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GIVING medical students practical experience in obstetrics is not just about “catching babies” but is an “essential part of a total medical education”, and medical deans around the country should make it a priority, says a leading obstetrician.
Professor Michael Permezel, president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, was responding to an article in the latest MJA which asked if medical students should deliver babies. (1)
Professors Caroline de Costa and Ajay Rane, both from the department of obstetrics and gynaecology at James Cook University in Townsville, said that due to increased student numbers and competition from student midwives, the opportunities for medical students to take part in birth was declining.
“Until the late 20th century, all medical students were required to perform at least some normal (uncomplicated) deliveries, under the watchful eyes (and, at times, the hands) of senior midwives”, the authors wrote.
“These requirements have been reduced owing to increased student numbers, increased competition from student midwives for attending births, decreased birth rates and increased caesarean section rates, competing demands from the many new disciplines now included within the medical course, and a greater say by women themselves in what happens to them during labour and birth.”
The authors cited a 2008 survey of the 19 Australian medical schools that showed only 10 had mandatory requirements for students to perform between one and four deliveries. (2)
“Our experience over the past 10 years has confirmed our belief that the requirement of compulsory deliveries … sends a clear message to students and staff that delivering a baby under the skilled direction of a midwife is an important step towards becoming a doctor”, the authors wrote.
Professor Permezel, from the department of obstetrics and gynaecology at the University of Melbourne, went even further, saying “students learn a lot more from obstetrics than just catching babies”.
“Yes, the actual mechanics of childbirth are important to learn”, he told MJA InSight. “Every doctor, no matter what their speciality, will care for pregnant women. Knowing what they are going through, what their issues are, is important.
“Medical students gain a certain emotional maturity and enhanced communication skills by going through that experience with parents, who can be highly emotive.
“They will also learn about pain relief and fluid management — skills that are useful more generally”, Professor Permezel said.
He said that despite increased numbers of students and competing interests, making delivering babies a compulsory part of medical training was “absolutely doable”.
“It’s a matter of what priority the medical deans and teaching hospitals put on the education of their students”, he told MJA InSight.
“The priority of midwife educators is the midwives. The priority of the medical educators is the doctors and it’s up to the deans and hospitals to see the needs of both and balance them.
“If the deans give obstetrics its rightful place in medical education then they will exert pressure on the hospitals to get that balance right.
“This is not just about catching babies”, he said. “It is the deans’ role to provide the community with the all-round, best possible graduates.”
Professor Justin Beilby, president of the Medical Deans Australia and New Zealand, said that he agreed that obstetrics practice was a “core part” of a student’s medical education and that medical deans had a responsibility to ensure students were able to deliver two or three babies during their obstetrics rotation.
“It is difficult [given the competing interests and increased student numbers] but it is my view that we should hold to that aim”, Professor Beilby said.
“I don’t think the number of medical students will increase much more — we are approaching status quo — and perhaps it is time we looked at this in different ways.”
Professor Beilby said the private system was already used to provide some clinical training. “Perhaps we need to focus a little less on the public system”, he said
– Cate Swannell
1. MJA 2013; 198: 307
2. O&G Magazine 2008; 10 (1): 30-32, 34-35
Posted 2 April 2013
As a recent medical graduate, I think this debate is an important one. I don’t think anyone would question that having the average medical grad have experience with births may help the general public as a whole, and further the students education. For those saying that it should be only for the few, just imagine a generation of Dr’s where if you went into labour prematurely at the shops and perhaps a Dr happened to be there, yet had never seen/helped/assisted in a birth. Well put by Jeremy Oats in a previous comment.
Most women, if approached in a considerate manner, and asked respectfully, were amenable to a student (myself) being present.
As for Beverley Walker, your wealth of misinformation is close to staggering. Apt comment from anonymous as well at 12:08.
“Apart from that the Cytotcec in the prostaglandin given to induce is composed of Misoprostol designed to kill cancer cells.” Not in the slightest. Firstly Cytotec is Misoprostol in tablet form. Following is a direct Mims quote regards to its indication:
Prostaglandin E1 analogue. Prevention of NSAID induced gastric ulcers (when assessed to be at high risk of gastric ulceration or complications and NSAID therapy essential); postsurgical stress induced upper GI lesions, mucosal bleeding in ICU. Treatment of acute duodenal, gastric ulcers.
It’s used off label for its use its effect on the uterus, causing contractions and softening, which can aids in induction, as well as to control post-partum haemorrhage. Currently in the WHO list of essentials medicines for induction, where you can access for free in pdf form via (http://whqlibdoc.who.int/hq/2011/a95053_eng.pdf) where it is on page 29.
“When safety is compromised by htmones derived from horses urine – I am aware that male human prostaglandin along with sexual intercourse is probably the most pleasurable and private inductiin of labour especially in times of high tides thrunderstorms and a full moon.” Seriously. Not even going to touch this one.
As for the concept of artificial speeding up of labour. Not sure how many women would like to spend 50+ hours in labour of their own accord. Nor are any drugs administered without consent or explanation to women. Now unfortunately I do believe that sometimes there should be a better discussion or possible outcomes/possibilities with a medical professional prior to birth, so that administration of analgesia/synthetics/other meds are fully understood, but it’s hard to prepare for every eventuality.
I am thankful I was able to spend time with women in vaginal and caesarean deliveries, and encourage all women to allow a student to be present during their own births, my future kids included.
A major problem is that while many student/junior midwives start with good intentions, they are soon indoctrinated by people such as Beverly, who preach the nonsense that all doctors are evil chemical-wielding money-grubbers out to ruin a woman’s birth experience, rather than a valuable part of the team attempting to make the birth as safe and pleasant as possible for both mum and baby. As for nonsensical statements such as birthing “as nature intended”, in more natural birthing times, infant mortality was around 40% and maternal peri-natal mortality was also very high. Presumably this was “as nature intended”, so we should all aim to go back to those good ole days, and you obstetricians can look for new careers, leaving future mothers in Beverly’s natural hands…
In response to the comment by ‘Anonymous’ 02/04/2013 at 10:46 am. I am a medical student who has recently completed my obstetrics and gynaecology rotation where i saw and delivered by first baby. A moment in my training which i will never forget and am so very grateful to experience. Bare in mind that your highly paid private consultant was trained in a so called ‘free dangerous public system’. The standard of care regardless of the system is often surplus when students are present due to the detailed teaching which is required. There have been many a time when students have noticed something a consultant hasn’t. two heads are always better than one.
Even though i’m a nil paid medical student, i too am also paying top dollar for private health insurance covering obstetrics. I will not have any issues allowing a medical student to assist in the birth of my child in my nice cosy private room with my ‘gold class’ obstetrician. They will learn valuable skills and i will still receive the articular care i expect as a patient, regardless of whether i can afford private or not.
It is important for students to work with a competent and exprienced role model. Choosing who and how is a matter of supreme importance. As a supervisor of clnical practice and Senior lecturer in the subject I suggest that the Curriculum Vitae and track record about : numbers of normal labours attended, that is normal – requqired no intervetnon either chemical mechanical or even suggestion of early elective induction and caesarian birth, number of caesarian births attended, number of eipiotomies cut, number of infections post partum, number of haemorrhages due to anaemia. Apart from that do they take a history which includes knowledge about normall nutrition, diet, family history including children social history including family support systems, Are there qualifications to pracitce approved by the National Body, Do they supply a CV to the family so that the choice is fully infomred. Will this practitioner be with me during the labour and will this practitioner be visiting me at home every day with a first baby to help with breastfeeding. Will this practitioner introduce me to a partner in case hte opr she is away when my baby is born. I think the practitioner should pass an inberview and exam by the family before the family decides to accept him or her. What is the practitioner’s view of holistic care. Will I be free to birth in a position of comfort for me? Will this practitioner allow acupuncutre as a method of pain relief. What is this practioner’s track record on fetal dath in utero and stillbirths and maternal deaths. Now that applies to all intending births the givers and creators of the pregnancy and the intending attendants at that birth. I am sure I have fogotten lots of criteria here. How many home births has this doctor or midwife attended? That would be revealing especially those who are highly critical of home birth. An of course do you have a written agreement with the woman and her family without coercion to allow the presence of a student midwife and or a medical student to be with this woman at her future child’s birth?
To those who decline having trainees involved in their medical care, have they reflected on where the practitioners that they have in attendance received their training? Have they also considered where the practitioners who they expect will provide the care for their offspring will be trained?
Dear Robyn,
Sometimes I wonder why we give these articles oxygen by replying. Since when did the midwife or the carer know what the community wants? When did they ask? My witness and experience demonstrates that women are coerced by placing fear of danger. The community relies on comprehensive and truthful information to lead them to decide what is in their own best interests and that of their future child. The weasal words of the hospital routine and medical model ignores birth as a normal physiological and biological phenomenon. What women tell me is that they want to be safe and have the same person caring and to have control over decsisons abouth their birth. When safety is compromised by htmones derived from horses urine – I am aware that male human prostaglandin along with sexual intercourse is probably the most pleasurable and private inductiin of labour especially in times of high tides thrunderstorms and a full moon. I have visions of the prostaglandins being provided by thousand of males NUP They use an untrialled experiment with Misoprostol and Cytotec thinly disguised with the name PG3. If the woamn is not fast enough in go the alligator teeth of m etal forceps and along wiht it the infection. The immune system is compromised already by the gel placed around the cervix and the baby is compromised by lack of oxygen to the uterine muscle in small frequent artifical contractions. There is no need to produce mega amounts of prostaglandins in order to speed up labour and placental delivery because the simple act of breastfeeding causes natures hormones in mega doses to arrive.The physiologcal release of the placenta and the uterus remains intact and empty thus minimal bleeding as nature intended. Of course if in the care of a holistic carer such as a midwife her HB would have been in tip top condition. AS we know very few hospital practitioners would wait long enough for a baby to find its way to the breast where the incredible process of latching on by the independently moving baby takes place. I was told recently by a professor of aboriginal health that they have to evacuate women away from country because of possible litigation – I suggested this was another weasal word. So litigation drives how our women give birth – the other culprit is that women are not fast enough when giving birth impatience reigns or would it be cynical to suggest the almight dollar!
Hi, Robyn. I’m not sure I understand what you mean by “normal progress of labour, birth and breastfeeding.” It is “normal” that these physiological processes sometimes end in poor outcomes. Modern midwifery and obstetrics has evolved so that “normal” may be modified, thereby improving outcomes. If, by “normal”, you mean vaginal delivery with no pain relief and no interventions, then I’m not sure that’s what our community wants.
Neverending discussion Sue but really very intersting. This article originally talked about students having more access to normal birth and as most of these conversations it was derailed into “catastrophic” conversation. You have kindly hit the nail on the head “but they are not there just to allow birth to proceed “normally”, they are there to assist when “normal” goes awry.” There is no debate about assisting when the normal becomes abnormal. Sue, you have highlighted the whole issue for women. Most women given the chance with skilled observation, can give birth without our unnecessary assistance. The problem is the large majority of modern obstetrics and midwifery practice no longer has the knowledge and professional confidence to facilitate normal progress of labour, birth and breastfeeding and only intervene when predicatably necessary.
Hi, Robyn. I’m interested in your phrase “midwives or doctors who practice normal birth”. How does one “practice normal birth”? Labour and delivery are physiological processes that sometimes go catastrophically and unpredictably wrong. That’s why the professions of modern midwifery and obstetrics evolved. I agree with you that hospital midwives and obstetricians work in complementary roles, but they are not there just to allow birth to proceed “normally”, they are there to assist when “normal” goes awry.
Hi Sue
As a midwife of 40 years I think it is imperitive that doctors who are interested in women giving birth should graduate having the experience of normal birth, preferably invited by several women who give birth with midwives or doctors who practice normal birth. I think we are all on the wrong pathway if we think we can’t do without each other. You will also be exposed the practice and experience with skilled obstetricians. Our professions of midwifery and obstetrics like medicine and nursing are complimentary not competitive. I have been some amazing obstetric and general practitioner colleagues simply because we respect each others professional skills and work side by side in non authoritarian relationships.
Sue, How about asking permission from the mother if a student or two may attend? I did read a study that most women are happy to help students learn if they are asked first. Simple respect is all that is required and perhaps as one already suggested, if possible, it would be preferable if the student could build a rapport by meeting the mother before the birth.
It isn’t rocket science. If women are going to be treated like secomd class citizens (ala Greg the physician) because they chose to go public and not be asked but ordered to have students observe, then of course these stories are going to get out and put other women on the defence.
I know that during my own pregnancy, I was asked if a student could contact me about my feelings about the pregnancy. After hearing about my mother’s and my friend’s mothers awful birth stories, my first defensive question was “Are they going to be at the birth?” I was afraid that this was the first step into railroading me into having my birth used for the student to learn from. If I had not heard these horror stories I would not have been so defensive. So the point I’m making is, these doctors brought the reluctance of women like me to help students, upon themselves, by their disrespectful treatment of our mothers and grandmothers.
The chickens have come home to roost.
From one “woman with feelings” to another – yes, there were poor practices in the past related to consent. While things are far from perfect, much has improved. I would be interested to know, however, whether you think doctors should graduate without ever having seen or been involved in a vaginal birth, and what is the best way to bring this about.
I know women of my mother’s age who received the abusive health care that Dr Greg is so emamoured with.To this day, and we are talking about 50 years ago, these women still feel the violation vividly for being used as subjects for medical students to learn on. The most private and special day of their lives were ruined by more than one (usually male)medical students being present without their permission. I often hear them say that they lost “all their dignity” when they gave birth.
Public health care is not “free”. These women and their husbands are taxpayers.To treat public patients less respectfully than private patients is offensive.
Dr Greg obviously learnt no empathy from his O%G rotation and even less about respecting women’s bodily privacy and autonomy.I wonder how many students he allowed at this wife’s births.
And some doctors wonder why women wish to give birth at home.
If the word “delivery” is still being used by doctors, it demonstates how little the profession has evolved.
Thanks for informing the woman about Viamina K and Syntethetic hormones. Whichever way you look at it this woman was not educated about these two injections not was it likely to be informed consent.Neither of these human invensions should be used for prevention. I have been around long enough and with a major in education and a Masters in Bioethics and 50 years experience plus SEnior University Lecturer in Midwifery and Health Sciences for last 15 years of m y professional life saw these drugs come and go. For example Vitamin K was given in such large doses it caused Kernicterus that is jaudice in teh fatty tissue of the brain. Once they brilliant person took notice the amount was reduced by half. Then they decided instead of injection they would give the campoules of substance by mouth some babies inhaled and nearly died. and on and on. Now my answer is if you knew about the diet and health of the mother you would be inclined to pump up her diet with all those ingredients which by nature produce viatmin K – a baby is at risk if the mother is deficient due to liver disease or too many babies. I would rather give the Vitmain K to the mother. Apart from that the Cytotcec in the prostaglandin given to induce is composed of Misoprostol designed to kill cancer cells. Accidentally doctors discovered that some women miscarried.
Re: Anonymous 3/4/2013 12:00 pm post above. I believe the injection you would have received would be syntocinon (synthetic oxytocin).
The baby would have received Vitamin K. This is to prevent HDN – haemorrhagic disease of the newborn.
I was born in 1973 and had grown substantially large being 22 days overdue. My mother’s doctor had never delivered a baby before, and as I was so large by that time, the doctor sent for the largest/heaviest sister in the hospital and instructed her to lay across my mother’s abdomen to ensure I was engaged lowly into her hips in the birthing position. The doctor did an episiotomy and whilst my mother laid on her back the whole time, I had moved up again, away from the birthing position. So again, the doctor asked for the same large heavy sister (who was elsewhere in the hospital) to come back and lay across my mother again to move me back down, into my mother’s hips. The endurance of pain my mother felt throughout the whole ordeal was immense. An educated Farmer’s wife, I remember her saying so many times; that if someone was present with a gun and had offered to put her down, she would have gladly agreed, pleading them to do so.
There may be obvious complications in birth, and pregnant mothers are certainly not permitted to go that overdue anymore, however, I can’t help reflecting that perhaps being more experienced with births, the doctor could have made better decisions than he did. A pregnant mother places all her trust and indeed, both their lives in the hands of the doctor and midwives. I myself, would prefer only midwives present, and in fact, had my third baby before the doctor even arrived. I do see the point of this article as important though, as there may well be times doctors have to perform, and experience accounts for so much. It’s an obligation to all mothers.
I agree and support what Robyn Thompson says in her post on page two. If all is safe, then it is best to support the mother and baby through as natural a birth as possible. When the doctor arrived after the birth of my third baby, I was in haemorrhoid pain, and he insisted my baby and I have the Vitamin K needle to release the remaining placenta and move on out of the birth suite. I understand birthing suites are busy places, but I labour and birth without any drugs or medical intervention, and wanted my body to naturally release the placenta which it half had already. I felt his arrival rushed the final process. He wasn’t my doctor, never having met him, I had no relationship with him at all, and yet he insisted we have the vitamin K needle, without him asking me anything about my health, diet, or past births.
I would welcome one student join me along the development and progression towards the birth, and welcome them to be there at the event of birth.
The main issue in medical students being able to participate in delivering babies is obstuctive and uncooperative midwives. It has always been like that. It seems that training to be a Doctor is less important than learning to be a midwife. The midwifery students have years to complete their deliveries. The medical students are usually allocated 1 week. Its ridiculous.
Also the first comment by Aniello Iannuzzi regarding muslim ladies not allowing male medical students to assist. Many women refuse male medical students, I think in this day and age a womans right to accept or refuse the presence of a stranger during a birth is a given. Relgion has nothing to do with it. I would expect comments like that from less educated people, its a bit dissapointing that its coming from Drs.
Are we talking about students learning and participating in the art and skill of normal birth? Or are we talking about the obstetrics when specialised skills for the abnormal are absolutely necessary? My understanding for this discussion is that there is a need for young professionals to learn about the normal progress of labour and birth preferably in a non-competitive environment? Learning the abnormal, appropriate skills and timely intervenion is equally important for all students.
There needs to be a common meeting point between needs of medical students and student midwives. Perhaps a common subject with integrated sessions in a Unit ‘normalising birth’ could be a start.
Unhelpful comments here only harms the respective professions. Yes midwifery comes from being ‘with women’- lights, dim, calmness, careful timely observing mother work with her body promoting normal birth something one rarely sees in the busy birth suites of hospitals.
As a HB midwife I would welcome a medical student to come with me, firstly developing a relationship and seeking permission from woman and family. Yet when there are concerns my ICU nurse hat switches on- frustrates many in birth suites having extended knowledge and experience.
Yes I agree there are some people who simply shouldn’t be near a birthing woman and a birth suite! It comes down to what the woman wants and the need to respect clients decisions.
Important discussion but clearly not new. Felicity had the same issues in the 1960s, as I did at the beginning of the 80s. Medical education theory has two poles – the “must experience and learn everything” school vs the “early streaming into sub-specialty” school. Balance must lie somewhere between. Of course doctors need to be aware of the nature of labour and vaginal birth, but the best place to learn this is not in a home birth, with a limited number of providers and no capacity to cope with complications. The hospital labour ward is there to manage the not infrequent situation where so-called “normal birth” goes wrong. There is no innate ability to give birth – as the cemeteries of old will attest.
1. Midwifery training should incorporate the role of individual team members. They need to embrace the culture and the role of a medical student and doctor.
2. Labour room experience in the public hospital is a place of learning for all supervised, indemnified health field students.
3. Obstetricians should give leadership in conjunction with the labour room NUM and medical students should be rostered.
4.Staff who oversimply the physiology, science and the potential dangers of a delivery should be closely monitored.
5.Medical students should even learn to do an episiotomy and suture with the supervision of a senior registrar or Staff Specialist on site with a teaching role in job description.
Even in the 1960s it was very difficult to assist at 10 normal deliveries . Even living on site at Queen Vic I only got 8 deliveries .There is an unfortunate them and us competion between midwives and medicos fuelled by community ignorance .Thankfully there are exceptions and 18 yrs of GP obstetrics has been well worthwhile.
So now Beverley Walker is advocating the milkman deliver babies. Seriously!
Depiction of a newborn screaming, handled supine by a stranger who replaced the mother with strange smells, rubber gloves and plastic apron is not an opening to normal birth. A sad baby denied olfactory and other sensory integration at birth with the mother, what are we teaching? This is frustrating and saddening for those who have been privileged to observe women giving birth and breastfeeding untouched by others. Future professionals can only learn about normal birth when they learn not to deliver babies, when they are exposed to womanly birth driven by innate desire, strength and knowledge. An internalised experience that only women understand.
If professionals haven’t seen a woman give birth to her baby in a quiet and protected environment without anyone else touching, without drugs and machinery, without clamping or cutting the cord, and see the pair breastfeed untouched soon after birth – HAVE NOT HAD THE PRIVILEGE OF WITNESSING NORMAL BIRTH.
Has professionisation of pregnancy, labour, birth and breastfeeding been the demise of normal birth? The wisdom of future learning about normal birth is not competitive between students as this article suggests. It is about women making decisions while unobtrusively supported to give birth, not be delivered. It is solely is the right of every woman to decide who will be privileged enough to be with her, including the presence of students, while at her most vulnerable and personal time.
Rather than suggest that lack of knowledge in normal birth is competitive, why don’t the responsible professionals assist one student to be invited by one woman to be with her during the whole of her pregnancy, labour, birth and breastfeeding, and enjoying the side by side learning with an experienced professional guiding the way.
I think it sometimes gets forgotten that today’s medical student is tomorrow’s doctor, who will be called upon in an emergency to help with a birth. Better that student have their first experience being responsible for the care of a woman in labour be with the support of an experienced midwife, rather than trying to recall what they observed during medical school. There definitely needs to be some sort of policy support for the students so that they don’t have to negotiate with other medical staff to be involved in births directly. If they are there, have put in the time with the pregnant woman and are directly supervised, it is just as important for a medical student to learn as it is for a midwifery student and they should be accorded as much priority as each other.
Childbirth is a highly emotional and personal experience. I don’t want medical students involved unless they are interested in being a part of it, or requiring skills and experience for their future practice. Making deliveries “essential, tick-box criteria” enforces some disinterested students to become involved. Why does a future orthopaedic surgeon need to experience a birth? I feel the same way about Pap smears, unless the student plans to use the skills learned, I don’t want them practicing on me.
A difficult one, but until the O&G team take the lead and ensure that students have access/right to deliver this will be an ongoing issue. I entered medical school looking at O&G as a specialty, but due to the interface with the midwives and difficulties with access to normal births, the shine was taken off it! I watched/participated in 5 normal births at medical school (3 was compulsory) but I made a massive effort to do so. I spent an elective in Barbados which was entirely different, the 4th year med students almost ran the labour ward and had significant responsibilities. They delivered large numbers of babies, did the episiotomies, and had a huge input. However the woman’s rights were of minimal consequence and I cant forget the time a group of 10 medical students surrounded a professor whilst he did a PV examination, inviting all students to do so also. (I declined – this was in 1999). Surely there must be a balance though. I am now a psychiatrist….(by the way I would never go through the public system to deliver as I would absolutely want a consultant, but I would have been very happy to have a medical student attend both of my deliveries in the private sector).
it is a real problem. No-one could really contest the value of medical students being involved in a minimum number of deliveries, just as no one could contest the need for student midwives to have their opportunities too. And there are diminishing numbers of vaginal deliveries in the public system with increasing numbers of students of both kinds fighting over the spoils. Here’s an idea, what about introducing a Student-as-Doula system? Doulas (birth attendants) are increasingly popular among mums-to-be, and are really handy to have around to take pressure off the midwives caring for labouring women, too. But they can be expensive and aren’t rebatable of course. Could the medical schools set up a roster whereby willing mums (public and private) sign up to have a student as their doula for free except the promise to have the student in on the delivery. The student would gain valuable experience both before the birth, meeting the women in their homes and talking to them about their pregnancies and expectations of the birth, be with them for the labour and delivery, and post partum. Any women with a student doula would be off limits to student midwives to avoid punch-ons in the second stage. We did something like this at Newcastle medical school and it was terrific.
I did my medical student term in O&G at the Royal Women’s in Melbourne 7-8 years ago, and also remember working very hard attempting to obtain my quota of births (which at that time was to observe 7). Despite trying my best to be polite, respectful and hardworking, I was treated with hostility by many of the midwives who seemed to see my very presence as something negative, as though I was doing something bad/evil by trying to learn some skills that would enable me to become a good doctor. After spending an inordinate amount of time there, I observed 3 births, caught none and with the pressure of needing to study the rest of the O&G curriculum, gave up and joined my fellow students in the Operating Theatre, where the remainder of the quota was signed off easily. I didn’t feel that being a female made it significantly easier, as many male classmates were better at ‘charming the midwives’ and got more deliveries that way.
I felt that the main barrier (at least at the time) to getting hands-on experience with deliveries was the attitude of the midwives and their anti-doctor culture, which I frequently saw demonstrated in the things they would say to the patients after the doctors had left the room. I am not sure how this culture can be fixed but it is unprofessional at best and toxic and harmful at worst. Not sure what our colleagues in O&G think?…
It seems clear that medical students are having to fight to get to do deliveries, yet many of them could end up on a rural/remote rotation as a JHO where they really need obstetric skills. When I was a Year 5 med student doing my O&G rotation, the consultant obstetricians made it very clear to both the patients and the midwives that we were to do a certain minimum number of supervised vaginal deliveries and PV exams on pregnant women, regardless of any other considerations. I can vividly recall one patient being told that, if she wished to avail herself of free obsteric care in the public hospital system, she would have to agree to have medical student involvement in her ante-natal clinic visits and her delivery. Presumably that is politically incorrect now. I also clearly recall one very obstructionist midwife being verbally chastised by the matron in the labour ward for trying to divert medical student deliveries to student midwives. Oh, for the good old days! The system worked then, and I was able to avoid any obstetric disasters when I was rotated to become Medical Superintendent of a country hospital for two months soon after completion of my intern year.
I suggest that the RACOG be given responsibility for determining a uniform undergraduate O&G curriculum across all medical schools in Australia, and the authority to enforce compliance from hospitals for minimum numbers of medical student deliveries.
Obstetrics/midwifery is one specialty where one learns to deal with a specialty which is highly consumer oriented where communication with consumer,[ the patient]is extremely important and being able to discuss the pros and cons of modalities of treatment and offer the optimum treatment which is the safest. It also helps how to deal with emergencies and prioritise clinical problems as they arise. Obviously “Catching babies” should not be forgotten and every medical student should and MUST do obst. term as a student and should include delivering babies.
I did my OandG term in Queensland and I was a very keen medical student and always asking to go to births and often stayed with a woman the whole day supporting her in her labour and assisting the midwife only to have a student midwife enter the room just prior to the birth and take over. It was really unfair. I put in the effort, built a rapport with the mother and mother was happy for me to assist with the birth only to have a midwife student take my opportunity away from me. This happened on multiple occasions and I wasn’t the only one it happened to.
I think midwives need to be fair and allow the medical students to assist more if the mother is happy for it, and to be less biased towards their own. If we want competent doctors and also want to attract the most talented doctors to the specialty of obstetrics I think it is essential that medical students have adequate clinical exposure to births, both normal and complicated.
I did my O+G term as a medical student several years ago at Melb Uni, and it was possibly the best rotation I’ve done, in terms of hands on experience, and quality of teaching. I was able to assist with several deliveries, and saw different methods of laboring, as well as doing my first urinary catheterisation, pelvic exams, IV cannula / blood taking etc. I found the experience both medically and personally rewarding. Although it is true there was competition with other students, the best experiences were to be had by committing to an overnight shift.
One birth in particular stood out, in which the woman was having her first child, used only gas as (medical) means of pain relief, a supportive husband who massaged her back, as she used a birthing ball and position on her hands and knees to manage her pain. We helped deliver her baby in this position (myself and GP doing her grad dip in obs). She had minimal tearing. It was a very beautiful experience. Thanks to the couple for sharing that time, and also to the GP+grad dip who was very supportive and involved me!
Although I am going through the private system for my own first pregnancy (presently 32/40 weeks), I would not have a problem with sharing that experience with a medical student, as I know the rewards that I had as a medical student myself. Particularly if I am to have a normal vaginal delivery, with minimal pain relief (here’s hoping!).
Send the medical students out with home birth midwives they might really learn something for example birth is a normal physiological event and home birth midwives eligible to practice are good teacehrs – they actually teach the family so the medical student might by accident learn about the empowerment of women in the home. They might learn to trust women’s bodies to instinctively know how to give birth. Nobody catches babies for the mother – the mother or father are capable of “catching babies”. Women give birth no one including the milkman delivers babies. The medical student’s language about time on night duty was typical of the lack of care given to women they don’t know and the medical student is a stranger to her.
I recently completed my week in delivery suite and it was a difficult and stressful time. There were often 4 student midwives on the ward each shift who were preferentially allocated labouring women as they had to meet a quota of “catches”. I was happy to do the “scut” work and did a number of overnight and evening shifts in order to avoid the “daytime rush” of students and to try get an opportunity to assist in a delivery. It wasn’t until the end of the week that any real opportunities arose and it was only through constant nagging/ reminding staff that I was really keen to be part of a delivery.
We receive no real support from the medical staff. We are essentially left to negotiate with the midwives – some who are very supportive, others who believe we have no place on the delivery suite.
One of the reasons I chose to go privately for my pregnancy and delivery was that I wanted to be protected from students and registrars. That’s why people pay for private care to have it delivered by consultants (not because of a private room!!).
I don’t think many paying top dollar in the private sector would let themselves be teaching fodder for juniors. If that becomes the case – may as well use the free public system and further overburden an already dangerous system.
Not only is the delivering of babies to consider, but our obstetrics term was the first one in which we learned scrubbing, gowning up and sterile procedures, invaluable for the rest of our medical lives.
This is an important issue. A few years ago, I had a student from Notre Dame Fremantle who saw her first normal vaginal delivery in Coonabarabran, a town with no elective obstetric service, AFTER she had done her O+G rotation!!! I have heard many students complain about the lack of opportunities to deliver babies during their training. The two most common reasons given to me have been hostility from midwives and the increasing number of Muslim ladies in the public system that refuse males participating or observing. If the Deans want student deliveries to start happening again, they should simply re-introduce a quota of deliveries that is non-negotiable. The backlog of students putting pressure on the labour units would force the issue.