To shadow an OB/GYN for a month

To shadow an OB/GYN for a month

This month has been very different for me.  Well, every month has been, but this one in particular has challenged me and amazed me in ways I hadn't thought possible.

My OB placement has so far been WAY different than I expected it to be.  I'd heard from other students about 24 hour OB shifts at larger hospitals, where a student could expect to go to 7-15 births in a shift.  The advantage of this is a large volume of experiences put closely together.  It can rapidly increase skill in things like suturing that us midwifery students worry so much about developing.

Apparently, an OB placement at a small Level 1 hospital is not at all like that.  In fact, although I'm on call a couple of days a week, I have yet to go to a birth with my OB preceptor in three weeks.  And frankly, part of me is terrified.  I had really looked forward to this placement as an opportunity to gain skill in suturing, and I'm just over a week until the end of my placement and it's likely there won't be a single opportunity at all. When I realized that, I  had a major feeling of let down.  I'm thankful at times like these that my Normal Childbearing placement was so busy and full of these types of opportunities.  Hopefully this means that I won't be too far behind my classmates who enjoyed the benefits of repeated births in the same night to hone their skills. I'm also super thankful for one of the lovely midwives in this community who took me under her wing one night and brought me to her client's birth.

 The great thing about this placement is how much gynecology I'm being involved in.  I'm going to all of my preceptors gynecology clinic and surgeries, and there is SUCH a wide variety of experiences that I think it's amazing.  I've heard from other students that many OB preceptors don't allow involvement with the gynecological patients but mine does and I am so greatful for it.  The way my preceptor sees it, although our scope is limited right now, perhaps eventually we will become more similar to the Nurse-Midwife model in the U.S. where the midwives provide well-woman care throughout life, rather than just the childbearing year. 

What has thrown me off, is how alone I feel.  Opinions and management choices come up sometimes in OB clinic that I really struggle with. Sometimes it's because I'd prefer to present them differently (prenatal screening like ultrasounds or group B strep), and sometimes because I simply have a really strong bias that I haven't gotten over (like topics such as VBAC and circumcision).  It's hard to hear the medical perspective when you've walked on the wild side your whole adult life.  Sometimes, I'll have a typical day, but I'll end up crying all the way home and I can't even figure out why (and no, this isn't something that usually happens for me, only the odd day since I've started here).  I think it's an internal battle.  I believe in midwifery care, I would fight for it to the very end, and I made pretty radical choices as a client of midwifery care myself.  So I think I'm fighting with myself because sometimes the explanations that my preceptor makes for the way that she practices make total sense. But it still goes against the way that I do things.  It's hard to sit with that feeling - I like to know what is right.  But it seems like maybe there isn't always one right answer.  I should have already known that! 


Anyway, the whole experience is pretty humbling.  These doctors do not always deal with the same people that midwives deal with.  When I have a day in clinic in midwifery care, I am usually very happy and feeling confident.  I walk into a room with a client who is also usually very happy, have a great discussion full of respect and choice, give her good prenatal care, and am on my way.  In this scenario, we have some of that, but we are also seeing those women who are not lucky enough to be in midwives care - those who are suffering from infertility.  Those who are recovering from a miscarriage or abortion. Older women undergoing hysterectomies.  Women who have lost their husbands and are now facing other health issues. Not a day goes by that someone doesn't cry in a clinic visit (or ten), because an OB/GYN, just like most doctors, are not always the bearer of good news.  Sometimes these women are being called in to find out that they have cancer, or that they'll never be able to have the baby that they've so desperately wanted.  Certainly midwives aren't always the bearers of good news either, but we definitely see it a LOT LESS.  And in the midst of this, I see my preceptor as an amazing doctor.  A little while ago, I looked into the window of the operating room to see her with a patient who was about to undergo emergency surgery.... and she was holding the woman's hand as she waited to fall asleep.  How many doctors take the time to comfort their clients?  I don't know, because this is the only one I've spent a lot of time with.  But I hope she's among many like her.