Reflections on OBGYN

Just finished the last day of the rotation. I was pleasantly surprised. I thought that I would find absolutely no interest in it, but really, it wasn't what I expected. It is a field that encompasses a wide range of patient populations and covers almost every other branch of medicine. My favorite part was OB. First, from a purely scientific point of view, what happens to human physiology during pregnancy is simply amazing. When looking at an obstetric patient, you might as well forget normal physiology and normal lab values that you learned in internal medicine (for example, the white blood cell count, which is normally below 10,000, with a really bad infection being 20,000, can go up to 30,000 during normal labor). Then there is labor and delivery. It's something that is nice most of the time, but every once in a while it gets very scary and very sad. It's the one time that people are hospitalized for something that is completely normal and the expected outcome is not to make them better, but to make sure nothing goes wrong. Delivering babies is pretty fun, but watching the emotions of the people in the room affected me more. There are some interesting social dynamics in the delivery rooms also (like the patient who wasn't sure who the father was and was waiting until she saw the skin color of the baby before giving her a last name or the woman at 43 1/2 weeks gestation who refuses any medical intervention). Overall, each patient is completely different and OBGYN is a branch of medicine that combines the solving-a-mystery aspect of internal medicine with the get-in-there-and-fix-it aspect of surgery. No, I don't want to go into it, but I definitely had a lot of fun in the last 6 weeks.

8 more hours to go

I'm on night duty on labor and delivery this week. This is my second night, and although it is cool (I've gotten to deliver a couple of babies), it is pretty damn tiring. I'm actually pretty good at staying up at strange hours and can handle being on call overnight every once in a while, but working nights day after day is not easy to get used to. I'm a med student and don't have nearly as much running around as the residents do. How do they do it? It just seems really dangerous to have overworked and sleep deprived people dealing with emergencies. I guess they get used to it (or learn to sleep during the day better than I can). 5 hours down, about 8 1/2 to go.

Learning Abortion

We had a pretty interesting discussion about how education about termination of pregnancy fits in with resident education in OB/GYN. According to the accreditation board, no residency program can require that residents participate in a termination of pregnancy. However, all residency programs are required to accommodate residents who wish to learn about and participate in such procedures. This applies even if it's a Catholic hospital/university that provides no such services (and equates such services to murder*). Such hospitals have an agreement with another institution that does provide it. Which means that it is possible that somewhere in the country, an anti-abortion institution has an agreement with an institution like planned parenthood that provides abortion services in order for them to keep their accreditation**. I wonder what the atmosphere was at the meeting that led to that agreement. And, how stigmatized is the pro-choice resident in an anti-choice hospital, if they do decide to take this option? Also, how likely is an interested resident going to take the option if the nearest clinic providing abortions is hundreds of miles away?

Another interesting part of this discussion was that each institution has an unspoken reputation about whether it has a pro-choice or anti-choice lean. And, although it is illegal for them to use the applicants views on abortion as a litmus test, according to the attending we were talking to (who has been intimately involved in national ob/gyn resident education), these institutions do look for clues on the residents' applications about where they stand on the issue (i.e. if they said they were a member of Medical Students For Choice) in order to make decisions on whether to interview them or not. Sounds like a litmus test to me.

* though, in my opinion, they really don't. See this discussion.
** although, some of them do get around it by saying that their abortion training is "limited to patients with medical indications," which can equate to early induction of labor and is not really what most people think of as abortion.

An unreasonably natural labor

Being in OB and expecting a child makes me see many sides of being pregnant and labor. I see pregnancy and childbirth as a natural process and think that there are some physicians who "medicalize" it too much (C-section rates are higher than the should be, people are induced more than they should be, etc.). So, I see the why people would want "natural" childbirth, with no medical interventions (like pain control). But, the extent to which some people take it is completely, in my opinion, unreasonable.

Case in point is a woman who recently delivered at our hospital (she was not my patient, so this is second hand). Things went relatively smoothly and, except for receiving a small perineal tear, she was able to successfully go through labor without any medical interventions. The baby was born relatively quickly and was completely fine. The woman just needed the tear sutured and was otherwise fine. When the resident explained that she will numb up the region around the tear with some local anesthetic before suturing, the woman became angry and was adamant she wanted a natural birth without any "chemicals."

Kind of ridiculous. But, childbirth is a highly emotional time and whenever people are dealing with emotional events, they tend to stop thinking rationally.

From one end to another

That's what my Pathology attending said when I said I was doing my OB/GYN rotation next. I suppose he meant from one end of life to another (it could have also been from one end of the body to another, since I focused on Neuropathology). I started OB this week. We switch teams every week or so. Right now I'm alternating between an infertility clinic and an OB clinic. I haven't seen enough to comment on (although some of the infertility treatments are pretty clever), but it is nice to be expecting our own baby while on this rotation. It not only motivates me to study a bit more, but it definitely helps relate to what the patients are going through (since I've seen Mrs. mxh go through a lot of the same already). It's also a bit reassuring, since it has made me realize that a lot of the fears and problems that we've had so far are very universal.