I've spent March and April on my ob/gyn rotation and I have two weeks left. I've been primarily working at Good Sam hospital down the street and the rotation started with my car getting hit as I was pulling out of the street parking lane (my bad). 3 weeks and $600 dollars later my car was fixed only to be hit again by a law student who decided to turn right into me. So basically I've spent the whole rotation walking to work. The last two weeks in outpatient clinic have been more eventful then I would have liked. A few memories that stick out include the morning when I was kicked out of work for not wearing a tie, the patient who played PSP while getting a pelvic exam, and the manic woman who told me "You have a great smile and a good sense of humor, now get out!" right before her pelvic exam.
I guess the pinnacle of an ob/gyn rotation as a third year med student is delivering a baby (I've delivered three). The intern I was following during my ob segment was not terrible, but she generally preferred for me to find a quiet corner and keep busy rather than follow her around. The first baby I delivered was with a midwife who was nice enough to talk me through the whole procedure. To start, I always asked the patients if it's ok for me a 3rd year medstudent to deliver her baby, and each time I was always surprised when they would say yes. I've already forgot the name of the patient whose baby I delivered, but I remember that her second and third stages of labor dragged on for about two hours which felt like a lifetime to me. The first time I really caught a baby, I slid the nuchal cord over the infants neck and then awkwardly caught the child, who was heavier and more slippery than I would have guessed. I can honestly say that handing a child to her mother for the first time is something very special that I'll never forget.
The cord was cut and segmented, and everyone was momentarily relieved. And then we waited patiently for the placenta. I advanced the clamp on the cord, applied suprapubic pressure, and very gently pulled on the cord to get the placenta out. This went on for about 30 minutes. There was no gush of blood or real cord lengthening that I had seen before in previous deliveries. The mom asked why she wasn't done even though she had delivered a healthy baby girl. Her family and friends who came with her to the hospital kept on trying to enter the room although the placenta had not been delivered yet. The patient was starting to complain that her epidural was wearing off and she was in pain. Her mother, who was a nurse, told the midwife that her daughter is in pain and needed something to treat it. Through all this commotion, the midwife stayed focused and eventually stuck her hand up the patient's vagina and dug around gently. Eventually the entire placenta was delivered and everyone was happy. The midwife sewed up a few small first degree vaginal lacerations. The two of us then removed our gowns, cleaned up, and I was given the privilege to sign the birth certificate.
I walked over to the new grandmother and mother to congratulate them. I patted the baby on the head, and then the grandmother told me that I did a good job and that I'll be a good doctor. The father of the baby then yelled "Excuse me! Is it alright if I hold my daughter?" I came into the rotation hoping to learn how to deliver a baby and do a pelvic exam. I guess I've accomplished those things. I still don't think I'd be able to deliver a baby in an elevator or on an airplane. What would you use to clamp and cut the cord?? How do you tell someone to cope with her pain without an epidural? How would you sew up vaginal lacerations which apparently occur in 80% of vaginal deliveries according to Scrubs? I guess these are things I realistically won't have to worry about in my lifetime, but who knows...
