My obstetrics and gynecology (OBGYN) rotation was one of my favorite rotations in my third year of medical school. I credit this rotation to my early interest in women’s mental health and reproductive psychiatry. Even though I decided I never wanted to step foot into the operating room (OR) ever again and that psychiatry was the best fit, I enjoyed working with the patient population from this rotation. Working with women across their lifespans was fulfilling, often when they were most vulnerable and stressed, including exciting times like labor and delivery.
This rotation was my last clerkship for the third year before embarking on the capstone course and starting the excitement that is the 4th year of medical school. The capstone course is meant to prepare students to start thinking about residency applications and preparing for audition rotations. That was the time I worked with several faculty members to perfect my CV and personal statement for residency applications.
In OB/GYN, I learned a lot in diverse settings. In 4 weeks, I had three 12-hour day call shifts in labor and delivery, five 12-hour night call shifts in labor and delivery, two full days in the OR, three days in the clinic, a day observing non-stress tests and mammography, one day with gynecology-oncology, one day with pelvic health physical therapy, and one day with ultrasound. I also had the opportunity to attend the tumor board meeting and grand rounds. With my time spent in labor and delivery, I caught 11 babies delivered vaginally, assisted in 6 c-sections, and performed 4 circumcisions. I saw several women with hyperemesis gravidarum as well as a few women with polycystic ovary syndrome (PCOS) who struggled with fertility. It was my first exposure to seeing how PCOS is treated with weight loss and lifestyle changes focused on first, instead of medications. This supported my understanding of PCOS beyond the foundation that medical school provided. Looking back on this, it is crazy to think I was still about a year away from receiving my diagnosis of PCOS. I never saw the symptoms in myself.
Out of the deliveries I assisted with, about half of the women were induced. In all but one, the women had an epidural, which was more common than I expected. The one woman who did not have an epidural wanted one but was unable to get one because she was so far along (it was not her first delivery). The labor and delivery unit was not just all deliveries though. Many women come in and are not sure if they are in labor. They would be unsure if their water broke. Many women come in for triage to get their cervix checked or their vaginal discharge checked. This part of my experience was far different than I expected from how labor is shown in television, movies, or even what we are taught in medical school.
In the clinic, prenatal checks usually involve asking about concerns, measuring fundal height, and seeing the baby’s heart rate. We also monitor blood pressure and temperature every visit. If there is a complication, more is done, but I was surprised to see how quick these check-ins are for healthy pregnancies.
With my time in the clinic and labor and delivery, I’ve learned the importance of having medical conditions under control before conception. Exacerbation of medical conditions can lead to poor outcomes for mom and baby. Preeclampsia is not as rare as I thought. I saw many women with it in just a 4-week rotation. Sometimes there were multiple women with preeclampsia on the unit at once. I also saw many women with gestational diabetes. Other less common complications I saw included tubo-ovarian abscess and an ectopic pregnancy.
It was interesting to see women in the office, then later see them in labor and delivery and again postpartum. I found this continuity of care to be very fulfilling and could see myself enjoying working with this patient population. I took particular note of the mental health of these women, which sparked an interest in pursuing reproductive psychiatry, an important field that combines OB/GYN and psychiatry.