DO clinical training in obstetrics

[ashbrant]

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If there are any third or fourth years out there, or even residents, I would love your feedback.

I am considering attending MSU COM next fall (class of 2012, already recieved my admissions offer), and I am wondering if the training in obstetrics will be any different that the training I would recieve at MD granting institutions.

I am interested in learning things like vaginal delivery of breech babies,
external cephalic version, less invasive methods of pain relief, and more holistic ways to manage normal and abnormal labor.

I'm interested in these things because I really value the midwifery model of care, but I also want to be equipped to handle complications that midwives can't handle.


Any insight is really appreciated.

 

[yoosername]

Ashbrant,

The training received at an osteopathic institution is unlikely to differ much from training at an allopathic hospital. You should graduate from an osteopathic OBGYN residency fully equipped to handle all the most common complications of L&D. However, possible differences between DO and MD programs include:

1. There are few fellowships at osteopathic institutions: If you're interested in REI, MFM, urogyn, gynonc, etc, this is a bad thing. If you're interested in a generalist OBGYN practice, this may be a good thing as there will not be fellows snapping up all the subspecialty patients.

2. Osteopathic programs are typically quite small - usually 2 or 3 residents per year, with larger programs closer to 5/year. You can double that for MD programs. Would you prefer many colleagues or a small, close-knit group?

3. Osteopathic programs are more likely to include specific training in the use of manipulation in the management of pregnancy, labor and delivery, BUT THIS TRAINING IS NOT UNIVERSAL. It's a part of some programs, but not others.

4. With regard to "holistic" training: I am an OUCOMer and can only speak to my experiences in Ohio, but I didn't find my osteopathic training to differ from my sister's allopathic training in terms of its treatment of patients. "Holistic" is a buzzword the osteopathic profession applies liberally, but I'm not sure there's any real meaning to the claim that DOs "treat people as whole." It's possible things are different in Michigan, but it has been my experience that DOs and MDs in Ohio do not differ in their approach to patient care.

 

[drchick331]

As a third year at MSUCOM, I think that you will like the Reproductive class that is offered during second year. It is very clinically-oriented and many of the things you claim to want to learn are integrated. My husband (an allopath) was really surprised by the scope of clinical practice that I had learned. (It actually has really peaked my interest in Ob/gyn.)

There are ~26 hospitals in the base hospital system here at MSUCOM offering a wide variety of places to learn different Ob/gyn techniques. You may want to take a look at the COM website under Academic Programs --> Clerkship programs --> MSUCOM Base Hospitals to see which hospitals have Ob/gyn residencies available.

On a side note, we also learned several OMM techniques that work well on pregnant patients and newborns. If there was one specialty that I felt OMT could benefit strongly, it is Ob/gyn. My friend is currently on her OMM rotation (third year) and said that she has seen several patients that are pregnant or post-labor.

Just remember, that no matter which school you choose to attend, most of third and fourth year is what you make of it - the more pro-active you are, the better your experience will be. If you take the time to seek out physicians that teach certain principles, your clinical knowledge and skills will benefit.

Feel free to PM me with questions regarding MSUCOM...😀

 

[ashbrant]

I'm a pre-med currently applying to both MD and DO programs and I am wondering how the clinical training in obstetrics differs between the two (except the obvious differences related to OMM during pregnancy).

I've worked as a doula and with midwives, so I'm really interested in learning about things that may not be regularly taught in medical school. Things like vaginal delivery of breech babies, external cephalic version, less invasive and non-medical methods of pain relief, and more holistic ways to manage normal and abnormal labor. Do any schools teach these things?

I'm interested in these things because I really value the midwifery model of care, but I also want to be equipped to handle complications that midwives can't handle.

Any insight is really appreciated.

I've also posted in the DO forums.

 

[mules05]

I'm a pre-med currently applying to both MD and DO programs and I am wondering how the clinical training in obstetrics differs between the two (except the obvious differences related to OMM during pregnancy).

I've worked as a doula and with midwives, so I'm really interested in learning about things that may not be regularly taught in medical school. Things like vaginal delivery of breech babies, external cephalic version, less invasive and non-medical methods of pain relief, and more holistic ways to manage normal and abnormal labor. Do any schools teach these things?

I'm interested in these things because I really value the midwifery model of care, but I also want to be equipped to handle complications that midwives can't handle.

Things like this are not taught to medical students, at least at my school, because these skills are above the level of what a med student should be doing. Medical students should be taking part in uncomplicated deliveries and just observing anything else. Assuming you end up going into OB/gyn, these are good things to ask a residency program. However, assuming you go into ob/gyn, remember that the residency also involves a lot of surgery and ambulatory gyn, not just delivering babies.

 

[Ashers]

I went into a couple deliveries with some midwives. They were really nice when I showed any interest in their methods.

 

[smq123]

I've worked as a doula and with midwives, so I'm really interested in learning about things that may not be regularly taught in medical school. Things like vaginal delivery of breech babies, external cephalic version, less invasive and non-medical methods of pain relief, and more holistic ways to manage normal and abnormal labor. Do any schools teach these things?

No medical school teaches these things. The expectation is that a med student will know how to handle a normal, uncomplicated vaginal delivery by the end of their rotation. You'll never handle a breech delivery, and you'll never learn external cephalic version. (You can certainly ask your attendings about version, though - ACOG recommends it, so your attending should be familiar with it.) Most med schools don't even expect you to be very good at Leopold's maneuveurs by the time you leave.

They also don't even formally teach you how to do a c-section until you're a resident. The things that you asked about are things that an MS-4 should be asking when looking for a residency. But OB education at all med schools is roughly the same - all very basic stuff.

 

[deleted29780]

I

I am interested in learning things like vaginal delivery of breech babies,
external cephalic version, less invasive methods of pain relief, and more holistic ways to manage normal and abnormal labor.

oh really...well for a start there are three types of vaginal breech delivery
- spontaneous
- assisted breech
- breech extraction

techniques you will come across are the Mauriceau-Smellie-Veit Maneuvre
the Burns-Marshall maneuver

About ECVs, the recommendation now is to avoid them. Their place in modern obstetric practice is still questionable due to the complications associated with the technique.- Rupture of the membranes, cord entanglement, abruption etc. However in cases of example a shoulder presentation of maybe a second twin --- one can readily perform an internal podalic version.
The caeserian section rates are at an all time high now, breech presentations are an important reason for this trend too you know.

 

[smq123]

About ECVs, the recommendation now is to avoid them. Their place in modern obstetric practice is still questionable due to the complications associated with the technique.- Rupture of the membranes, cord entanglement, abruption etc. However in cases of example a shoulder presentation of maybe a second twin --- one can readily perform an internal podalic version.

FYI - ACOG (American College of OB/GYN) actually recommends that you try ECV before going to c-section. I don't know if all OBs are necessarily following that recommendation, but that is what ACOG recommends in the US.

 

[deleted29780]

it is actually not being applied to the letter in practice. At the last FIGO ( Federation of international OB/GYN) conference it was discussed in some professional circles. Its a matter of weighing the risks and the benefits. In these days of almost safe abdominal deliveries, its becoming less fashionable.
Almost similar to placenta praevia. For low grade praevia it is recommended that one attempts a vaginal delivery.- i am sure its not the practice in the US. SECTION ALL PREVIAS. That is becoming the general trend all over. There is no longer a place for the DOUBLE SET UP ( its certainly archaic) I see the same thing happening to ECVs in due time, because the procedure is becoming a lost art. Very few young residents have acquired the skill of ECVs.

 

[MeowMix]

I would look for a program in which you could rotate at a place with a strong midwifery program AND a very strong supportive relationship (NOT adversarial) between midwives and the OB residents/faculty. This can be difficult to assess. OB residents who train in such a program will be more comfortable with longer labor, birthing balls, tubs, etc. But they will not stray far from the standard practices, and this will be true of both DO and MD.

As above, you will NEVER do a vaginal breech etc as a med student and you will probably never even see one. You will have trouble even finding attendings who are comfortable doing vaginal breeches. What you will discover is that OBs are very conservative (not surprising considering the horrific malpractice situation) and will never do a procedure in which they have not been adequately trained. There are just not many people left with enough experience to supervise and teach vaginal breech.

 

[peppy]

As another MSUCOM third year, I agree that our school does a good job of teaching female reproduction and ob/gyn during 2nd year.
When the time comes to pick your base hospital for rotations, just make sure you pick a hospital that has a strong ob/gyn department. I don't think you would have any trouble finding a hospital where the ob/gyn dept. was in line with what you want.
Good luck to you!