Tuesday, April 12, 2011

OB or not OB?

We have been up to our eyeballs in pelvic floor muscles lately as our last few cases have been covering pregnancy, babies, ambiguous genitalia, labor and delivery. 

Now normally I am not a fan about learning the differences between the somatic, autonomic, and visceral nerve supply to muscles, but I have to admit, knowing the practical applications for managing labor pain has made this memorization a bit more interesting. I am sure it is because I love procedural skills and can't wait to do my first nerve block, epidural, lumbar puncture, and perineal repair. I started thinking about all the hands on work that OB/GYN's do and then having thoughts that were alien to me until now ..."obstetrics? maybe?"

Truthfully, back in the days when I was an annoyingly-militant-vegan-self-righteous-naive-hippie I seriously considered midwifery (not to say that midwives are those things, I am just elaborating on a phase I went through in my early twenties). I even took my doula training and looked into various programs across the country in midwifery. The only thing that really held me back from pursing this career was the fact that Canada has some ridiculously archaic and paternalistic conservative attitudes regarding who ought to be bringing babies into the world. Depending on what province you live in it can be a seriously uphill battle to create a career for yourself as a midwife--that is, no hospital privileges, being shut out by the medical community, lacking public subsidies, and having to conduct only home births without OB back-up. I just wasn't up for the challenge, I guess. 

Fast forward to medical school where I continued to reject the Western approach to birth, until very recently.

We had an OB/GYN lecture us this week. She was Irish but had spent 10 years specializing in the US in high risk delivery and maternal/fetal medicine. Her lecture was delivered in a soft spoken but direct and powerful way. About half way through she stopped on the slide shown to the left, and said,

"I have always wanted to be a part of this event in people's lives. Even when it is cold, dark, and in the middle of the night I love to get up and head to the hospital knowing that this is what I get to be involved in. When the babies start looking the same and I am not thrilled to be there, I am going to quit. But right now, I feel nothing but privilege for being invited to take part in this pivotal moment in people's lives".

She apologized for how hokey it sounded but I felt that it was quite lovely, to hear someone speak so passionately and honestly about their career choice. I suppose it is what we are all striving for when we choose our future specialty, what are we passionate about? Am I going to love living in the O.R, or intubating patients in a helicopter, or prescribing chemotherapy regimes? It is so hard to know at this stage having only seen as sliver of the health care system. But when you hear someone speak from the heart, and they clearly do love their job, it makes you wonder...could I love constantly being sprayed with amniotic fluid and having only female patients for the rest of my life?


OB/GYN Pros:                                                                     OB/GYN Cons:
-lots of healthy patients                                                          -on call, forever and ever, amen
-plenty of hands-on procedures                                              -bodily fluid exposure extravaganza
-O.R from time to time                                                           -bad outcomes are very bad
-emergency situations*                                                           -only female pts
-many good outcomes                                                             -continuity of care
-continuity of care                                                                   -highly litigious
-many happy/excited patients                                                 -crazy women with 5 page birth plans
-immediate results                                                                  -having patient load
-the whole 'miracle of birth' thing                                          -the training

If nothing else, I am trying to keep my mind open to the possibility of areas that I hadn't considered. I know how most medical students start rocking in the fetal position (pun intended) when you mention their OB/GYN rotation but...who knows? Maybe I will be one of the lucky ones and will actually enjoy labor and delivery!

Or maybe I'll just end up with countless pages of blog fodder.

Either way, win!

*I know that sounds twisted...but I am wired to enjoy emergencies for some reason. I blame my mother for not breast feeding me long enough. (Hi Mom!) 



OMDG said...
This comment has been removed by the author.
OMDG said...

The cons are mostly what Ob residency seems to do to the people who go into Ob.

Chief residents who make their interns cry three times a week. Who yell at their patients. At my institution it takes really sweet (mostly) young women, and turns them into really unpleasant people. This trend seems to reverse itself somewhat once residency is over, but I'd hate to go through 4 years of my life like that.

If you can find a program that's not malignant (good luck with that), I say, why not? I suppose that applies to any specialty, though. And I really DO hope you have the good experience that completely eluded me.

James said...

I'd add that OB is a totally different world than the GYN part. Delivering babies rocks no doubt, but make you are going to love both parts of it.

Other things I think you should add to your PRO/CON list where you think they fit.

1. Need for a practice. Can you be tied to one area?
2. How to you feel about routine? How are you going to feel after your 1000th pap smear?

Cartoon Characters said...

After working many areas of nursing, L&D definitely was the area I liked the best. It has a lot of the excitement and turnover of ER but without a lot of the crap you get in ER.

I think of what my mother went through to deliver her babies, and how much better I wanted for my own patients that I looked after.

I think the large hospital I did L&D in - in Vancouver (not BCW)was quite receptive to the residents. I know there were a few residents we convinced to be OB/GYNs... :)

Things have changed in BC as far as Midwifery goes. Definitely it is a WORLD different than in the USA - I didn't care for L&D in the USA...too medically oriented and unnatural. In the four hospitals I worked L&D in in BC, all were much more laid back than any US L&D I ever worked in (5).

Young female patients aren't that bad, really. There is the family unit after all...

And there are ways to avoid "amniotic fluid showers"... haha. I can tell u about the resident I told NOT to sit right in front of that bulging bag, and he refused to listen....he found out how salty it tasted... ;)

Cartoon Characters said...

I think it would be easier to be mobile as a female OB...to tell you the truth...most women would prefer a female OB...from what I have observed......

Shrtstormtrooper said...

Up to your eyeballs in the pelvic floor? That seems like an awkward place to be :)

Unknown said...

Good choice for a specialty,offers a mix between medicine and surgery that no other specialty can match.

Ps If you think canadian attitudes to obstetrics are outdated just wait until your ob/gyn rotation in ireland...

OMDG said...

Sean -- What about Urology, Ophtho, and ENT?

Also, I am really curious about the outdated techniques employed in Ireland. Do tell!

Unknown said...

sorry slight oversite on my behalf those specialties do also offer a good mix, just that i've more experience of OB/GYN (8 week rotation +elective) relative to those specialties (1 week each) so didnt have much info on them.
Situation in ireland is that although by international standards we have extremely low maternal/perinatal mortality rates there has been an excessive tendency to over medicalise pregnancy, obstetricians manage pregnancy with very little input from midwives,in fact midwives are marginalised here much more so than the rest of europe, home births in ireland are extremely rare,caesarean section rates are significantly higher than accepted international norms, Irelands episiotomy rate is approaching 50% although the one benefit to this is a lower rate of third/fourth degree tears compared to rest of europe.

Anonymous said...

I thought about other things while in med school, and even early in residency, but now am totally happy as an OB/GYN. I get to do great surgeries and have mostly happy and healthy patients. Most problems that my patients have are very treatable, and its not hard to figure out what to do. There's lots of action and fun, and not much sitting around.

For me it was the right choice. The lifestyle isn't so bad now that everyone is in big groups, and the pay is strong relative to the length of residency.

Just figure out what lights your fire the most and do that.

Unknown said...

I am fortunate that I live in a province where midwives have hospital privilages and are covered by my provincial health insurance. I had two midwife-assisted births at the hosptial, and one lovely textbook midewife-assited homebirth. I loved the level of care I received from my midwives and wished I had my second one at home as well.

The only annoying bit about midwives here is that they are not cleared to insert IUDs so I had to chase an OB down to insert my beloved Mirena instead of having it done at my six week post partum check up.

Albinoblackbear said...


I just spent 20 mins answering all these comments on the SLOW PAY AS YOU GO computer terminal in Heathrow...and it dissappeared!


Ok, for now, thanks for all of your thoughts on this...

Ryan said...

as an aside: that kid's doing a hella fine job of impersonating a telephone.

Robert said...

I agree with OMDG, every resident I've come across seems to be about as pleasant as a carbuncle.

Liana said...

OB makes up about 80% of my practice and I think it's a good sign that even after a few years, I still get teary eyed at deliveries sometimes. Since I'm a family doc, I follow some of the babies I deliver and their moms in my family practice which I find really wonderful.

Bostonian in NY said...

I loved OB/GYN on my rotation, except for the constant sensation of drowning in estrogen. I'll never forget being the only male in the OR holding a retractor on a transvaginal hysterectomy while two of the residents, an attending and the three nurses bitched about their sex lives...immediately I knew that I was not cut out for OB/GYN.

On the bright side, I do a lot of primary/acute OB/GYN in my practice now in the ED...sans deliveries and OR time.

H said...

I'm a nurse in the U.S. considering midwifery, or maybe trying to decide whether I should consider it..., and my pro/con list looks almost exactly like yours! Ack! How to decide?