Labor & Delivery
The OB/GYN (Obstetrics and Gynecology) field as a whole was a complete mystery to me prior to medical school, and even after my Labor and Delivery (L&D) rotation and as I continue my USMLE Step 2 studying, the specialty still seems like it’s own world. Their language is full of acronyms not used in other specialties, and many other specialties won’t work closely with pregnant patients at all so pregnancy physiology and pathophysiology tends to be left to the experts only.
I was also really blown away by the range of skills and types of care the OB/GYN’s provide. They act as primary care providers for many women, they of course follow pregnant women throughout their term, and they’re also surgeons that perform a wide range of procedures. Prior to my third year of medical school I had no idea that this specialty covered such a wide range of practices. If the OR was a place I wanted to spend my career, I definitely think this would be on my radar for a specialty choice. (But nothing else was able to change my love for Emergency Medicine.) That being said, one of my favorite parts about hoping to match into Emergency Medicine is that I can relate every rotation back to the ER in some way, and I really enjoyed my L&D rotation. The residents I worked with played a huge role in this, and I’m so grateful for the friends and mentors I met, and grateful for all the time they spent teaching me and trusting me with their uniquely vulnerable patients.
Watching little humans being born was shocking and truly amazing
Whenever friends ask me what some of the “craziest” or most memorable things I’ve seen so far finally being in patient care, my first thoughts definitely include lots of moments from this rotation. Prior to this rotation, I hadn’t seen a live birth in person before, and I’d never seen anything like a C-section. The whole process of pregnancy and childbirth is a beautiful traumatic miracle in my opinion, and I was really speechless each time I got to witness new life coming into the world.
I watched moms with all different types of support systems, including some who had no friends or family with them, and this was a good reminder to me that everyone’s story is unique and it’s only my place to support my patients never question or pass judgement. At first I was surprised to see some patients going through such a big life-event without family around, but this was a good reminder to my immature and constantly growing perspective that not everyone’s support system will look the same as mine, and everyone’s needs are unique.
In the actual moments that I was watching a vaginal delivery or a C-section, I think my primary emotion was just shock and my only thoughts were trying to figure out how to be helpful or at least not get in the way. It wasn’t until I reflected on my day or on the rotation later that the significance of what I was seeing really sunk in. I remember walking out of a patient’s room after she delivered and seeing a group of excited family members waiting outside. I smiled and congratulated them and let them know the nurse would let them know when the patient was ready. As I walked away, it hit me just for a second what a privilege it is to be able to be witness and play a small part in these patients’ life-changing and most vulnerable moments. Working in medicine puts us in such unique situations, and I think being part of a labor and delivery team is definitely one of the most special, and I’m glad I got to experience it during my third year of medical school.
A little about C-sections (skip if you get queasy)
C-sections were hands-down the most shocking, wild, surreal surgeries I’ve seen. The first C-section I saw was actually during my first month of third year, several months before this rotation, and it was the only time so far that I’ve gotten light-headed myself. I was holding the “bladder blade” (I don’t know the correct surgical instrument name), which was protecting the bladder and holding traction on the abdominal incision as the resident cut into the uterus. More blood than I expected came oozing out towards my hands, and when I felt the warmth of the blood through my gloves and as I watched waiting to see a baby’s head be pulled from this woman’s abdomen, I felt my face get warm and my knees get weak. Thankfully I was able to clench my fists, bend my knees a little, and remind myself that my hands were in the surgical field and I needed to be still.
Seeing a baby be pulled out from the uterus is a much different experience than seeing one be pushed through the natural way. It’s so traumatic to the body, so bloody, and surreal to watch. After the baby is passed on to the pediatric team, one of the most jarring parts of the surgery in my opinion, is when the surgeon wraps a laparotomy pad around the uterus and yanks it out of the abdomen. The uterus, which was just home to another human for 9 or 10 months, just sitting there exposed getting unceremoniously sewed back up, was a sight that just never stopped throwing me off. Getting “pimped” (asked questions by my attending) with this in my view definitely resulted in my least intelligent sounding answers. Staring at this scene and trying to remember all the ligaments that hold the uterus in place or trying to remember what a myofibril does just didn’t go together well for me, but thankfully I had nice residents who helped me out.
To top off the rest of the jarring aspects of this surgery, most of the patients are awake, with this being done using spinal anesthesia, and it never stopped alarming me when I’d intermittently hear the patient asking questions from behind the plastic drape as they’re obviously completely pain-free as their abdomen is being dissected then put back together layer by layer.