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?”
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!!