First night... L&D

[marshac]

---

Members do not see this ad.

My first night ever as a new physician is coming up July 1 and I'll be on the L&D floor at a large hospital. In all other fields of medicine I feel as though I've had very good training and experiences during my clinical years, but there's one thing I never did in medical school- catch a baby. From talking to my new chiefs apparently I'm not the only one in this boat, but knowing that I have company is of little comfort. What (if anything) can I do between now and July to better prepare for this, and for those of you who may have been in a similar situation, how did your preceptors/seniors help you through this? Thanks in advance.

 

[shan564]

Do whatever it is that helps you relax. If you really feel the need to do something medical, read "House of God" or something by Atul Gawande. Nobody expects a new intern to know how to do anything, and no matter how much you "prepare," your learning in the first several days will dwarf all of that preparation.

 

[colbgw02]

Guessing you'll be a TY rather than an OB/GYN, or you probably would have found a way to catch a baby by now...

Repeat after me - don't worry about it. No, really. Don't. Worry. About. It.

Even if you spent every waking moment between now and July 1st learning the intricacies of the SVD, no one is going to trust you to do anything except maybe pick up dinner on the first day (only slightly hyperbolic).

 

[Law2Doc]

My first night ever as a new physician is coming up July 1 and I'll be on the L&D floor at a large hospital. In all other fields of medicine I feel as though I've had very good training and experiences during my clinical years, but there's one thing I never did in medical school- catch a baby. From talking to my new chiefs apparently I'm not the only one in this boat, but knowing that I have company is of little comfort. What (if anything) can I do between now and July to better prepare for this, and for those of you who may have been in a similar situation, how did your preceptors/seniors help you through this? Thanks in advance.

I agree with the others that there's not much you need to do to prepare, and that you'll be fine.

But if you really want to prepare, get a grapefruit, cover it in K-Y, and practice handling it in wet gloves. They are slippery suckers, and it's poor form if the baby ends up on the floor.

 

[Raryn]

I agree with the others that there's not much you need to do to prepare, and that you'll be fine.

But if you really want to prepare, get a grapefruit, cover it in K-Y, and practice handling it in wet gloves. They are slippery suckers, and it's poor form if the baby ends up on the floor.

 

[BlondeDocteur]

Quite seriously, before you graduate and lose your malpractice coverage as a student, why not volunteer for a few L&D night shifts at your med school's hospital?

 

[Perrotfish]

I got stuck with L&D early as well

1) I thought case files was an excellent review and only took a day or two to get through.

2) Everyone is right that they don't expect anything from you. They don't even expect anything from the OB residents on day one, from everyone else they wouldn't even expect anything at the end of Intern year.

 

[drcrispmd]

Review fetal tracings. You will be looking at these all night. You need to know what you are looking at.
Know your doses of terbutaline, methergine, hemabate, and cytotec and when they are used.
Know what is considered an OB emergency
Know when you would use Magnesium, what needs to be monitored when a patient is on it and what to do if urine out put drops below 30cc/hr or they become mag toxic.
Know what HELLP syndrome is
Know what labs you will need to order for PIH
Know what FFN is
What to do with pregnant and vaginal bleeding, PPROM, Confirming ROM.

Our residency has a pocket book that all interns get and these are just a few things that it contains in the OB section. I would make your own reference book with some of this info to refer to.

 

[sakata8242]

Yuck. Hated OB/GYN and especially hated L&D. Touchy patients, touchy residents/attendings, didn't get to do jack that week, but still had to sit around in that team room all goddam night even if nothing was going on.

OB during my anesthesia month though...that was actually kind of fun.

 

[VenusinFurs]

OB is one of the riskiest fields, liability wise. I'm pretty sure you'll have tons of backup to cover your behind. If you're worried about the actual mechanics of catching a baby, don't. Basically, don't touch anything until the head is all the way out. The rest then basically tends to deliver itself.

 

[drcrispmd]

OB is one of the riskiest fields, liability wise. I'm pretty sure you'll have tons of backup to cover your behind. If you're worried about the actual mechanics of catching a baby, don't. Basically, don't touch anything until the head is all the way out. The rest then basically tends to deliver itself.

This is not the best advice.
Never let the head "pop." You will learn if you do nothing until the head is out the woman will have a worse tear. You need to guide the head slowly out. You will learn (hopefully).

 

[VenusinFurs]

I don't have a ton of experience yet, and I do have 0 interest in doing OB after I get out of residency, but different attendings keep saying different things. Some want me to stretch the perineum, some are like "don't touch anything until the head is out!"

 

[Bacchus]

I don't have a ton of experience yet, and I do have 0 interest in doing OB after I get out of residency, but different attendings keep saying different things. Some want me to stretch the perineum, some are like "don't touch anything until the head is out!"

Women who deliver the head quickly tend to have worse tears as said above. Providing some stretch isn't a bad idea, but once the baby begins crowning it'd be wise to help guide the head (externally) and protect/support/reinforce the perineum.

 

[anonperson]

I don't have a ton of experience yet, and I do have 0 interest in doing OB after I get out of residency, but different attendings keep saying different things. Some want me to stretch the perineum, some are like "don't touch anything until the head is out!"

This is provider dependent.

Overly aggressive perineal stretching can exacerbate lacerations and just make the patient more comfortable. Plus, putting fingers in, especially with a head at the +5 station is just taking up valuable room for the fetal head to exit. I'm generally hands off especially if a patient is pushing adequately on their own. The times when it may be helpful is when a patient isn't getting the concept of pushing and I basically tell them to push my fingers out. Again, I think it's more of a issue with an obstetrician feeling like they constantly need to be doing something.

As far as actually delivering the baby. Guide the head out. Don't let them blow out a kid or else they can get bad trauma. Sometimes even offering a bit of resistance is helpful. Let the head restitute. I can't stress that enough. I've seen overly eager interns try to rotate the kid in the direction it does not want to go to and jamming things up. Gentle downward guidance for the anterior shoulder and the rest should be straight forward.

 

[VenusinFurs]

Oh yeah, that whole gentle counter tension thing when the head is at the perineum?

I need to do hella reviewing before my next OB rotation.