Studying for exams: Reproductive System

Today I studied for my Reproductive System examination. Yes, I am trying very hard to take this studying-thing seriously.

The more I study this system, the more I am scared of having children one day. Nevermind that, the more I fear my Obstetrics rotation which will happen next year. That is a bad thing, since I would really like to be an OBGYN one day.

Take episiotomies, for example. An episiotomy is an incision through the perineal muscles for delivery of the foetus. To make it clearer: you cut through the muscles between the patient’s introitus and anus… I do think that hurts. I think it hurts the doctor almost just as much.

The general rule in any medical set up is that you have to stitch that which you cut. Sewing up an episiotomy means sewing three separate layers. Sounds to me like a huge needle-prick risk.

Did you know that Trophoblastic Disease can present much the same way as pregnancy? An enlarged uterus and sometimes even a positive HCG-test (Human Chorionic Gonadotrophin is the hormone utilised in home prognostics).

If an expectant mother is certain of her last period, you can work out the baby’s due-date relatively well by saying:

[(Date of last period) + 7 days] – 3 months

Then there are even formulae for figuring out how far along a pregnancy is if you’re not sure that Mum is right about her dates. Pretty cool.

I used to cringe when people spoke of the “miracle of life”. After reading my whole textbook today I am inclined to agree – it is a bloody miracle that this planet is over-populated as it is. There are so many things that can go wrong during conception, pregnancy and labour.

Goodness. If you are lucky, the baby has no genetic abnormalities. If you are lucky, the foetus grows well and the placenta stays well intact and does it job. THEN baby’s shoulder must be sure not to get stuck anywhere on the way down.

There is a chapter in the textbook that made me cry – about “destructive procedures”. These are procedures that used to be done to deliver a dead foetus vaginally. The chapter is there for “historic relevance” since these procedures are supposedly now considered inhumane and no longer performed. But to give you an idea of the kind of methods that used to be employed, they fall under headings such as craniotomy (perforation of the foetal skull), decapitation and cleidotomy (trans-section of the clavicles).

Imagine having to perform that. Imagine being the mother! I know the foetus would be dead already, but still… apparently when these procedures were indicated, the doctor would induce temporary amnesia so the emotional trauma could be reduced to the mother.

Something which I find really cool is that we are even taught how to deal with our future patients.

A story: I developed a fever at 24 hours after birth. The doctors were very worried, ordered numerous tests and put me in the neonatal ICU. At some point, my mother asked the paediatrician when she could see me. He responded, “Before Christmas.” I was a January baby. My mother cried (I was her firstborn), and when her OBGYN heard what happened he ordered that the incubator be brought to my mom’s room and that a neonatal nurse stay there with her. Needless to say, the OBGYN is still a hero in my mother’s eyes, and the paediatrician is considered a terrible doctor.

I admit that I don’t have nice thoughts about a doctor that was so rude to my mum either. But then, I know that in years gone by, bedside manner was not considered such an essential skill. Now we get to learn these things and hopefully not scar a young mother.

Now I have found another reason for the extreme length of this course (six years). If I were to be a doctor anytime soon, I would induce extreme panic in my patients and turn them all completely off reproducing. [Not that that would be a bad thing for some of them, but then that is not the doctor’s call to make.]

Medical students need time to turn into real doctors: time to get used to scary situations, time to desensitise ourselves, really.

One day in the delivery room, the only people that should be freaking out should be the mum and her entourage.

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