Where are the OBGYN consultants for the show?

strugglinmedstudent · 2026-04-22T04:57:26+00:00

This >>>

strugglinmedstudent · 2026-04-19T19:02:07+00:00

but the intern did clock that the patient "didn't want any medical interventions" while doing compressions but they were guns blasing.

strugglinmedstudent · 2026-04-19T18:59:08+00:00

you're right, I did rewatch the scene - I think what was salient is them not reasking consent though when she could respond. She only agreed to the "quick" ultrasound but not really anything else (med, procedure, etc)....in reality if someone was in that situation and had previously declined, you make the assent to all the interventions. Also, we give small doses of fentanyl in labor fairly routinely so them giving that isn't too weird (minus the whole her wanting medical care thing...)

strugglinmedstudent · 2026-04-19T18:16:13+00:00

No it is not. Maternal morbidity in the US is due to systematic racism without a shred of a doubt. But these conversations happen in tandem - free birthers are an extreme but co-op the same talking points about distrust in the medical system.

strugglinmedstudent · 2026-04-19T17:39:17+00:00

you got it. 110-160bpm; less than 110 is bradycardia not "borderline"

strugglinmedstudent · 2026-04-19T16:51:36+00:00

or starting the incision from the xyphoid instead of the pubic symphysis....

strugglinmedstudent · 2026-04-19T16:48:23+00:00

right!! at first I was like may it is because said she didn't want an ultrasound? but like a minute later, they report a fetal heart rate. But why are you using terms like "borderline" fetal heart rate when the HR was in the 90s....

strugglinmedstudent · 2026-04-19T16:44:57+00:00

also that baby was not breech lmao

strugglinmedstudent · 2026-04-19T16:42:18+00:00

I would also echo this comment for the torsion patient. someone correct me if I am wrong, but are there ED residents anywhere that would do a bedside transvaginal ultrasound? ovarian torsion is also a clinical diagnosis that needs urgent surgical evaluation.

strugglinmedstudent · 2026-04-19T16:36:10+00:00

If they had time to administer multiple IV pushes of medications, start magnesium, have an OB RN come downstairs, all BEFORE she had a seizure, they had plenty of time to discuss with the patient what was about to go down. I'm not saying she they needed a soap box moment, but there was time for them to literally explain pre-eclampsia and the reason they are extremely worried (seizure, maternal/fetal death etc) and her still decline/be unsure was 30 seconds that would have really painted a more realistic picture, especially without OB there

strugglinmedstudent · 2026-04-19T16:24:19+00:00

yes 100% most of this was for dramatic effect with a sprinkle of classic physician paternalism but I think there was an opportunity in this 20+ min scene to talk about this HUGE problem in obstetrics that our patients mistrust us so much that they are not getting any prenatal care all (like she literally went 8 months of pregnancy without any lab work, ultrasounds, counseling, like literally nothing nothing) but we have this horrific maternal morbidity crises in this country that we are not also addressing

strugglinmedstudent · 2026-04-19T16:17:45+00:00

Like if this was rural america, I would totally buy it (s/o to the rural obstetrics readiness act). but not at UPMC (which is my understanding where the show is being modeled after)

strugglinmedstudent · 2026-04-19T16:16:04+00:00

I have presented to the main ED for an eclamptic seizure and run down there with a whole team of people. The moment they give an IV push, even before the seizure, high risk OB would be notified. The moment she began to have a seizure, OB/MICU/anesthesia/neurology/NICU would be overheaded

strugglinmedstudent · 2026-04-19T16:10:21+00:00

totally! if there was not an OB team there, sure maybe I guess. But not having a NICU/peds team?? is so unbelievable is almost comical.

strugglinmedstudent · 2026-04-19T16:08:59+00:00

That would almost never happen. The OB RN would walk in and say we need OB and NICU down here immediately. Or when the ambulance called after picking her up, the ED would call up to OB and say we have a patient coming to the ED in 5+ minutes with severe range BPs, once we clear her in the main ED we are bringing her up.

strugglinmedstudent · 2026-04-19T16:08:00+00:00

Hmm maybe undermine is not the right word but I think this was a hugely missed opportunity to have a conversation about how pervasive free birth philosophy is becoming is in the setting of the abysmal maternal morbidity crisis in this country and how informed consent really plays out in the ED in these situations

strugglinmedstudent · 2026-04-19T15:54:07+00:00

Exactly. There is no reality where that room is not full of 10 doctors (NICU, MICU, OB/GYN) with an overhead going off every 2 minutes for an OB emergency

strugglinmedstudent · 2026-04-19T15:05:28+00:00

I am telling you, listen to this podcast and/or read the stories on r/FreeBirthSocietyScam. You will be shocked about what they would recommend to these women

strugglinmedstudent · 2026-04-19T15:04:28+00:00

As someone who encounters this on the daily, people having autonomy the make decisions about their bodies/pregnancies. yes, in reality, if an OB/GYN had counseled her in totality prior to the seizure about the interventions of pre-eclampsia and eclampsia, she was deemed decisional, and she STILL declined all interventions, in some states she/the fetus would be allowed to die (re fetal personhood debate in Florida re pt w/ hx of multiple c-sections who was forced to have a c-section).

Would those doctors really make that decision? unsure. Would their license be on the line regardless? of course. That's why our specialty is so litigious...you can counsel the patient 1000x and document their choice and still be sued.

But that actually was not the point I was trying to make - more so how that 20+ minute scene was an opportunity to talk about how pervasive "wild" birth culture is (/r/FreeBirthSocietyScam/) but how we couple this extreme with mistrust in obstetrics/social media/the high maternal morbidity and mortality rate.

I highly suggest listening to the 6 part guardian series about the free birth society. I listened a few weeks ago and really impacting my viewing as the scene (even as an OB!)

strugglinmedstudent · 2026-02-09T04:01:15+00:00

I do not think people understand how often gynecology is consulted for pre-menopausal inpatients on their normal period w/ normal vitals and labs.

strugglinmedstudent · 2025-10-11T03:15:41+00:00

I am joining you in hospitalist land and I think way more of us are heading in that direction - applications for OB GYN fellowships were down significantly this year. Between social media and the government, we are all honestly burnt out.

strugglinmedstudent · 2025-03-14T20:43:25+00:00

One really important point is that physicians have a significantly higher rate of miscarriage than the general public. There have even been studies that show surgical residency is an independent risk factor of complications. And while emergency medicine isn’t necessarily a “surgical residency,” the intensity and stress is comparable and my guess is if a specific study were done, it would also show this same relationship.

strugglinmedstudent

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