Labor and Delivery

[DocReymundo]

Hey guys!

I will be starting off my ob/gyn rotation with labor and delivery. What are some things that medical students can do to be helpful and standout? I think answers to this question well benefit us all so hopefully you guys can share some pointers!

Thanks!!

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[DermViser]

Hey guys!

I will be starting off my ob/gyn rotation with labor and delivery. What are some things that medical students can do to be helpful and standout? I think answers to this question well benefit us all so hopefully you guys can share some pointers!

Thanks!!

First off, I'm so sorry. Second, be helpful and DON'T standout. You also might get better advice on how to ace your OB-Gyn clerkship in the Clinical Rotations forum.

 

[DocReymundo]

First off, I'm so sorry. Second, be helpful and DON'T standout. You also might get better advice on how to ace your OB-Gyn clerkship in the Clinical Rotations forum.

Thanks for the tip and I will re-post it in the clinical rotations forum.

 

[DermViser]

Thanks for the tip and I will re-post it in the clinical rotations forum.

No don't cross post. That's against TOS. You can report your OP and have it moved.

 

[SplenoMegastar]

L&D is all about "reading the room." The environment can change quickly, so just try to be in tune, somewhat similarly to being in the OR.

Find out who is laboring and if there are any scheduled C-sections. Introduce yourself to the nurses if there's a moment when they aren't talking or charting. Make sure the attending or resident knows that you're excited to be there and looking forward to seeing deliveries. Depending on how many MDs/DOs/CNMs are around, you may get to gown up and get really close. It's not unlikely that they'll ask you to do something like pass stuff from the sterile table, draw up cord blood, etc. so have some idea what's on the table and be alert. If you don't drop any of those things, maybe next time you'll get to deliver the placenta or even go straight to being first hands on the baby (when this happens the baby will likely already be mostly out and there will be hands beneath yours but still fun). This is sort of best case scenario. Worst case is that you really only get to watch from the sidelines occasionally on a super-multip who no longer cares who is in the room because she's done it 8 times and her babies fly right out anyway.

If you are able to "follow" a laboring patient, just check on her occasionally and ask the nurse if there's anything you can do to help. If you can go with the OB for her cervical checks, you should. Check on her postpartum and know enough about the patient and delivery (and a little about baby) to present her on rounds if applicable.

You can ask people to page you if something happens, but they might not. So try to stay near the unit but not in the way. I know this can be hard at the end of a 24 hour shift.

As far as c-sections, in my experience there were more people around for C-sections than in a normal OR environment, so it can get easy to feel in the way. Try to do the simple intuitive things to be helpful as you would in any OR, but stay in your lane. Ask if you can gown up and assist and be ready to retract at any moment and be ready with suction (but don't hoard it).

You may find yourself getting yelled at by an L&D nurse or resident for seemingly no reason. If you really are in the way or did something dumb, just apologize and try to learn from it. Can get a little tense when there's PPH, etc. Sometimes it's just the culture and you really didn't do anything. By this point in the year you probably know the difference. Have fun!

 

[4thQTHailMary]

I wish that I had read the labor chapter in blueprints before starting l&d. That chapter is money and makes things make much more sense.

 

[URHere]

Based on my experience on L&D:

1) Whenever possible, meet your patients before they are in active labor. This allows you to avoid the awkward situation of showing up in the room with your resident only to realize that the woman is absolutely not on board with a medical student being involved.

2) Whenever possible, show interest and ask your resident/attending what they are comfortable letting you do before you go into the room with the patient. Again, this will make things flow more smoothly once you are actually in the delivery room or OR and you will know whether or not you are expected to gown.

3) Pull gowns and gloves for yourself and your team members. Most of the team probably won't notice that you've done this, but some may be very irate if you don't.

4) Practice suturing when you have down time. With gloves and actual suture material. Don't make a fool of yourself by being unprepared when someone hands you a suture.

5) Don't be in the way. If your resident thinks you are too slow and doesn't want you to write delivery/procedure notes, that's ok. If they get annoyed when you ask questions, then stop asking questions and do your own research or find someone who enjoys teaching. On this rotation, being unobtrusive is often more important than being helpful or "owning your patients". Remember that.

6) For the love of god, wear the booties that go up to your knees.

 

[alpinism]

Lol

ITT:
Question - What can I do to be helpful and stand out on OB?
Answer - Introduce yourself to people and don't get in the way.

Sad but basically true. Unless you get lucky, OB is for the most part glorified shadowing.

 

[rjaacd]

Do you guys think that it would be better to do my obgyn clerskship at a private practice if my school's clerkship is famed for being rather malignant (i.e. they make med students stand in the back of the room and the residents are miserable beyond measure)?

 

[SplenoMegastar]

Do you guys think that it would be better to do my obgyn clerskship at a private practice if my school's clerkship is famed for being rather malignant (i.e. they make med students stand in the back of the room and the residents are miserable beyond measure)?

Haha this sounds very familiar. I did what you're suggesting for the same reason and it made OB/Gyn more attractive than it may have been otherwise. That said, I routinely worked 90+ hours per week because I was following attendings with no work hour restrictions. That may or may not be the case for you and I didn't mind because I was either keeping busy or learning and usually got a few hours of sleep on call. my reasons for choosing the site were beta-dog but it was a good experience.

 

[alpinism]

Do you guys think that it would be better to do my obgyn clerskship at a private practice if my school's clerkship is famed for being rather malignant (i.e. they make med students stand in the back of the room and the residents are miserable beyond measure)?

Yes.

If you've already heard about their "malignant" reputation as a preclinical student its likely that bad or even worse.

 

[Tigeracademy]

Hey guys!

I will be starting off my ob/gyn rotation with labor and delivery. What are some things that medical students can do to be helpful and standout? I think answers to this question well benefit us all so hopefully you guys can share some pointers!

Thanks!!

I just dont understand why when new residents enter our unit,no one introduces him,no one even tell us his name,nothing.

 

[Psai]

Yes.

If you've already heard about their "malignant" reputation as a preclinical student its likely that bad or even worse.

Fact

 

[itallbelongstoyou]

I wrote this for our 3rd year students: Surviving an Ob/Gyn Rotation as a student.

 

[TraumaLlamaMD]

After a day or two of losing all the multip/uncomplicated deliveries to family med residents, I just started scrubbing on every C section I could. No regrets - that was the first time I'd set foot in an OR, and it meant that when I started my surgery clerkship, I already knew how to scrub, tie, etc.

 

[Bacchus]

After a day or two of losing all the multip/uncomplicated deliveries to family med residents, I just started scrubbing on every C section I could. No regrets - that was the first time I'd set foot in an OR, and it meant that when I started my surgery clerkship, I already knew how to scrub, tie, etc.

That's unfortunate. I always asked the attending if a student could gown with me and the OB resident. You're there to learn. That said, unfortunately if I have numbers to make I'm not going to be giving up the opportunity. Welcome to medical education.

 

[Nasrudin]

I wrote this for our 3rd year students: Surviving an Ob/Gyn Rotation as a student.

That was horrible. What I could read of it before I starting having flashbacks of full blown PTSD. That blog was more of a here's how we roll and if you want to be one of us you do this ...and this...and then this...that, that...this....etc. etc. etc......

I've got a different take. Here it goes:

Hide. Look busy. Do what you're told. Hide. Pass.

God what a horrible specialty with a horrible work culture.

 

[SLC]

Take a private practice rotation if you can.

Mine was busy, but still surprisingly chill and I learned a TON!

Every morning before rounds I'd show up to a local restaurant (that the attending had selected the night before) for breakfast and a didactic session. Then we'd round and head to clinic. In clinic I did everything: paps, breast exams, fundal height and Doppler, etc. the paitients didn't mind, their OB was a man so having a male student wasn't a big deal it seemed. I even got to place and remove a few IUD's and do hysteroscopy.

For surgeries I scrubbed all the cases and helped with everything I could. Suturing, holding laparoscopes, installing and using the uterine manipulator etc. I also assisted on many of the c-sections; which was scary at first since I'd never scrubbed before; but the doc was patient and taught me what I should do and how to do it.

I also got to catch all the babies for the patients who were OK with me being there. He'd handle things till the pushing started and then I'd jump in and catch the baby and hand it off to the mother.

All in all it was an awesome rotation, one of the very best I had in medical school.

 

[Apoplexy__]

Every morning before rounds I'd show up to a local restaurant (that the attending had selected the night before) for breakfast and a didactic session. Then we'd round and head to clinic.

Awesome. I definitely want to do that if I get the chance to take on med students as an attending.

 

[Psai]

Take a private practice rotation if you can.

Mine was busy, but still surprisingly chill and I learned a TON!

Every morning before rounds I'd show up to a local restaurant (that the attending had selected the night before) for breakfast and a didactic session. Then we'd round and head to clinic. In clinic I did everything: paps, breast exams, fundal height and Doppler, etc. the paitients didn't mind, their OB was a man so having a male student wasn't a big deal it seemed. I even got to place and remove a few IUD's and do hysteroscopy.

For surgeries I scrubbed all the cases and helped with everything I could. Suturing, holding laparoscopes, installing and using the uterine manipulator etc. I also assisted on many of the c-sections; which was scary at first since I'd never scrubbed before; but the doc was patient and taught me what I should do and how to do it.

I also got to catch all the babies for the patients who were OK with me being there. He'd handle things till the pushing started and then I'd jump in and catch the baby and hand it off to the mother.

All in all it was an awesome rotation, one of the very best I had in medical school.

...so lucky! my ob experience was pretty much the opposite lol

 

[Kaustikos]

Awesome. I definitely want to do that if I get the chance to take on med students as an attending.

I'm gonna do that except it'll be in the evening, at a bar and called "Ebstein Bar Rounds"

 

[KnuxNole]

That was horrible. What I could read of it before I starting having flashbacks of full blown PTSD. That blog was more of a here's how we roll and if you want to be one of us you do this ...and this...and then this...that, that...this....etc. etc. etc......

I've got a different take. Here it goes:

Hide. Look busy. Do what you're told. Hide. Pass.

God what a horrible specialty with a horrible work culture.

The blog post was pretty good, I don't see what's wrong with the advice :/