Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

An Interesting Encounter With A Medical Student May 8, 2009

Yesterday while I was at work, I had an interesting encounter with a medical student.  It was about 9:00pm and for me the shift was finally beginning to wind down.  I was taking care of a patient who was being induced for *post-dates* at 40 weeks and 1 day (don’t even get me STARTED on that!  Sheesh!) who had received a cervidil a few hours earlier.  I had just assisted her up to the bathroom and then tucked her in so she could try an get some rest.  As I came back to the desk, there was a medical student flipping through the book I had been reading called Silent Knife: Cesarean Prevention and Vaginal Birth after Cesarean (VBAC) by Nancy Wainer Cohen & Lois J. Estner.***   Typically the medical students do not spent much time talking to the nurses, at least in my hospital they don’t!  In my hospital, they generally can be found in the back lounge either sleeping or reading for class and they only pop out if a woman is about to deliver (they need to fulfil their quota after all ,so they can “pass” their OB rotation).  So for one to actually be sitting at the desk with me was a rarity, never mind actually talk to me!  (God forbid fraternizing with the enemy! Haha!  I kid!)  The following is our (brief) conversation:

 

Med Student:  “Is this your book?”

 

Me: “Yah.”

 

Med Student: “Do you have to read this book for work or school or are you reading it for fun?”

 

Me: (chuckling) “I’m reading it for fun.”

 

Med Student: (Holding my very reasonably sized book as if it weighed 500 pounds)  “I can’t believe you are reading this book for fun…It seems pretty intense.”

 

Me: “Well to be honest, I believe that the rising rate of unnecessary cesarean sections and the lack of VBAC opportunities for women in this country are pretty intense.”

 

Med Student: (quite perplexed yet in a “know-it-all” kind of tone)  “Well they are worried about a uterine rupture with a VBAC.  That means “vaginal birth after cesarean” right?”

 

Me:  (amused that she seems to be “schooling” me but doesn’t know what VBAC stands for)  “Who is the ‘they’ that you are referring to?”

 

Med Stuent:  “Well the medical community of course!”

 

Me:  (very calmly)  “The funny thing is my friend is that the research does not support this unnecessary, unfair “fear” of VBAC, especially for a spontaneous labor that is not being influenced by uterine stimulants such as misoprostol, cervidil, or pitocin.  RATHER decades of research have shown time and time again that the risks of unnecessary (especially repeat) cesarean surgery far outweigh the risks of a vaginal delivery, even if it is a VBAC.  It’s just that obsetricians in this country prefer to just cut people open instead of “wait around” for a vaginal delivery.  It’s quick and easy, for them anyway, not for the woman.  You see, with a cesarean, they can be home in time for dinner.  The only people that our skyrocketing cesarean rate is benefitting in this country are obstetricians.”

 

Med Student:  (completely and utterly dumbfounded)  “Well that is certainly not the impression they give you in medical school!”

 

At this point I could help myself, I laughed and laughed!  The med student was laughing too!  I told her that when I was finished with the book she could borrow it from me.  I don’t think she’ll take me up on the offer but at least I can take some comfort in knowing that I might have shaken her world up, even if just for one moment.

 

The moral of the story:  Any moment can be a teaching moment!

 

 

***Side Note: Silent Knife is an AMAZING BOOK and a MUST READ for anyone who had had a cesarean section or is being told she needs to have a cesarean section.  I am about 3/4 of the way through the book and I have a hard time putting it down.  It was written in the 1980s so some things are a bit dated but overall it is scary how little has changed for the better in our maternity care system in 25 years.  They might not be cutting as many episiotomies as they once were in this country but our skyrocketing cesarean rate and relatively poor maternal and fetal outcomes compared to other countries is makes this book as pertanent as ever!!

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31 Responses to “An Interesting Encounter With A Medical Student”

  1. Katherine Says:

    Way to go with that teachable moment! 🙂 Hmm . . . makes you wonder just what they are being told in med school. I still don’t understand how medicine is the one field that is allowed to continue practicing methods that fly in the face of their own research . . .

  2. i was recently with a woman for 4 days (off and on) during her induction at 42 weeks. lots of cervidil and pitocin, with a happy ending despite a few change of plans.

    what made me laugh (and feel a bit upset..) is the fact that one of the midwives from the birth center next to the hospital (and was her caregiver) came barging into L&D upset because they had hassled HER patient about turning up the pit, and getting this “over with”.

    we over heard the group of residents saying “i can’t believe WE have to take THIS from a MIDWIFE!”

    it made me laugh, and feel sad all at once.
    first that the midwife was sticking up for her patient, and doing the induction as gently as possible was amazing and i love her for it.

    i was sad that the residents had the gall to be so disrespectful and not understanding of the “whole point” to begin with.

  3. enjoybirth Says:

    I have had 2 VBACs, but I haven’t read that book. I WILL add it to my list of to read books. 🙂 Sounds great.

    My friends DH is an OB resident. He didn’t know the risks of Cytotec. He was being told to use it by those above him and he did. It was his wife (a fellow Hypnobabies instructor) who told him the risks associated with it.

    Something is very wrong when the OBs being trained in this country are not being taught the risks associated with cytotec.

  4. Hilarious… kind of. =)

    I love Nancy. I wish I’d looked her up when I went to Massachusetts a few years ago. Here’s her site if you ever want to contact her…

    http://www.birthdaymidwifery.com/

    Doesn’t it blow your mind that even doctors were decrying the c/s rate way back when it passed 20%? A few still do but it seems like the vocal ones have just become complacent. Bummer.

  5. jenny Says:

    Dear Nursing Birth,

    Love your blog – I’ve been following for about two weeks now (and passing it on to everyone I know that is currently pregnant or wants to get pregnant). Anyways, I was hoping I could recommend/request a topic for your blog – “Top Ten Questions to Ask your OBGYN if you are planning a natural birth.” Or however many questions you think is reasonable. After reading your blog and others I’ve realized that just telling a doctor that I want a natural birth isn’t going to cut it. I plan on interviewing several OBGYN’s when I do get pregnant before deciding who will deliver my baby….but I have no idea what I would ask them and I’m sure other women feel that way as well. 🙂

    • nursingbirth Says:

      jenny that is a GREAT idea!!! Thanks for reading and I will start working on that post for next week (I’ve got a string of 12 hour shifts coming up, starting today, so hopefully by mid next week I’llhave something for you!!)

  6. Joy Says:

    If I was on rotation on OB I’d be all over the place, following nurses around. Okay, so I have no clue what being a medical student is like. But OB would definitely be the most thrilling to me!

  7. Denise Says:

    You think quick! Good for you and thanks for sharing.

  8. Let’s face some facts that not all medical students will go into OB. In fact, many want nothing to do with it. They are there to fulfill their educational requirements. Just like nurses who want nothing to do with Med/Surg because they know they will be L&D nurses (right nursing birth?). It is the OB residents we should be concerned about. They are the one’s who will actually delivering babies one day. BTW, where I work residents are forbidden from having anything to do with a Midwife patient. They can attend their deliveries to learn, but they can not actively manage them in any way.

    • nursingbirth Says:

      realityrounds, I hear you and I spend pretty much 85% of my encounters with our OB residents just trying to convince them that women have the innate ability to give BIRTH and that pregnancy is not a disease that needs to be cured! As at your hospital, our OB residents do not “manage” the midwife patients but can attend deliveries with the midwife/patient’s permission to learn (and when they get the chance, they have all said they learn A LOT). That being said, anytime I might be able to share some birth wisdom/midwifery model of care concepts with ANYONE, whether it’s a med student who has no intention of going into OB, the gas station attendant, my father in law, the girl waiting at the bus stop with me, the woman checking me out at the grocery store, or ANYONE who comments on the books I’m reading, the T-shirt I’m wearing, my profession, or the bumper stickers on my car, I DO IT. When it’s appropriate, I do share. Because maybe this med student may not be going into OB (or maybe she will, I have no idea) but she is a woman and will one day probably start a family.

      So I hear ya reality rounds, we as nurses need to be concerned about OB residents. But it’s hard for me not to feel concerned for everyone in America sometimes too!! 🙂 🙂

  9. Sharon M Says:

    Piggybacking off of the “C-sections” topic, I’d like to know your thoughts on breech births. You mentioned it briefly in your Feb. 23rd post as a Catagory IV Intrapartum Scheduled C-section, but I wondered how medically necessary they are. It’s a wide topic, I know, and I know in certain cases, it’s less risky than an actual vaginal birth, but I also know that few doctors are actually trained to deliver breech births vaginally.

  10. Missy Says:

    Thank you for sticking up for us who are fighting our ways to VBACs!
    I have been so frustrated lately with the lack of birthing options I have, especially living in AZ. Who gave these people the right to say that I can’t have a hbac with a midwife present and that my only options are hospital or unassisted home birth??? Why is it ok to hbac with a midwife in several surrounding states but not ok here? The situation they have put mothers in is WRONG…Ok, so that came out more like a vent, but it’s true. I just wish it would change.

  11. Sharon M Says:

    Wait, I found your April 9th post on Breech Births. You can just delete my last comment. How did I miss THAT?!

  12. Renee Says:

    I am in the middle of “Pushed” right now. It is excellent if you have not read it yet. I have a book waiting for me at the Library, I think it is “Silent Knife”, so that should be my next one. After a lot of research I decided that I wanted to have an HBAC next time instead of a VBAC in a hospital. It just took watching “The Business of Being Born” with my husband to get him on board as well. When we talked to my in laws today about it they really didn’t get it, but they didn’t have the terrified reaction that I was expecting. We tried to explain things about the system to them and things I found out about being in the hospital after I got a copy of my records this week. They still think “what is something happens?” I’m not even pregnant yet, we’ll see how things pan out with them and other family down the road on how everyone feels. Though we’ve made up our minds anyway!

    • nursingbirth Says:

      Renee, Rock in sister! BOBB changed my life too! I am finishing up Silent Knife now, then the next two books on my list are “Immaculate Deception” and “Pushed” so I’m glad you are reading Pushed too! I can’t get enough of birth books! Haha! Silent Knife is a MUST READ if you are planning an HBAC. It was printed in 1983 so some of the stats are a bit outdated ( for example, when this book was written the episiotomy rate in USA was 90%. It’s not that high now. On the other hand it FLOORED me how much they knew about the saftey of VBAC via RESEARCH 25 years ago and how so many OBs are still ignoring it! AHH! Crazy!) Enjoy!

  13. vbacwarrior Says:

    Great book. 3 days after returning home from my cesarean my doula visited me. I was *trying* to breastfeed my baby. I began crying and said to my doula, “I don’t love her. I don’t feel like she’s mine.” Then she told me about Silent Knife.

  14. MomTFH Says:

    Great post!

    As a future med student on OB rotations, I know I will be yakking it up with all the L&D nurses and midwives. I can’t wait.

    I am afraid of being the black sheep at my OB residency, having midwifery background in my training and for my own births. The residency nearest to me and by far the most geographically desirable is at an institution with greater than 50% cesarean rate. I have heard of a program that is supposedly more progressive, but would be harder to go to because I would have to move my family. But, working in a pro-woman, not-as-medicalized, dare I say evidence based obstetrics department may be worth uprooting everyone.

    • nursingbirth Says:

      MomTFH, Wow!! Greater than 50% C/S rate is OUTRAGEOUS! Wouldn’t it be nice if we could all just make career decisions based soley on following our hearts instead of having to worry about all the other important things that complicate our decisions, e.g. family, finances, geography etc. I personally find it a constant, ongoing battle to defend my philosophy and a TRUST IN BIRTH attitude to the majority of nurses/doctors that I work with. It can be done but it gets really tiresome. Good luck in your upcoming years. I will be sending some good vibes your way!

  15. Rebecca Says:

    I have spent a couple of hours on your blog, and I have to tell you how much I admire you for standing up for natural childbirth! I am expecting my fourth baby in July, and due to my health have to have a hospital birth. I so wish that you were working at my hospital!

    Thank you for everything you do. Just knowing that at least one nurse out there is like you gives me hope!

    Rebecca

    • nursingbirth Says:

      Rebecca, I am so happy you are enjoying my blog!! CONGRATS on your pregnancy! I truly believe that positive and empowering births can happen anywhere as long as families are active participants and truly informed! It is so nice to hear from moms out there that are doing just that!

  16. EG Says:

    I there, I couldn’t find a “contact me” button so I’m commenting instead.

    I’m 32 weeks with my 2nd, hoping for a VBAC. I’ve been doing a ton of reading and research and there’s one thing I’d love you to talk about. That is clamping/ cutting of the cord after it stops pulsing. From my research it sounds like this is something that MIGHT be good for the baby because the cord blood is so rich. Is there any downside to waiting?

    Actually, it’d be super if you could have a “birth plans” post permanently on your page!

    • nursingbirth Says:

      EG, there is NO downside to waiting until the cord stops pulsing unless there is something medically wrong with the baby/prematurity that requires the baby to be recusitated by the NICU staff immediately upon delivery (and hence the cord be cut). Also, if the cord is wrapped tightly around the baby’s neck or arm/leg/shoulder, the doctor/midwife might have to cut the cord to get the baby out. If you have a normal, uncomplicated pregancy and you and your baby are happy and healthy, requesting that the cord stop pulsing (often about 5-8 min) is something REALLY GREAT that you can do for your baby by putting it in your birth plan. What mommymichael might be refering to is the old practice of “MILKING” the cord. This is when doctors used to put the cord between their thumb and pointer finger and squeeze and push the blood that was left in the cord into the baby (like trying to get the last toothpaste outof the toothpaste tube). THIS PRACTICE was what used to cause jaundice because the baby was getting TOO MUCH blood and the extra blood was broken down, which produces excess bilirubin in the blood and hence jaundice.

      Also, what are you looking for exactly when you say “birth plan” post permanently on my page? I’d love to do it but don’t know exactly what you mean!! Are you looking for a sample birth plan? If so one resource that might be helpful is http://www.babycenter.com/calculators-birthplan Enjoy! I hope you frequent my blog throughout the rest of your pregnancy!!

  17. i’ve heard that as well. That it “causes” jaundice if they get too much of their cord blood.

    Honestly, I’m not believing it.

  18. Mollie Says:

    I was wondering if you could talk more about the “40 weeks and 1 day” comment (even though you said “don’t even get me STARTED on that!”). Sorry!
    I’ve just watched two friends get induced at 40 weeks + 1 day, each with not-so-great results (one very stressful birth with vacuums and an unwanted epidural, and the other with a C-section and a “of course you couldn’t birth that baby, look how big he is” comment). I had never heard about the 40+1 phenomenon before this. My friends mentioned a “legal” issue, like they couldn’t get induced before then for liability issues. Can you talk more about this, or point me in the right direction to find information on it?
    thanks so much!

    • nursingbirth Says:

      Mollie, great question. Its all about loopholes and politics. At my hospital you have to have a reason for induction or else you might have to defend your reasons if your case called in for review (very rarely does this happen however, and it needs to happen more than it does. I wont get into it but its just a big friggin “secret society” where the docs just protect other docs so everyone will stay off their back!). So if you dont have a reason, and you are a doctor that I work with, you just make up some bullshit reason! Why not, right? (*sarcasm*) So many of these docs will send a patient in for induction with no other reason but they just want to induce them and control the situation instead of waiting until they go into labor on their own (because *GASP* she might come in on a weekend or at night if they let nature take its course and allow her to go into spontaneous labor!) And so they send these patients in for “post dates” inductions at 40 weeks and 1 day. Because if your “due” date (or more like “guess date” in my humble opinion) is lets say, June 15th, then technically you are past your due date if you get induced on June 16th. So you can technically call it an induction for “post dates” even though IN REALITY A POST DATES INDUCTION SHOULD NOT EVEN BE CONSIDERED UNTIL 41 WEEKS AND 5 DAYS! (and if all baby testing is reassuring and reactive, who says some babies dont need a bit more time to cook. This is more controversial however, so I will not get into the “42 week debate”.)

      Oh lord, now I’m all worked up! See! I told you not to get me started! LOL

      Thanks for your question!


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