Reflections: OB/GYN Rotation

How fitting it has been to start on my OB/GYN rotation. After months of hibernating in the gestational sac of preclinical year, we are being birthed into the world of clinical medicine. These past three weeks of active labor have been punctuated by periods of contraction. With each patient experience, I am pushed further along as I grow into my professional identity.

 At first, much like the brand new parents, G1P0s who present at the first sign of Braxton Hicks, I found myself anxiously checking and rechecking the triage board of Labor and Delivery in between cesarean sections, unsure of what my role and responsibilities were on the team. The residents, PAs, nurses, and attendings were like the multips who had been through the trenches of childbirth and navigated their surroundings with ease. Throughout my first week on night float at Bellevue, I could feel the rupture of membranes. This gush, not of amniotic fluid but of information, flooded my brain as I tried to absorb the alphabet soup of acronyms. I had to decipher this new language of BPPs, NSTs, SVDs and TOLACs. The squiggles of the fetal heart monitor looked like nothing more than squiggles to my untrained eye. Like a fetus relies on its mother’s umbilical cord for gas exchange and nutrients, I relied on my residents and attendings, didactic sessions, the Blueprint readings, ACOG Bulletins, and APGO questions for this exchange of knowledge. With each newborn, I reached new milestones like the first placenta I delivered, the first cord gases I drew, and the first sutures I snipped.

By my last day of L&D, I had reached full term—still very much an infant compared to the experienced clinicians by my side, yet mature enough to appreciate the meanings of the words that felt so foreign to me not long ago. When the labor and delivery board showed that my patient was 8 cm dilated, 100% effaced, and at -2 station, I readied my gear from the supply room in preparation. The fetal heart tracing looked great—baseline of 140 with moderate variability and a few accels. As the time to push neared, I greeted the laboring patient and her family who had camped out all night in the cramped room to witness this special moment. Watching the toco rise, I supported the patient’s leg and encouraged her to push. One, two, three, four… Come on, just a little more! Exactly like that! 

The phrases that once felt unwieldy in my mouth, now rolled smoothly off my tongue. She did wonderfully. Within five contractions or so, her baby’s tufted hair peeked out to greet us. My hands clasped over the baby’s head, and my preceptor's hands were clasped over mine, as we gently lifted him out and over to his delighted mother. This new baby had so much to learn—how to breathe, how to feed, how to move his little hands and feet. As I have entered this next stage in my training (ex utero), I too have so much to learn about how to clinically reason through cases, interpret lab findings, and manage patient care. In time, our baby steps will turn into great strides.

Additional Highlights 

A very memorable didactic session on about the normal labor and delivery process included a demonstration of how the fundus of the uterus contracts. You'll need a balloon which represents the uterus, and ping pong ball which represents the baby. Set up the demo by placing the ping pong ball in the balloon and then inflating the balloon with air. Maneuver the balloon such that the ping pong ball sits over the opening of the balloon to prevent air from escaping without tying a knot. Once you're ready, push from the TOP of the inflated balloon (the fundus of the uterus) with steady, even contractions. You should see the ping pong ball slowly descend until it completely pops out from the bottom! If you try contracting the balloon at other spots (i.e. lower down on the balloon), you should find that it is much more difficult to pop out the ping pong ball. Overall, this demonstrates the importance of fundal contractions in the stages of labor.

 One great resource that was recommended to me was the Pimped: OB/GYN Podcast. It contained really concise and comprehensive information about various obstetrics and gynecologic procedures in easily digestible episodes that were convenient to listen to before bed or walking back from work.