Tips for helping deliver babies on your OB-GYN rotation

I spent my clinical years of medical school looking forward to the start of rotations. As such, I was overjoyed by the start of third year. Prior to the start of medical school, I had spent some time working in clinics; however, at this point, I had had no experience in inpatient care, and I recall feeling nervous on my first day. Each rotation brought its own challenges, with an abundance of content that needed to be reviewed. Some rotations I felt more prepared for than others, but I was fortunate to have worked with some wonderful fellows and residents who were happy to answer my questions.

While first-day jitters and imposter syndrome are still very real sensations, as a fourth year, I now feel a sense of security in my capabilities. There is still plenty more to learn from my rotations; however, I now feel secure in my knowledge and am excited to share my knowledge and advice with others.

As a student on an OB-GYN rotation, the first day on labor and delivery (L&D) can seem intimidating. Just like on any other rotation, it is essential to get to know your patients, which starts the night before.

Prior to the start of your day, check the patients who are on the L&D floor and look for those who haven’t delivered yet. These may be the patients whose babies you get to help deliver on your first day, so make sure you check their medical history—how far along are they in their pregnancy? Have there been any complications?

Make sure to take note of blood pressure and glucose trends. Has the patient had any reason for concern about their baby? Review past notes in the patient’s chart, noting if the patient has been sick throughout their pregnancy, what medications they are taking, previous pregnancies and surgeries they’ve had, fetal monitoring, ultrasound findings and any symptoms reported by the patient.

While you will likely find yourself doing this during downtime for new patients who arrive during your shift, you want to be prepared in advance for the patients who are already there.

Handling patients with TLC during your OB-GYN rotation

Regardless of whether it’s your first day on the rotation, you always want to start your day off by introducing yourself to new patients and checking in on your patients from the previous night. When meeting a new patient, it’s important to remember that not everyone will be comfortable having a student around during the delivery. However, don’t let that mindset deter you from providing quality care. If the patient is not currently in active labor, this is the perfect opportunity to introduce yourself and express interest in their care.

Don’t instantly ask if you can be present for the delivery; not all patients will be comfortable with you right away. Talk to the patient and ask how they’re feeling. Check their vitals and remind them that you are constantly monitoring their and their baby’s vitals and labs, which will serve to let them know that you are attentive and ready to help with anything they need.

Even something as simple as offering them water or ice chips, offering to help them move into a more comfortable position or bringing them an extra blanket or cold compress for their forehead can go a long way.

Every patient’s length of stay may vary, so it’s important to check on patients regularly. The more interactions you have with the patient, the more likely they are to get comfortable with you. Once you see that a patient’s contractions are becoming more frequent and you decide to ask to be present for the delivery, she’ll be more likely to say yes if you have built a rapport.

While you’re outside the patient’s room, it’s important to interact with the residents and nursing staff. Ask them where things like towels, sheets and gloves are located. You want to prove that you can be of assistance not only to the patient, but to your team as well. Being able to anticipate their needs and bring them whatever they may need will display not only your desire to help but also your interest in caring for the patient. Discuss with the team if any medications need to be administered, and ask any questions you may have about the choice of medications being used to make the most of this learning opportunity.

The immersion into active labor

While the patient determines if you can be present in the room during active labor, the midwife or attending physician determines what role you play. One way to showcase your willingness to assist is to be aware of your surroundings.

When standing at the bedside, offer patients as much support as you can. If the patient is lying on their side, you may offer to massage their lower back to ease the pain during contractions. If lying supine, you can offer the patient some resistance to push against you with their legs, whether they feel comfortable pushing with their foot against your hip or thigh.

While offering the patient support, make sure to observe the baby’s positioning and movement with each contraction. Pay attention to what the midwife or physician is doing, focusing on any hand movements that are being used to aid in the delivery. Make sure everything the physician or midwife needs is easily accessible and move with them to ensure you’re not getting in the way.

After the baby is delivered, the baby will usually be placed on the mother to provide skin-to-skin contact. Observe the delivery of the placenta and feel free to discuss the appearance of the placenta with the midwife or physician. Think about what you are looking for. Is it intact? How do the vessels in the umbilical cord appear?

Having these conversations is essential to your learning experience and will also showcase your interest. Afterward, maybe during the next delivery, you’ll get to take a more active role. Even if this isn’t your field of choice, every experience is valuable, so remember to learn as much as possible and make the most of your OB-GYN rotation.

When I first started medical school, I thought I knew what specialty I was interested in, and while that interest has remained, I watched my interests evolve to include other specialties as well. Initially, I found this stressful, wondering how I would decide on a specialty. However, with time, I learned to let my variety of interests comfort me.

As students, we are made well aware that not everyone matches into the specialty or location they’d prefer. It’s for this very reason that medical schools recommend you dual apply if you’re applying to a competitive specialty. Knowing that you have interests in multiple fields can serve as a reassuring thought that you have a greater variety of options for a career that will bring you joy.

As I complete my rotations, I strive to learn from them, regardless of whether the rotation is a specialty I’ll end up working in, because the greater my knowledge, the more I can do for my future patients.

Related reading:

Doctor, podcaster, advocate: Meet the DO redefining women’s healthcare

Insights from a rural OB-GYN: A Q&A with Tammie Koehler, DO