Obstetrics and Gynaecology (RETROSPECTIVE POST)

Women’s Health (or Obstetrics & Gynaecology, ie O&G) was the first Rotation I did after a year of Adult Medicine Rotations. I did it at a Women’s Hospital for 9 weeks. We were attached to a Team and were allocated Outpatient and Birthing Suite Sessions to attend on a weekly basis. The Birthing Suite Sessions included several night shifts, which in combination with Obstetrics tutes the following morning, kinda wrecked me, even with Medication. We also had Case Studies to do and exams to prepare for (of which we were given the pool of ~120 questions IN ADVANCE of which the exam will derive from, in which we had to prepare and memorize the answers in advance), which was frustratingly time consuming.

To partially balance that however, we had O&G Consultants who were very passionate lecturers and captivated the attention of nearly all the students in their Lectures and Tutes. One of them was extremely excited about an oncoming Blood Test, that would diagnose Trisomy 21 (Down Syndrome) in the 1st Trimester with supposedly up to 99% Sensitivity and Specificity, which would mean that the more complicated and dangerous investigations of Amniocentesis and Chorionic Villus Sampling would be abolished.

There were Outpatient Sessions for Gynaecology and Obstetrics (for Antenatal Assessments, ie assessing pregnant women’s health).

Gynaecology Outpatients to be honest felt rather repetitive, the most common medical complaints were Menorrhagia (excessive menstrual bleeding), and Dysmenorrhoea (painful menstrual bleeding). It may have seemed mundane, but I was very impressed by the intervention called “Mirena” (essentially a contraceptive IUD which slowly releases an oestrogen called Levonorgestrol to minimize menstruation), which was prescribed very frequently. Even Catholic Hospitals in Melbourne are now allowed to prescribe this “Mirena” for the above 2 indications, with contraception as a “Bonus Side Effect”!!!

We did have a special tute on performing a Gynaecological / Pelvic Exam, on special “Volunteer Tutors” who let us physically examine them, for the Pap Smear and Bimanual Exam. Being a male who was only allowed to do 2 or 3 Pap Smears at Outpatients in total (with the Registrar who initially inserted the Speculum), I appreciated this opportunity to examine a woman. I made the mistake of asking the Tutor to "Spread her legs", because apparently it had sexual connotations, but she assumed I wasn't being offensive coz she thought that I was an International Student and that English wasn't my first Language. For the Pap Smear I went too high up and accidentally rubbed against her Clitoris, and she was moaning, saying “Oooooooh, that’s too high up, go lower!”. I must say the Labia felt rather “fleshy”, and it was challenging for my left Thumb and Index Finger to part the Labia coz it was kinda “wobbly”. I eventually managed to part it and insert the metal Speculum to keep the vaginal wall dilated before using a flashlight and Speculum to swipe her Cervix.

For the Bimanual Exam, I gloved up again and applied some lube on my fingers and slowly put it in. Her vaginal canal felt moist and after asking her to cough IIRC, I eventually managed to slide 4 fingers in, tightly. I then pushed up to “palpate” the cervix and with my left hand on her abdomen, tried to “palpate” her ovaries for any abnormal masses, of which there were none. I was curious how deep and wide the Vaginal Canal was to accommodate a Penis during Sexual Intercourse. It seemed plausible, albeit with the Vaginal Canal being stretched. Although I read that the Clitoris is the most sensitive part of the Female (sexually), I hypothesized that some of the sexual pleasure would also be from the tight sensation experienced from having an erect Penis pushing against the Vaginal Walls. I also envied how a woman could hypothetically “fake” an Orgasm.

Obstetrics Outpatients was much more interesting IMHO due to the variety. I particularly enjoyed measuring the pregnant women’s fundus length (length of Uterus from top to bottom) at different stages of gestation, measuring blood pressure, and also using the Doppler Ultrasound to try to listen to the Foetus’ heartbeats. Hearing the Foetus’ heartbeats would invariably please the pregnant women. I had many opportunities to palpate the women’s uteruses (sp?), but was always paranoid about causing pain or “hurting the foetus” so I always palpated relatively gently, which actually annoyed the O&G Registrar. Medically, I took note of the medications that may be Teratogenic (damaging to Foetus), and I liked the complexity of managing pregnant women with Epilepsy or Bipolar Disorder given that all Anticonvulsants are Teratogenic to some degree apparently.

With regards to the birthing suite, although I didn’t assist much in the actual baby delivery, I did get to participate by helping to perform routine observations (of vital signs) on the mother, fetching blankets, and trying to maintain a conversation. I particularly liked how by talking to the mother, not only was I “helping the time pass”, but I was also partially distracting her from her discomfort or anxieties, ie “hitting two birds with one stone”.

I’d like to note that whilst I’ve heard numerous anecdotes about the hostility between Midwives / Midwifery Students and Medical Students, it wasn’t apparent at the Hospital I was placed at. The Midwives I’ve spoken to were all helpful to some degree and weren’t bullying, thank goodness.

It was a very eye-opening experience to see a baby delivered right in front of your very eyes, so surreal. For some reason I didn’t feel anxious, more excited, but was able to keep my usual flat affect surprisingly.  I was very curious to see what the baby looked like, and it was almost climatic to see the baby’s head get exposed to the outer environment. The mothers seemed to be quite happy and calm upon seeing their child. I also loved the process of slowly pulling on the umbilical cord and eventually pulling out the Placenta, which felt like "warm meat of a mild silicone-like texture". It was very pleasing to my hands, almost as if I could use it as a "stimming-tool" like a stress-ball (obviously inappropriate).

I always wondered why people have children. I know that some of them do it coz they want more “atmosphere” by creating a family, others coz they want “unconditional love” or want to feel needed due to their low self-esteem, and others coz they have seemingly poor judgment and continue to have babies even though they don’t have the personal or financial resources to do so (especially “bogans”). I was disgusted when I saw very obese women who were pregnant, coz it jeopardizes the foetus’s health, but supposedly who am I to judge?

But for a short moment after the baby was born, my internal prejudices about anybody having children when they “shouldn’t be”, vanished completely. I felt privileged to be able to witness childbirth, and to be able to be a participant in their experience. I thought it was being too NT to see it as a privilege, so I had to ask myself later on why it was so, and more objectively I suppose it’s coz it’s a rare experience for me, to be able to observe something that’s literally a once-in-a-lifetime experience for that individual (baby), the pure novelty. I’m sure that if I was hypothetically an O&G Consultant, the baby deliveries and placenta extractions would eventually become mundane as well.

I have extremely early on, ruled out O&G from the Medical Specialties that I’d consider (if I stay in Medicine) due to lack of academic interest and also fear over Medico-Legal Issues. I was also concerned that this very strong Medico-Legal fear would eventually override the joy of observing childbirth which I personally predicted would wear off with repeated experiences. I’ve also read and heard rumours that with the rising Power and ongoing Lobbying from Midwives to have a greater share in Antenatal care and undertake more “normal” baby deliveries independently (with the ongoing funding problems of Australian Healthcare likely giving them even more leverage), the Obstetrician’s role will progressively be devalued.

However, nevertheless, this Rotation was very eye-opening. I think I would’ve enjoyed it a bit more if it weren’t for the “Shift-work” from the Birthing Suite Sessions and the horde of O&G questions I had to prepare for, although I should be grateful in that it’s supposedly better than not knowing the questions in advance, at all.