
Also, seeing so many women having problems in PG- miscarriage, ectopics and couples with fertility problems, made me realise that it doesn't always work out fine & lovely, and it's a lottery as to who is affected.

Midwives were great overall, the fantastic ones stood out & it struck me how it really is chance who you get given when you come on to the labour ward. One thing that bothered me was that frequently the women didn't seem to have adequate pain relief while being stiched up after vaginal delivery, it looked and sounded just as painful as the main event!

Having seen a variety of types of birth, I have to admit that personally I would want to have a elective C-section. I have felt this way for a long time and recent experiences have reinforced it. Maybe seeing/knowing too much is not always a good thing?!

Thanks for all your tips & advice, I got hold of a few of those books, really great to read another perspective on birth that is not purely medical.

It makes the world of difference to have warmth and compassion from medics ante, during and post birth. I remember the awful comments and care vividly and painfully, but I also recall those who made me feel human with simple care and respect - basic kindness.

Your approach sounds like it would suit any specialty - incl obs/gynae. Thank you for taking the time to approach it so carefully and kindly.

amandine07 You sound like you'll we a wonderful addition to medical community I'm glad you enjoyed it.
I've always refused any student to be involved in any medical treatment especially childbirth but you've made me question it, maybe next time I'll allow a student to be present.

I had a really lovely midwifery student at the birth of ds who was my 3rd child. She was the one around whose neck I hung while the official mw sat in the corner writing up her notes.

Six months later she recognised me in a shop (strange because I had clothes on and wasn't moaning) and chatted about the birth.

She was a great help because she was calm and encouraging.

i had a great experience with a student midwife , it was my 1st pregnancy and was in hospital for 3 months with various probs.we hit it off straight away, and when my date was decided for my c section, it was me who asked for her to be in the operating room. 9 years down the line we are great friends, and she sends her child to the nursery where i work xx