Friday, June 11, 2010

I just don't trust em.

My hospital is a teaching hospital which means that we take baby docs and turn them into real docs. Of course, we have a 4 year OB/Gyn program, but my hospital also has a Family Practice program that rotates through OB. You see, if the FP is in a rural area they need to be able to deliver babies if there isn't an OB around- or so they say. My issue is that I have over and over seen the FP docs make dumb errors. Not all of them, some are actually pretty good, but enough errors that I get concerned. For example:

1) A little G1P0 that I pushed to beautifully crowning. Her perineum was generously lubed with mineral oil and I kept my fingers out of her vagina while she was pushing to prevent swelling and tissue injury. The FP doc comes in for delivery (baby is at +3 station when I call for a doc) and she delivers in 2 pushes. I am telling her to breathe, to push just a little, while they are yelling at her to push HARDER and counting to 10. I can SEE her perineum split because there is not a hand there supporting it. 3rd degree repair that this inexperienced doctor sewed up with staff looking over her shoulder. It's just not right.
2) How about the FP that missed the vagina all together and stuck his fingers up her rectum for a vaginal exam. It gets worse, but trust me you really don't want to know.
3) How about the FPs coming into my room while I am pushing my patient. Repeatedly. Seriously, stay the heck out of my room until I call for you. It makes the pt nervous to have people trooping in and out. I will call you when I need you and not a minute before.
4) Baby deceling and an FP not being able to put a scalp electrode on. Move out of the freaking way and let a nurse do it.
5) An FP nicking a bladder during a c/s or a freaking artery. OB is a SURGICAL specialty. Just because you have MD or DO after your name doesn't mean that you should be operating on people.
6) I swear the FP's want to have surgical vaginal deliveries- just so that they can practice. It feels like nearly every FP delivery they are asking for a freaking vacuum.
7) First year FP docs acting snotty towards me. Yeah, I may be a newer nurse but I know what I'm talking about when it comes to birth. Shut the heck up and learn something.
8) First year FP that breaks my baby's clavicle because she pulled up before the anterior shoulder delivered.
9) Grinding their thumb on a pt's clitoris during a vaginal exam. She doesn't have an epidural, watch your freaking thumb.
10) Taking pt after pt that is a high risk patient. Really, you don't need the PIH'er, chronic hypertensive, A2diabetic. Seriously, send that lady to an OB.

There is more, but really I think that you all get the idea. I hate it. I am pro midwives and would never go to an OB/Gyn unless I was high risk for some reason, but at least I know that they won't make some of these really irritating and harmful mistakes.

Now, one good thing.
1) There is one FP doc that ALWAYS writes for a liquid diet (instead of strict NPO) and for the pt to ambulate PRN. I appreciate that. He says that the research supports it, and it does. But this really is the only good thing that I can say about them.

I am NOT anti-FP docs. Heck, the primary doctor for my family is a FP DO, but I don't think that they should be delivering babies. OR, if they are going to deliver babies, they should have the same kind of constraints as CNM's and limit their practice to normal pregnancy and birth. Surgical deliveries, vaginal or otherwise should be moved to an OB, high risk pregnancies should be moved to an OB. And thats all I have to say about that.


  1. Wow! That was really scary! Too bad more people don't know that. Thanks so much for the blog - I am enjoying reading!

  2. we had an fp doc cut a cord below the clamp once. Had to clamp the kid's skin so he didn't bleed out. I understand the utility of having fp docs deliver in rural areas where providers are limited, but in urban areas they're busy enough with primary care that they just don't get enough exposure to know how to do ob right, or they get competent with the basics, but are all thumbs in an emergency.

    They don't do sections though, thank god. They consult OB for that.

  3. I'm glad we got rid of our FP residents. It's bad enough with the cocky OB residents (not that they all are like that, but some are just STOOPID!)

  4. I actually love most of our family med residents and attendings. They have the same constraints on the type of higher -risk patients they can see as the CNMs, and most are very good at consulting with the OB team when there are issues. The Family med docs do a good amount of OB in our university system (which has one of the top ranked family medicine residency programs in the country). Our Family Medicine births tend to be a lot less intervention heavy, and I like how the same doc is following the mom and the baby after birth. Too bad it isn't the same everywhere.

  5. @Julia, I think that they should learn to deliver babies, but with the same constraints as CNM's. I wish that we had that at my hospital. They will usually consult out, but if it is a "primary" for them (they need several during their residency) they don't.

    To everyone else, I think that I am extra nervous right now. July is coming and a whole new crop of baby docs to break in. July and August of last year was just one bad thing after another. Prolapsed cords, inverted uteri, and generally bad decisions. They don't know enough to be scared until September which scares the crap outta me.

  6. I have worked with many wonderful FP's - especially the female ones and the South African FPs... I haven't seen the really bad stuff that you might have seen and I have worked in 5 different Canadian hospitals. In fact, it is a relief when the OB isn't involved because the delivery usually goes a lot smoother.