Each year, the RCOG invites foundation trainees to tell us why they’ve chosen a career in O&G for the Why Obs and Gynae? prize.
This is a submission from Annabel Harbidge, an FY1 at Heart of England Foundation Trust.
Why obstetrics and gynaecology?
When I was 9, we bred our pet guinea pigs. I remember cupping the firm, expectant belly of a pregnant pig in my hands and feeling the lively squiggles within. Pregnancy held then, and still holds for me now, an excitement like that of an unopened present. This interest and joy at new birth has gradually drawn me towards obstetrics and gynaecology as a career.
As a pre-clinical medical student I became involved in crisis pregnancy counselling. This service offers free pregnancy testing and a peaceful, safe environment to discuss the options available in a crisis pregnancy. It is here that I have seen the realities of pregnancy. For some, pregnancy is a time of rejoicing, perhaps it has been long awaited, for others it is unplanned and unwanted. But, no matter the circumstances, the emotional ties of a new life can weave complex and lasting effects on all involved.
At this time as a pre-clinical student I had not even thought about a career in obstetrics and gynaecology, however, my interest in the area was growing. As I entered clinical medicine in 3rd year I had the opportunity to choose a module for a student selected activity block – I chose obstetrics and gynaecology. This time in 3rd year was my first real exposure to the specialty. I spent two weeks doing gynae-oncology at a regional centre and then a further two weeks doing obstetrics.
In gynaecology I saw a specialty which combined complex and extensive surgeries with proactive measures to reduce ill health, such as the cervical screening program. I also found that as well as the practical clinical opportunities offered in gynaecology there are many other challenges too. In particular this speciality requires excellent communication skills to manage a variety of difficult consultations, from simply gaining the trust of patients for intimate histories and procedures to the delivery of bad news such as ovarian cancer. I found this speciality to be both clinically interesting and professionally challenging.
During this same SSA I spent two weeks doing obstetrics. I was taken under the wing of one of the consultants on call for the labour ward and for me this was fantastic. He was keen for me to see as much as possible and would post me into all the rooms where women were about to deliver or where something interesting was happening. I was able to see many different problems during labour, scrub in for caesarean sections and even help deliver babies. In particular I remember seeing my first normal delivery, where I was able to cut the cord and other unusual cases such as preterm, vaginal, breech delivery. One case that particularly stood out was the birth of a baby with multiple malformations who died shortly after birth. The parents had known about the problems and yet had chosen to continue the pregnancy; their only wish was for prayers to be said for the child before it died. Although this was an impossibly difficult situation for the parents I believe it was sensitively handled by the staff. The wishes of the parents were well accommodated and they were able to see, hold and spend time with the baby after it was born. I felt their needs were met and hoped that this might in some way help them to grieve and move on from this loss.
Seeing difficult situations such as this did not put me off a career in obstetrics and gynaecology, rather, it helped me to have a more realistic insight into the career. Obstetricians will inevitably see a skewed picture of pregnancy as by nature they are involved in the more challenging cases. Sometimes these difficult cases will not have happy endings, however, I am sure that in these cases especially, patients benefit from good, respectful and sensitive care.
In Birmingham we take an elective at the end of our 4th year, I chose to travel to Kenya and work in a rural mission hospital. While I was there I spent much of my time on the labour ward. This was very different to obstetrics in the UK. In that region, women usually gave birth at home so if they did come to the hospital there was frequently a problem. Due to the expectation of a home birth, women often left it quite late before presenting and had usually travelled many miles to get to the hospital. There were several occasions where babies had died before the mother arrived. In contrast to the inevitable loss of life I described for the baby with multiple malformations, here the deaths were avoidable. Kenyan women rarely complained, however it was only too clear that the loss of a baby left these mothers poignantly empty.
For me, scenarios like this highlighted the true value of good and accessible obstetric care. It is a reminder that even in the UK it was not so long ago when childbirth was one of the most dangerous times in a woman’s life. I would like to be a part of the modern obstetric care that has saved the lives of so many women and children over the years.
During my 5th year obstetrics and gynaecology block I was placed at a large hospital and was able to see more of the diversity that the speciality contains. In particular I was able to explore several areas of gynaecology including urogynacology, fertility and hormonal problems. This broadened my understanding of obstetrics and gynaecology as a speciality, revealing the way that this speciality incorporates many different aspects of medicine and surgery. I have observed this diversity not only within gynaecology but also within obstetrics, where obstetricians manage cases of women with complex medical problems.
In my 5th year again I had the opportunity to choose a special study module; I chose fetal medicine and it was one of the most enjoyable placements in my medical training. I was placed in a tertiary centre for fetal medicine, with an enthusiastic team who saw and treated a great variety of problems during pregnancy. In particular I found it exciting to see the treatments possible for babies while they are still in-utero. I was able to see several types of intervention including in-utero blood transfusions and fetoscopic laser ablation of aberrant vessels in twin–to-twin transfusion syndrome. I found this area of medicine particularly inspiring as it seems there could be potential for many other interventions in a similar manner. This felt like a speciality with room to make big advances in treating the unborn.
During my attachment with the fetal medicine team I was also able to be part of a research project into twin to twin transfusion syndrome. I worked alongside some of the research fellows and helped produce a paper looking at the impact of operator experience and other factors on survival outcomes of twins undergoing laser ablation therapy for TTTS.1 This was my first opportunity to participate in a research project and it helped me to understand the process of writing, editing and publishing a paper. Being part of this research helped me recognise the importance of evidence based practice in maintaining optimal patient care and the need for further studies to answer evolving clinical questions. I found obstetrics and gynaecology to be a forward looking speciality offering many opportunities for further study and to be at the forefront of clinical research.
As I have described during the course of my medical education I have been drawn towards a career in obstetrics and gynaecology. In particular, my interests lie within obstetrics and the intriguing ways that the physiology of mother and child are linked. I am open to the prospect of a career which includes elements of research alongside clinical work as I feel it is important to continue to strive for improvements in care. My aims for the future are firstly to obtain a training post in obstetric and gynaecology and later become a specialist in obstetrics. I am also open to working abroad and have a particular heart for developing nations. These countries have huge health care needs yet resources are limited on an institutional and individual level. Improvements here are not impossible; education may fuel positive health beliefs and these may over time bring about significant changes. There is a need for professionals for clinical work, the training of new clinicians and to instigate organisational changes. In these ways progress may be initiated and then sustained.
I have come a long way from my childhood where I was first captivated by the miracle of birth. But, as my understanding and experience of obstetrics and gynaecology has grown so has my interest and passion. To me Obstetrics and gynaecology is a vibrant speciality; it tracks the intensity, struggles and spectrum of the human experience from conception and new birth to healthy li fe, ill health and finally to death. It offers a rich selection of clinical activities from complex surgeries, multiple areas of medicine, opportunities for research and the unique study of the union of mother and child in pregnancy and birth. I have been challenged and inspired by obstetrics and gynaecology and I am certain that this will continue as I move further into the field.
1. Morris R, Selman T, Harbidge A, Martin W, Kilby MD. Fetoscopic laser coagulation for severe twin-to-twin transfusion syndrome: factors influencing perinatal outcome, learning curve of the procedure and lessons for new centres. BJOG. 2010 Oct;117(11):1350-7.