Fun on OB

Just finished my first week on OB rotation, and I love it! So far, I've done two C-sections, delivered seven babies and done two circumcisions. Of course, all of that is with supervision. I'm becoming a bit more comfortable with the deliveries - at least the straight-forward ones. On Saturday, I was helping to deliver a baby that was really big. After the head was delivered, the mom had a lot of trouble pushing the rest of the baby out. We call that shoulder dystocia - when the shoulder gets hung up on the pubic bone. There are a number of manouvers we can try to get baby out. In this case, we were able to deliver the baby, but it was pretty scary. Fortunately, the baby is doing really well now, with no injuries, and so is mom. In fact, I got to do the baby's circumcision today, so that was fun.

The circumcisions are also a little scary, if you think about what you're doing and what could go wrong. However, the equipment we use is designed to minimize the risk of harm to the baby's anatomy. One of the senior faculty walked me through the first circumcision - showing me step by step how to do it and then letting me actually do the procedure. He was a great teacher, and I really enjoyed working with him. The second circ was a lot more familiar. But I still have a long way to go before I feel completely comfortable with it.

On Saturday, I had my first 24-hour call - 7 AM to 7AM on Sunday. It was a LONG day, but thankfully not too hectic. During our call, I had to keep tabs on all the women in labor (there were only a two at the beginning), checking how their progress every hour or so. That involves reading the fetal monitoring strips for the baby's heart rate and mother's contraction rate, checking cervical dilation and baby's position, and making sure mom's vital signs are stable and mom is comfortable. Then I have to update the patient's OB doctor to let them know what's going on and see what else they want to do. In the meantime, there are always patients coming into the PSU - Perinatal Support Unit. That's where all the pregnant women with problems come for care - like the pregnancy ER. They come in with contractions, bleeding, rupture of membranes (when their water breaks), and lots of other symptoms. Some are full-term; others are in early pregnancy. Some get to go home once we establish that the baby is okay and mom isn't in labor. Others are admitted from the PSU to the labor and delivery unit because they are in labor. My job is to figure out what is going on and if they need to stay. Also, on call, I get to solve any problems from the post-partum floor - fevers, pain, nausea/vomiting, itching, etc., including problems with newborns. Between all these responsibilities, there isn't a lot of free time. Although, I did have some down time between 3 and 6 AM. That gave me time to update my log of clinical procedures and to some practice board questions just to keep me awake.

The hardest part of the job is communicating with attendings. I have to be sure I know exactly what is going on with each patient and have a plan for what I'd like to do. Obviously, I'm no expert yet. You would think the attendings would understand that I'm just beginning my training, but they aren't always that gracious. I guess I wouldn't be either if I was getting called in the middle of the night. And they have huge liability issues on OB. So I try to make sure I check everything out with the upper level resident on call before I call the attendings. I've already been chewed out a couple of times for not having all the right information and not being concise enough. Guess I'll develop some thick skin by the end of the rotation. I'm trying to learn to anticipate the questions and think like the attendings so I can be helpful, thorough and efficient.

Fortunately, I only have one other 24-hour call. The rest are just overnight. I can handle 12-14 hours if it's not to busy. There is always an upper level on call with me, so that is good. But if it's really crazy, he or she may be in a delivery or emergency c-section, and I am on my own on the floor. So far, there hasn't been anything I can't handle. But there are still 3 weeks left!

Despite the challenges and quirky personalities of the attendings, it is a happy, upbeat rotation. I love my teammates and enjoy working with the moms and babies. Please pray I will continue to gain experience, wisdom, and the skills I need to be good at this!