Perspectives
Women's health
Volume 198 - Issue 6

Should Australian medical students deliver babies?

Authors:  Caroline M de Costa and Ajay Rane

Med J Aust 2013; 198 (6): 307. || doi: 10.5694/mja13.10109
Published online: 1 April 2013
Experiencing the sights, sounds and smells of childbirth can’t be replaced by plastic models or videos
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Sharing the experience of normal vaginal birth is an important formative experience for medical students

Hearing or knowing “I’ve done this before” would, no doubt, be more comforting to both the labouring woman and the doctor than “Well, I’ve delivered three plastic babies — with a good deal of KY jelly — how much harder can it be?”

In late 2012, around 3500 new graduates emerged from Australia’s medical schools,1 more than twice the number that graduated in 2006.2 Whether all these young doctors will obtain intern places and future training posts has been the subject of robust discussion. Less attention seems to have been paid to the quality and extent of their clinical experience as students.3-5

Until the late 20th century, all medical students were required to perform at least some normal (uncomplicated) deliveries, under the watchful eyes (and, at times, the hands) of senior midwives. However, these requirements have been reduced owing to increased student numbers, increased competition from student midwives for attending births, decreased birth rates and increased caesarean section rates, competing demands from the many new disciplines now included within the medical course, and a greater say by women themselves in what happens to them during labour and birth. A 2008 survey of the 19 Australian medical schools showed that 10 schools had mandatory requirements for students to perform between one and four normal deliveries during their time in obstetric clinical rotations.2 However, the remaining schools (some of which were in the process of developing their courses) all emphasised the importance of their students spending mandated and productive time observing labour, birth and other related birth-suite activities.

At James Cook University School of Medicine, we aim to prepare a proportion of our graduates for rural practice and have, since the inception of our Reproductive and Neonatal Health course in 2004, required our clinical students to witness three births and “perform” two. Our experience over the past 10 years has confirmed our belief that the requirement of compulsory deliveries — that also include the student remaining with the woman and her support persons during labour, birth and the immediate postpartum period — sends a clear message to students and staff that delivering a baby under the skilled direction of a midwife is an important step towards becoming a doctor.

As second year interns, many of our graduates may find themselves rotated to small rural Queensland hospitals that no longer have maternity units but which, nevertheless, may be the immediate port of call for women who were booked elsewhere but unexpectedly go into labour. Of course, a week in a birth suite (including two normal deliveries) does not an obstetrician make; but it does give students some familiarity with the sights, sounds and smells of childbirth, which will be helpful in such situations. It will also help them to understand what is normal, what is not normal and also how quickly the normal can become abnormal.

Yet there is much more to it all than that. To explore the feelings of students, we asked our 2012 graduating students to write about their own experiences. As one recent graduate recounted:

On my last day of medical school I was asked what has been the best experience I had had as a student. I replied “My first time assisting in a delivery”.

This is an opinion that other students have echoed. Spending time with a labouring woman and her partner, and participating in what is usually an amazing and joyful event, is something that cannot be replicated by plastic models or videos. As another student wrote:

I went home that afternoon with goose bumps. To have assisted a mother to bring a beautiful life into the world was remarkable. This was the most memorable day of my entire medical school.

Such experiences will be vital if we are to continue recruiting competent junior doctors into our specialty training. Trainees should personally experience normal deliveries long before they commence registrar training. Some of our students have come to realise that they would like to make a career of obstetrics — as a specialist or general practitioner — or to work in the area of women’s health. One wrote:

It was in my birth suite week that my plans to become a gastroenterologist took a U-turn and I began to appreciate the field of obstetrics and gynaecology.

But even for students who will never practise obstetrics or see another baby born, the experience is part of the important process of becoming a competent and caring medical practitioner.

For all these reasons, we will continue to ensure that our medical students deliver babies during their clinical terms. We believe that it would be a great tragedy if, after years of study, our future graduates were to have their medical diplomas pressed into their hands by a vice-chancellor without having participated in the miracle of normal birth.

Authors

  • Caroline M de Costa PhD, FRANZCOG, FRCOG1
  • Ajay Rane PhD, MD, FRANZCOG2
  • 1. Department of Obstetrics and Gynaecology, James Cook University School of Medicine and Dentistry, Cairns and Townsville, QLD.

Correspondence: caroline.decosta@jcu.edu.au

Competing interests

No relevant disclosures.

References

Provenance: Not commissioned; externally peer reviewed.

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