4 weeks in Ob-Gyn
Originally published: July 8th, 2019
My time on Labor & Delivery was highlighted by my week of nights. I was placed at St. Ann’s, which to me meant that I would be seeing a higher volume, lower-risk patient population. I was excited to perform vaginal deliveries and caesarean sections, but also looked forward to working with patients and families during a very vulnerable and exciting time in their lives. One major takeaway from my time at St. Ann’s was developing my skills as a communicator with the rest of the care team, especially on my nights rotation when patient care often came down to myself and a resident.
One place where I learned to communicate effectively was in the Labor & Delivery triage. Oftentimes, triage would fill rapidly with patients, and in order to effectively see everyone, I would be tasked with seeing patients on my own and coming up with a plan of care. This tested my ability to take a good history & physical, because beyond confirming my findings after coming into the room, the resident trusted my ability to work up the patient. On nights, these patients were often coming in in the very early morning with complaints of vaginal bleeding or fluid leak – very concerning for an expectant mother. I had to work to reassure them, take a good history, and determine the best path forward. When talking to the resident, who was usually juggling many other triage patients as well, I worked to keep my presentation short and succinct. As I progressed through my rotation, I was given more freedom to handle patient care, and I think the resident appreciated my ability to take some of the workload on the busy nights. This collaboration included communication with the nursing staff to ensure everyone was on the same page with patient care. I came away with an appreciation for taking a focused history and keeping a plan of care in mind while asking questions to ensure that I had all of the information I needed when presenting to my resident. Being able to anticipate questions in advance allowed for a quicker transition of care, and when it for a mother going into labor, those extra minutes really helped.
My other experience with interpersonal communication at St. Ann’s was in vaginal deliveries. Often, I was allowed to deliver the baby with coaching from the resident and attending. Sometimes, however, there would be some complication during the delivery that would require the resident to take over emergently to resolve the situation. As I gained more experience on the floor, I came to realize when these situations were happening so that I could move out of the way and into an assist role for the resident. There was one patient with an expected uncomplicated delivery but had a shoulder dystocia. As I was delivering I noticed that the anterior shoulder was not releasing from beneath the pubic bone. After trying one maneuver, I moved out of the way for my resident to try additional maneuvers for successful delivery of the baby. If we hadn’t already established a working rapport together, that transition of care intrapartum would have been more difficult. By communicating expectations beforehand, my resident made it clear where my duties ended and where she would take over. In addition, I developed an understanding of when to step aside and continue in an assist role. I am excited to continue to develop my interpersonal communication skills on the floor. As I learned on Labor & Delivery, preparation was key to my ability to communicate expectations and to understand my role on the care team. I am hopeful that as my skills continue to grow, I can communicate my competency to the rest of the team and take on additional responsibilities throughout the rest of the year.