Should Medical Students Deliver Babies

This article for RANZCOG is typical of the attitude of doctors in this country. It complains bitterly about the lack of opportunity of student doctors to “catch babies”. How they are in competition with midwives (who of course really should be secondary to them) and they should be taught about the wonderful birthing process and how things go wrong all the time.

They feel that they have the right to attend births and “deliver babies” .

If they want to learn about normal birth then they should be attached to a home birth midwife so they can really find out about normal birth.

All schools face these problems, regardless of whether students are located in large tertiary centres or rotated to smaller metropolitan or rural maternity units for their birth suite experience. One reason is the increasing caesarean section rate, approaching 30 per cent and rising, in most of our teaching institutions, which means that a student may spend hours getting to know a woman and her partner, and observing the progress of labor (or the lack thereof) and then not ‘catch’ the baby when birth finally occurs by the abdominal route. A second reason is the large number of women who will not consent to a medical student performing the delivery of their baby, even though the hands of that student will be firmly guided by those of an experienced midwife or doctor.

Are women pieces of meat to be guinea pigs? How sad for Student Dr’s that the inconvenient raise of the section rate is interfering in their training. Shame on those inconsiderate woman.

Why are midwives always after thoughts when the recommendations are that the best outcomes for women comes with midwifery attendants?

Evaluations from medical students in 1999 showed distinct problems with gaining experience in the delivery suite. Medical students frequently met resistance to their approaches to be included in the care of laboring women and, although it is every woman’s right to refuse a student, evaluations reflected some degree of hostility coming from midwives who were aiming to protect women’s birth experience by discouraging medical student involvement

How dare midwives protect women’s experience when a very important medical student need “delivery experience”. When will these people understand that a woman’s birthing experience is not a public free for all. Maybe student Doctors should follow a women through her pregnancy and birth if that’s the experience they require instead of pushing their way into the most important event in a womans life.

28 responses to “Should Medical Students Deliver Babies”

  1. Anonymous

    I couldn’t agree with you any more Lisa. Surgeons and student surgeons have no right in attending normal birth what so ever, it is their job to see to complicated women. It is the midwives role to attend births, afterall is it their speciality.

  2. Anonymous

    I agree – at least where there is competition – it should always be the midwife who is given preference. If midwives can’t access normal birth experience then the consequence is that they don’t get crucial experience – and then we really are in trouble as more women will need obstetric help.
    Why do these med students need this experience at all?

  3. Leslie

    I have been reading and loving your blog, but I do take a bit of issue with this post. I’m 39 weeks pregnant, under care of two wonderful midwives.

    Personally, I see having students around as a way to expose these students to what a normal birth can be! I’ve had a couple of my appointments observed by a med student (not midwifery student) and I thought it was wonderful that this student was getting exposure to normal birth and care and informed consent.

    And besides, these people do need to learn somehow. Isn’t it better to catch one’s first baby as a student rather than as a fully licensed, legally liable physician?

    Otherwise though, I really LOVE your blog!!!!!!

  4. Lisa Barrett

    Thanks for a great point Leslie. My personal stance is that fully licenced Physicians should not be catching babies. Normal birth is for women and midwives, Obs are the specialists in complications and in surgery. Should student midwives get to cut a woman open? No because it’s not their role.
    In the current climate of birth however I can understand why you feel that Med students should be involved in normal birth.

  5. Claire

    This is an interesting discussion. In my previous life as a public health student I wrote an essay lamenting the medicalisation of childbirth, most of which I still agree with. Interestingly, I’m now a graduate medical student myself. I’m also a mum, so I have several points of view.

    During my own birthing experience, I was attended to by marvellous midwives in a hospital birthing suite, and would consider home birth for my next. I did need to be induced in the end, and once handed over to the “medical” ward, was attended to by a cold and rough doctor (OBS trainee I believe) and unfortunately a similar midwife. I learnt much from this experience (about what not to do!), and think it is very important that all medical students do get some exposure to both “normal” and more complex births. But I totally agree, they shouldn’t just be able to barge in and feel like they have the right to be there when the pushing starts.

    I did an elective last year (as a 2nd year student) and was lucky enough to follow a woman through 24 hours including a pre-eclampsia presentation and then being induced. I actually missed the “grand finale”, as I had to go back home to Melbourne to my son, but the experience I shared with the woman and her family was moving. I think it’s important that all medical students get to understand childbirth not just from the clinical point of view but especially the emotional. rollercoaster that is labour and childbirth. If the student is supportive and helpful through the labour process, I’m sure there are many women who would not mind them sticking around.

    As an intern in a rural location, junior doctors may be the only person present when a woman comes to hospital in labour. Once intern year is completed, junior doctors are registered to work anywhere in the country, as a locum, travel overseas etc. While midwives are specialists in this field, it’s also vital that doctors know how to care for both normal and complex births if the need arises. I’d rather not see such a divide – there are actually some of us medical students/doctors out there who want to take a more holistic approach to birth!

  6. Georgia

    I disagree. If birthing occurs in a public teaching hospital, then there is the reciprocal agreement between patient and carer that students have a right to be on the ward (but yes, not necessarily in the birthing unit as the mother has autonomy, of course). But your view is almost like saying “I’m in a public hospital, but I don’t want the resident or registrar to operate on me, I want the consultant to”. BAD LUCK – go to a private hospital then, where you’ve got to pay for your health insurance. Otherwise the public system is there to service everyone’s needs. GROW UP

    1. Meg

      Has it occurred to you Georgia, that maybe women might prefer to catch their own babies? It’s possible you know, with the right support. When they can’t its more meaningful for Dad or supporter to do it with guidance from their fully trained, known carer, the one they trust, whatever profession they might belong to. I’m wondering if you are the person who was behind the curtain at my son’s birth who insisted, as my baby crowned, on coming in. If so you should know that being ‘asked’ (read: pressured) to let a stranger into the room at that moment in my labour, stressed me so much that I freaked out and pushed HARD and out of rhythm with my contractions and got myself a revolting 2/3rd deg tear. Cheers for that, if that was you.

  7. keisha

    I disagree that medical students should not learn about normal birth.
    While it is true that midwives dominate the going-ons of a normal birth process and that mid-wife students need the experience, the medical student need the experience equally. We need to figure out what’s normal first before we can figure out what is abnormal. You do not show a histologist wannabe tons of cancer cells without showing him what a normal cell structure looks like. There are tons of complications that can occur and it’s impossible to encounter them all in your medical training. But knowing what is normal, having experience in it, gives us the opportunity to recognise that yes, something is not quite right.

    Honestly, your views are myopic and hostile. Your post reflect the same negative attitudes that you claim “medical students” have in birthing suites. I’m a final year medical student myself and the MAJORITY of us have been nothing but polite and willing to learn under anyone in birthing suites, IF we are given a chance to even learn. I have heard of mid-wife students pushing medical students way in the middle of deliveries to catch the baby even though the poor medical students have been beside the lady’s side for hours. Sure, we’ll love to follow a woman through her pregnancy and birth but all of us will probably have only
    one rotation (which is about 8 weeks) to learn the basics of both Obstetrics and Gynaecology so our time is pretty stretched over all areas but we do respect the teaching staff and patients’ time and energy in teaching us and do our best. You forget that as medical students, we have other parts of the body and other patients to learn about in 4-6 short years. To follow a woman through her pregnancy would take about a year… do you think that is fair allocation of our medical school time when there are other pathologies that we need to know about to be safe and effective junior doctors? And when we learn obstetrics and gynaecology in those 8 miserable short weeks, we have to learn a breath of knowledge that spans antenatal care, pregnancies, presentation of PV bleeding, discharge, obstetrics medicine and pharmacoloy, gynaecological cancers, learning examinations, investigations, etc. etc…. each one of those components are worth at least 1 thick textbook on their own. And in our second year out as doctors, we could be sent to a remote area where we are the only ones available to help with a birth… so our experience in this rotation is very important. I hate it when people deride medical students and say they don’t follow-up as much as other students do… I was an allied health professional once and my clinical prac rotations in that previous life does not even compare in terms of stress, experience, knowledge, study time etc.

    By your argument that the lady should be in total control of her birth experience, I concur. However, there is a caveat. She is in a public teaching hospital and while it is her right to refuse a medical student, mid-wives should not be hindering opportunities for the medical student to learn. Most mid-wives I’ve encountered are great. They can be both patient advocates while encouraging medical students to learn and encourage the women to give the medical students a chance. These two goals are not mutually exclusive. If the idea is that a “student” in attendance is not appropriate, then may I suggest that mid-wife students too be in that category.

    And it is true that many people in rural and remote Australia are not able to access mid-wife services. Who then manage their delivery and ensure that everything goes smoothly? The doctor of course. Due to the shortage of medical personnels in those areas, it’s not uncommon for a junior doctor to be the most senior physical presence in medical situations, and that includes helping a lady with her birth.

    Being less territorial and more generous of your teaching efforts in the end is beneficial to the health of all Australia’s residents, including yourself. I was once in a quite crowded clinic with a consultant who just enjoyed teaching students..there were already 3 medical students present in the clinic. However, he still consented for a nursing student to sit in and learn. What a great opportunity for all to learn from one another! And what an example of generosity he showed.

    In the end, I feel your “righteous” comments sounds more like an extension of your jealous and territorial hold on responsibilities that you feel only your profession should know about. The reality is that healthcare delivery is FLUID. There used to be only DOCTORS and NURSES generally speaking and allied health wasn’t that prevalent until after WWII. There will always be the crossing over of roles. Why don’t you take a more positive attitude towards teaching, knowing that the skills you impart will one day benefit a woman who needs her birth managed by the young medical student you just taught?

    The examples you raised are objective observations. There is no lamentation… just stating barriers for medical students to gain experience. Your reaction to them is just chocked full of unwarranted self-righteous rage.

  8. keisha

    My apologies for the atrocious grammatical and spelling errors. That is what happens when you can’t see straight after being awake for almost 24h juggling practicals, tutorials, studying and part-time work.

  9. SpareMe

    Birth is not about you, Keisha. Until you understand that, and reflect on that, you will never realise just how arrogant you are coming across as.

  10. Nicky

    “A mid-wife who goes into the woman’s birthsuite with 2-3 mid-wifery students… no need for permission… it’s just announced that the student will be doing the birth. They are mid-wifery students and thus they belong, just because they share the name. Or the medical student asks the woman and everyone involved for permission before they even start talking to the patient? A mid-wife student who barged into the suite and pushes a medical student aside to “catch” the baby because it’s her “follow-through” (but she neglected to follow the woman through the labour) when the medical student had been by the woman’s side for 5-8h and had the woman’s consent to catch the baby?”

    I take great offence to this statement….. Not ONCE as a student midwife have I ever entered a womans birthing space without introducing myself as a student midwife, and asking for HERS and hers only permission to support her and her family…. NOT ONCE. In addition, i make certain that she is well within her rights to refuse this request and that no offence will be taken on my part…. A birthing space is to be guarded – and whilst some women are more than happy to share this experience so others may learn and pass on their skills to future labouring women, many more need a private space where they feel safe, secure and nutured by those they are comfortable with.

    With regards to the ‘barging in’ to ‘catch the baby’ at the last minute – whislt the medical student has been by her bedside…..I have yet to experience that…. For all my 40 follow throughs so far completed – my care has commenced at booking in – atttendance at all their antenatal appointments…regular phone calls during the latent phase of labour providing encouragement and reassurance …. following them in my car on the hours drive to our nearest maternity unit and then remaining with them during labour, birth and for at least the first 2 hours postnatally….

    I am sorry that you have experienced this ‘barging in’…. I am not sure where you have done your O&G rotation…but on the whole…please don’t tar all student midwives with the same brush….

  11. DragonMumma

    Had a big post all typed out, then decided, keisha, go read ‘My OB say WHAT?’ or any traumatic birth section in any parenting or birthing website.

  12. Student Midwife

    “A mid-wife who goes into the woman’s birthsuite with 2-3 mid-wifery students… no need for permission… it’s just announced that the student will be doing the birth”.

    It is incorrect that student midwives have cart blanche to birthing women. We also come on shift and must have the midwife approach the woman about whether she is happy for a student or not, and only after she give consent can we enter the birth space and participate in care. There have been many shifts that I have gone to help out in an antenatal assessment on labour ward or found something else to do whilst there were women birthing because they had declined a student. And although those births would have been valuable to my learning, it did not bother me that the women had said no, and I did not feel that I was entitled to be there just because I was in a teaching hospital; because at the end of the day it is the woman’s birth, her baby, her body and her choice.

    As for the ‘follow through’ issue, you must realise that the student midwife does not just follow through a woman through her labour, we follow her through her pregnancy too and postpartum, attending antenatal appointments and participating in care postnatally up to six weeks. Often we are on placement in other wards or hospitals when ‘follow through’ women go into labour, we are only allowed work 12 hours because of insurance and that often mean missing labour, missing births or coming in when we can after enforced breaks. When we get the call at 2am that a woman is going into hospital and we get out of our warm beds to drive sometimes 45 minutes to the hospital to attend our follow through – many times either having to go home afterwards to sleep before go to work a late or a night (all unpaid of course) or having to ‘make up’ the shift because we are not allowed to work (that pesky insurance again). We don’t only do this a couple of times following a birth through during a rostered clinical placement – we are on call to our women 24/7, and in my 18 months training I have 20 of these women to follow through from booking to birth and beyond; in addition to our 40 ‘normal’ births that we not only have to attend but to accroucher; plus 20 ‘complex’ births which mean yes, caesareans etc so we know what complex is like… however, when we attend these ‘complex’ births that are out of our scope of practice, we are there to observe, document etc we are not scrubbed in making the incision, using the forceps or what not… and one might postulate that if medical students are to be trained in normal birth, midwifery students should be trained in performing caesarean, ventouse, forceps… after all in a remote area a midwife might be the only person there?

    It is interesting that obstetrics and midwifery are different professions servicing the same target marget, yet seem to want to do each others job. Coming from a mental health background, I see psychologists and psychiatrists, also differing jobs servicing the same target market, without this turf war… psychologists work privately with their own medicare provider numbers to provide mental health care to unwell clients, autonomously or within teams, without legislated requirements for collaborative agreements with doctors, and refer to psychiatrists only if their client needs something a doctor can offer that they cant, like formal diagnosis and medications; and psychiatrists (within their medical model) do this, and respectfully refer clients to psychologists for therapies that, whilst i am sure they could provide, but is the job of the psychologist, not the doctor. How is it that doctors and midwives can not have the same respectful relationship.

    I too have met many arrogant and egocentric medical professionals, particularly in birth who can not sit on their hands and do nothing, and want to intervene. Our improvements in maternity care were not due to medical advancement, but to improved nutrition, sanitation, social stability as so on in the earlier part of the 20th century. When you are seeing massive PPH’s and problems with birthing, remember that it is likely an iatrogenic problem caused by intervention in the first place – and I can guarentee that it is unlikely that you (as medical students or graduates, and even midwifery students), have EVER seen a normal physiological birth, so the understanding of the process and risk is actually skewed.

    Oh, and I do not hate doctors and DO have an inkling of what you need to learn in your training; after all, I am married to one… I asked him when he was doing his Obs & Gynae training as a rural GP why he didn’t become a midwife (as he loves birth)… he himself said that he would never be a midwife because they have no power and are treated like shit by doctors…

    When I read such posts it saddens me that the next generation are carrying on these heirarchal ideologies…

    1. Saucy Johnstone

      I totally concur with your post! My degree is in psychology, and my first interest in women’s health was mental health services. I wonder if this grounding gives us this view?

  13. Meg

    well. what an interesting exchange! Keisha I can see you genuinely want to learn to perform your trade well, and see some genuine barriers to achieving that. Lisa is quite right however, that women are the ones who birth. we are not ‘delivered’ of babies, we give them. I never understood this till I gave birth, but it is so important women OWN the whole birth, not just ‘be involved’ in the process. I think maybe it would be helpful to look at the 8 week attachement you get, I think it’s insufficient in the extreme, to give you any kind of understanding of birth – it’s a very deep psychological process, not only physical, and you do need to follow a woman, who is herself enthusiastic about helping a student learn, from the beginning. This is at least a 10 month commitment if you start in early 2nd trimester and follow through till 3 months postnatal. When I was pregnant, I had a lovely medical student follow me. We met at the hospital antenatal clinic and she came to my home antenatal too (I had a private midwife and birthed in hospital). I believe her practical study requirements were only about 8 weeks, but she was also required to follow a whole pregnancy and then 6 weeks postnatal, before she could submit her final report. I think this was a good model. In the end, she did not attend the birth itself as I didn’t want her there, but she did become a good friend, and I shared a lot of personal insight into how my birth was. She even came to my son’s first birthday. I read her final report and her greatest learnings came not from seeing a baby come out of my vagina (or god forbid, catching him!!!) it came from her relationship and understanding what birth means and what support is needed. If you want to see a birth, there are plenty of audio visual resources you can use. If you want to UNDERSTAND birth, then you need to become a mother or get very close to one. Good luck with your studies.

  14. Murasaki

    Why do students need to get their hands in there to learn? Lisa never touched me once during my entire labour and birth. You dont have to shove your arms up vaginas or “catch” babies to learn. Maybe thats why Lisa is so amazing – shes not there to be the hero – she’s there to witness the woman be the hero.

    Any good midwife (or Dr – there are some that deign to learn this stuff) knows that women need calm, quiet, dark, supported spaces to birth in, so if they are ever pushing away eager beaver students it is to protect the woman and her baby and keep their space safe. When its safe for you to get in and observe and the birthing woman is comfortable then its your chance to watch and learn. You’ll SEE when something isnt right the same way wise women for millenia have seen when something isnt right by watching the woman – not the machines or the clock.

    Yes, sometimes women need help, sometimes babies need help. You dont need to be the first with hands on baby to learn that. There are lots of ways other than machines and vaginal exams to know these things. If youre not being taught these ways in med school then please pop along to one of Lisa’s seminars or read some of Ina May or Gloria Lemay’s work. There are wise women all over the world that know how far dialated a woman is without VEs, they know baby’s position without ultrasound, they can be aware of something untoward by observing the Mother and they can act accordingly. A good MW is not afraid to ask for help when she needs it – but very few Drs are willing to ask the wise women of the world for the help they so clearly need.

    The rate of c-section for many traditional midwifery practices IS around 95%. Most babies will get out just fine without all the contraptions and hands grabbing. The fact that Drs think 40% of babies would die without their interventions just goes to show how little exposure they really get to unhindered natural birth. Stand back, shut up, put your hands in your pockets – and SEE how amazing birth can be. Then you’ll be in a place to start learning how to deal with that small percentage of births that really do need help.

    First do no harm.

  15. Sigrid Chapman

    “Maybe thats why Lisa is so amazing – shes not there to be the hero – she’s there to witness the woman be the hero.” I love this!!!

    I did have a medical student in my birth room with my first baby. She was so sweet and was a wonderful support to me during the 3+ hours that I was pushing (posterior/asynclitic 4200gm baby, 38cm head) before I had my emergency c/s. Poor girl had to hold on to the knotted bedsheet that I was using for leverage… I bet she was sore the next day!

    HOWEVER- with my second baby, I was VERY glad that my midwife shooed the medical student out of the room before I had my natural, unmedicated VBAC. I came to the hospital almost fully dilated and was so very focused, using hypnosis to hold myself together. The fewer distractions the better. My midwife was wise to the fact that I needed a dark, quiet place to birth and I was grateful to feel safe in that room… just me, my husband, and my midwife. It was such a sacred and revered space.

    I live in the US, and these issues apply to us here, as well.

  16. Saucy Johnstone

    Oh dear!

    I really think this is a place where women could be best served if we were to look at training of birth workers regardless of title or location and focusing on philosophy of care and the nature of how information and skills are transmitted to students. I see the exchange digressing to stereotypes of midwives who never touch women at birth, and meddling disrespectful physicians.

    First I’d like to give the anecdote that in the hospital where my OB friend primarily works as attending, he and another doc have good sized practices that are primarily women seeking unmedicated low intervention births. After a few complaints of the behavior and knowledge of the residents who are often there to meet and assess women upon admittance, it was decided to move the ENTIRE OB residency program at that hospital under the instruction of the nurse midwives to give the students a grounding in being hands off. This is a huge step in the right direction for a teaching hospital.

    Secondly, there are a number of women in the US who go to clinical sites in developing countries to learn yes, rather invasive, clinical skills. It’s conflicting for some who realize that they are getting needed skills from a population that is just glad to have trained help, even if it is an American midwife still wet behind the ears.

    I believe that med students in rotation should labor sit and watch. There is no need for “catching” at this point. Same as a new apprentice in the probation period of her training with me. If a med student wants to do their residency in OB, fetal-maternal medicine, what ever high risk speciality, then they need to understand what normal undisturbed birth looks like in order to render those high tech skills with as much understanding of their appropriateness, and ability to practice them in a way that honors birth for mom and baby. We suffer from too much polarization in what we envision midwifery and OB care to be.

    I have the annoying habit in discussions like this to go- “Ummmm, well this is going to go nowhere the way that the argument or point has been posited. Let’s get to the underlying beliefs that are faulty and dismantle the Rube Goldberg system that is perpetuating polarization.” If programs of training for midwifery and physicians were to start off grounded in 1) Respecting the Choice and Autonomy of Women 2) Babies and Mothers are not separate entities, they are mama-toto 3) Even poorly resourced mothers desire autonomy and wish for the best for their baby even if their actions may appear in conflict with what we the experts consider good choices. I have had the opportunity to provide off the books prenatal care to IV drug using mothers at mobile needle exchange programs. They do not access care because they no they will test positive for drugs, and face prosecution, incarceration, or have their baby scheduled for removal. Pregnancy is the only time they will have their child. But “harm reduction” prenatal care can provide an opportunity to discuss how to eat better, what is the schedule for the “Needle Van” and the meals that are provided by volunteers. It can make a difference.

    A class of pediatric nursing students set up a volunteer doula program at their teaching hospital after during a presentation to them they realized they had never seen a birth all they way through, or an unmedicated birth. And it is possible to gain clinical skills in a timely fashion for the student while respecting a woman’s autonomy. I think it is very important for a student to be told- “She does not want you doing such and such because you are a student.” It teaches humility and an attitude of service. As well, it teaches how to engage with a woman when you do feel that a procedure is helpful, but she is wary, rather than doing a Power-Over move.

    I know that I have digressed, but until we as guardians of birth, whether called to midwifery or medicine don’t start working for common ground based on the three principals above, our professions will stand at a stalemate. I believe that what I offer as a midwife should not be esoteric and only available to women in the know. Babies are just too important! As the majority of women do seek out hospital births, change must happen there. And I believe that midwives, homebirth midwives, have a substantial contribution to make to that improvement.

  17. esme watson

    This entire argument is so fucked … every post is so self righteous … tit for tat bullshit. Make a choice … in that choice will be a lesson, either a good one or a bad one … depending on the perceive r. Most doctors are driven by the almighty dollar and prestige, some of the midwives i’ve met scare the fucking pants off me (including homebirthers), expectations of the general public (including birthing women) is off the scale. People shit me no end. Walk away Lisa … go do the Ina May in ya bus and be humble for gods sake.

    1. Meg

      where you see bullshit I see deeply held and honest and VALID opinions on all sides. You haven’t actually offered an opinion on the issue being debated…do you have one?

  18. comadrona

    Most women don’t have too much choice about where or with whom they birth – they are FORCED to use the public system which purports to serve them. I agree with a previous post which reminds us that you do not need hands on to “catch” a baby. Midwives, doctors, even doulas and other support people have been guilty of taking the glory for the birth when it is absolutely the mother’s and hers alone. The most important attitude is one of humility – asking the mother if it is OK to have a quiet student observer or two and, if not, there should be no argument about it. Most of what I have learned about birth has been by watching – not putting my hands in there. Most assessment of the woman’s progress can be done by observation and we know that interfering hands can really stuff up the process. The other point, made by the student midwife, is that birth is not just about sitting with a mother for a few hours but the whole antenatal, birth and postnatal experience. If you doctors want that, you should take a semester as a student midwife!

  19. Keisha

    Firstly, Lisa, you are no doubt an experienced mid-wife. But your posts reek with the same arrogance and ignorance towards other professions etc. that you accuse me of. You remind me of this other retired Obs and Gynae who has her own blog about similar issues but from the opposite camp of this ridiculous debacle. Both of you are identical twins fighting for a cause that didn’t need fighting over… coz there shouldn’t be one in the first place. You say you support the woman’s rights but your posts read as if you’re the arrogant know-it-all basking in your own righteousness, hammering opposing views from others with snide remarks. The woman is lost in the midst of your often-time irrational anger against the hospital system which is bad and awful blah blah blah… but of course you qualify that with superficial conciliatory views like medical doctors have their role, they are for sick people etc. etc… but that is just your pathetic attempt to “balance” things out a little so you don’t sound like a one-sided raving fanatic. Shame though… just like the other blog writer, your attitude will only further alienate the people you should be working with to further your cause, get a healthy dialogue going and work towards the main goal which is the safety of the mother and the baby (sometimes babies!).

    No, it’s not about me. It’s about the woman. It’s always about the woman. In a patient clinic, it’s about the patient’s choice. We’ve been taught that if the patient is adamant about not wanting her ovaries out even though cancer cells might have spread there, we can’t take them out. That goes with most medical procedures except for true emergencies where lives would be lost if we dallied with asking for consent… such as waiting for a patient in shock to gather enough senses to say “yes, I would like to be resuscitated”. There are of course other things to consider like Advance Health Directives etc. which is well beyond the scope of this argument. The point I am making is that most doctors in training and doctors are not unfeeling butchers who do not care about the patients. Most of us are attracted to the profession because we are passionate about medicine and we love people. Why would we then want to hurt or disrespect their choices? Makes no sense.

    Whatever it is, I came back here to primarily apologise for painting mid-wifery students with broad strokes base on my experience. Generalisation and demonisation of certain professions is something the blogger is very good at. I find such statements tasteless in some of her posts and I apologise that I have inadvertently done the same in my anger at her uninformed arrogance about what went on in a medical student training and what she purports is “enough” for a medical student to learn… which is not true at all. Thanks for explaining to me about the follow-through. Perhaps that is something the mid-wives should have coordinated well beforehand. As for the mid-wife students, I have not seen many of them asking for consent before they attend to a woman. Perhaps they have already obtained consent in their clinics. And if they do (or if the mid-wife ask for consent on their behalf), the way it is done is very different, at times, than if the they were medical students. The way the mid-wife would ask the woman is very different… with the effect of sometimes demonising medical students as annoying little devils here to wreck a woman’s birth.

    I still stand by my ground. We need to learn what is normal before we can identify the abnormal. And to the lady who said you do not U/S or VEs to examine a lady properly, you’re quite wrong, especially about the U/S. And I do not “stick” my hand up there for fun. Do you think it’s enjoyable? Which pervert would think all medical students just wants to stick their hands up there to learn or do highly interventionistic stuff? Again this is the myth propagated by either bad experiences of people (and then painting us with broad strokes). Trust me, we are taught other ways to examine a woman too, by watching, palpating abdomen, taking histories, monitoring etc. It’s not just blood and gore… we’re not training to be unfeeling butchers. We do what is necessary and most of the time, what is necessary is simply watchful waiting.

    I don’t find my posts more arrogant that Lisa’s posts. At least I don’t purport to know EVERYTHING and poo poo every other opinions about mid-wifery. I am an expert in medical student training in my own right. I am after all, a graduating one. But she is not. I have never disrespected a woman or ignored her rights. I respect all who taught me as my teachers and am always learning with humility. Strangely enough, it’s an obs and gynae who taught us that we should always be humble… for we could have attended 100 normal births, no interventions needed whatsoever but the next birth could be a nightmare. We may insert in 1000 mirenas, no problems… and perforate the uterus in the next one. Each case is different, each woman is different. Each one is a learning experience and each patient/woman is a teacher to us in their own rights. Therefore we always have to be humble. Still, for this blog’s owner, this obs and gynae could well be just loving the sound of her own philosophical voice.

    1. Meg

      Keisha, just wanted to let you know I am an advertising and marketing professional and a mother. Not everyone commenting here is part of this cross-profession slanging match; some of us are just the mums caught in the middle.

      I have become passionate about birth as a result of my own (traumatic) experiences. Through these I felt very misunderstood and unheard by practitioners on all sides. I like to read blogs like these because it helps me understand what’s going on for medical folk in their heads, this in turn helps me make sense of my experiences.

      I hope that you can find ways to connect directly with women across their *whole journey* of pregnancy, birth and the first year and really understand what’s going on for them, and the impact that even *tiny details* (like exactly who is present in the birth room) can have on their experience of birth, their ability to mother, and the related impacts on their lives.

      Regardless of whatever obstacles you feel others are placing in your path. Regardless of whether you are invited to the actual ‘birth’ or not. It is up to YOU to find a way to gain this broader, socially-contextualised understanding of birth.

      My experience was that MANY medical people lack the perspective of the diversity of experiences women can have as they become a mother – both midwives and doctors. If you can gain that, you will have greater trust from your clients and do better business.


  20. meena

    I would welcome a medical student into the delivery room if I was giving birth, I would like to have the knowledge that I had contributed to the experience of that student and helped her to learn what a “normal” healthy, uncomplcated and enjoyable birth is like, so that if they have to deliver a baby in the future they will know what to do.
    Australia is an area where there are a lot of rural and remote hospitals and clinics, and often women are brought into ED on the point of delivery and the situation can be stressful, frightening and very negative if there is just one ED nurse and a GP or doctor.There are often no midwives, no support person, no-one.
    How can these students learn how to make the experience a positive one f they have never witnessed it?
    To be honest I would never allow a student midwife in, I respect those who do, but its not for me. I have worked with many student midwives who forget to mention the STUDENT word when they introduce themselves to the partner and woman in the delivery suite or at the home birth and this I find very alarming and a real worry as the woman may assume they have knowledge, opinions and skills that can be trusted when in fact they dont.
    I have never yet met a student doctor who has failed to identify themselves or correctly explain their role, and experience. But thats just my 30 years experience so I dont suppose that counts for much.