Before I started my OBGYN rotation, a former labor and delivery nurse told me that she absolutely loved obstetric work because, “It’s the only time people are happy to come to the hospital.” After heavy, sometimes tragic, experiences in the trauma ICU and in cardiac surgery, it was joyous to witness life coming into this world and tears of happiness, instead of the opposite. I spent the first week of my rotation rounding on postpartum patients and peeking at the hours-old babies first thing in the morning. -squee- The majority of the month was spent in clinic performing annual well woman visits, gynecology problem visits, and seeing new and return OB patients. On the weekends, I got to work in labor and delivery (which was the best part)! I really enjoyed focusing specifically on women’s health and having time with each patient to actually counsel on things that the vast majority of girls and women don’t get taught in schools. We spent a significant amount of time in true face to face patient education regarding anatomy, safe sex, self breast exams, breastfeeding, body image, and so much more. I was able to incorporate a little of my Master’s of Public Health into this rotation and that’s always gratifying.

How To Prepare

Learn the physiology of the menstrual cycle – It is complicated, no doubt. But your rotation will be a confusing mess of estrogen and progesterone if you don’t just commit it to memory. Brush up on the Hypothalamic-Pituitary-Ovarian (HPO) axis. The events of the menstrual cycle are controlled by an interplay of five hormones secreted by those 3 organs. Keeping this in mind, it’s usually easy to get to the bottom of abnormal uterine bleeding or select a medication to regulate a patient’s cycle.

Brush up on birth control – There are many, many options for birth control on the market. Luckily for women everywhere, it can be tailored to the patient’s specific needs. Maybe your patient wants something she can “get and forget” for 3 years. Maybe she prefers a daily pill. Birth control can be used to address other concerns such as acne and heavy bleeding too. I’m including a Birth Control Chart with all the options, and a SUPER handy bit at the end that tells you how to prescribe based on side effect or complaint including headaches, acne, depression and moodiness, and weight gain. This chart is a GREAT tool to keep with you when talking to patients.

Prenatal care schedule –  This can vary a little from practice to practice but for the most part, you can expect certain things to happen at each return OB appointment. Learn what labs and screening tests are needed in each trimester. What are the various options for genetic screening tests? What are the benefits of them? Review glucose tolerance tests, signs of preeclampsia, etc. Be ready to answer questions like, “When should I start feeling movement?” and “I feel like there’s a bowling ball in my butt, is that normal?” (Real questions!) Here’s a chart of  Routine Prenatal Care Guidelines that I referenced most every day to make sure each mom had what she needed at each appointment.

What To Expect

Actually using a microscope – For the first time since I took microbiology as an undergraduate, I used amicroscope again! I find it very satisfying to hear a patient’s complaint, come up with a differential, do an exam and take a sample, make a wet prep, and view it under the scope to instantly confirm a diagnosis. Choose the right antibiotic or antifungal and boom, you’re like a real PA. I’m not going to lie, it is sort of exciting to see Trichomonads. I think they’re cute (is that weird?) At least be confident identifying clue cells and yeast on microscopy before finishing your rotation!

Pelvic exams – My preceptor said that the only way to get good at pelvic exams is to practice them as much as possible. With patients’ permission, she made sure I had a good view of the cervix and that I was performing pap smears correctly. Experts in GYN make it look easy but I found it challenging to use the speculum correctly with one hand, receive and pass off swabs and brushes with the other hand, all while keeping the patient comfortable and acting like I had it under control. Do as many as you can while there’s someone there to make sure you’re doing it right! (Same goes for breast exams!)

Procedures – OBGYN clinic days are full of procedures, which I didn’t really expect. There were typically several procedures per day such as IUD insertion and removal, Nexplanon implant insertion and removal, endometrial biopsies and colposcopies. To guide your decision making regarding procedures, biopsies, etc. I recommend downloading the ASCCP app on your phone. It’s only $5 and tells you exactly what to do based on a patient’s age, pap history, cytology, and HPV status. This was a lifesaver as HPV can come and go and pap smear results can change from year to year.

Fluid, fluid, and more fluid – If you’re going into a delivery or assisting in a C-section, put on as much PPE as you can find. I’m talking sterile gown and gloves, shoe covers that come to the knees, and a face mask with a splash guard. Just do it, everyone else will be doing it too.

I wish I had some advice for you guys on the EOR for this topic. I found it surprisingly difficult and still haven’t gotten my grade back! (Help!) I’ve recapped every single rotation this year and only have two to go! Be sure to check out emergency medicine, inpatient medicine, pediatrics, general surgery, plastic surgery, psychiatry, trauma ICU, and cardiothoracic surgery. Follow along on insta @coutureinclinic !

Love and light,

Asia