MIDWIFE SUPPORT
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Who’s Who?? ……. By Dr Bianca Bryce

I remember when I first started medical school (and actually, don’t tell anyone, but even towards the end of medical school) I was baffled by all the titles that doctors had.  Registrar…intern…consultant…who are these people really?  If you’re anything like me you may be wondering the same thing.  Or maybe I’m the only dummy who doesn’t know the inner workings of the hospital system.  Or maybe, just maybe, you don’t really care – in which case feel free to scroll down to a more interesting blog post. Now I have to preface this by saying that I work in the public hospital system, which is probably where you will encounter most of these strange doctor creatures.  If you are planning to birth in a private hospital, chances are you will see specialist obstetricians and only specialist obstetricians (let me know if this is not true, as I really have a very limited understanding of the private hospital world).  Also titles and ways of training vary a lot between countries, and even a bit between states in Australia, so this is very parochial information. When I meet new people at work, I tend to stick to the easily understood “hi, I’m Bianca, I’m one of the doctors”.  Sometimes I might say “one of the gynae doctors”, or “one of the obstetric doctors”.  But people do often tell you their actual title, and next time this happens to you, you can flick to my trusty “who’s who” guide, and you’ll be all over it! So, for the uninitiated, here goes (from least to most qualified):

Medical students

Most of you will understand what a medical student is without any help from me.  They may also be introduced to you as a student doctor or a trainee doctor.  They are, as the name suggests, still learning how to be a doctor.  These days they could range from being (like I was) a stammering 19 year old who has come straight from school and may never have seen a vagina, to a postgraduate 50 year old who has children (and maybe grandchildren) of their own.  Regardless of previous life experience, they are usually pleasant, harmless, and tend to stay out of the way.  They are generally very grateful to be allowed to participate in your care, and you may even find that they are nice to chat to if you have a working epidural and a few hours on your hands.  They often need to meet a quota of births, both watching, and “doing” – don’t worry, the “doing” mostly means having a pair of gloves on and hands in the vicinity of your baby while your midwife facilitates the actual birth.  I still keep in touch with the first woman whose baby I “birthed” as a medical student (big shout out to Amanda and not-so-little-anymore Bailey!), so this can work well for both of you.

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Interns

Once medical students graduate they become interns for their first year of work.  Interns have what is called provisional registration – they are definitely bona fide qualified doctors, but they still have their training wheels handy in case they need them.  Medical school is great, but there is a lot of on-the-job training that goes on in those first years of work, and so interns usually have plenty of supervision (which may not be direct supervision that you are aware of, but will be happening behind the scenes).  Interns are required to rotate around the hospital doing different things for (usually) 10-12 weeks at a time, so they get a good broad exposure to different aspects of medicine, surgery and emergency.  They are not required to do obstetrics, and indeed some hospitals don’t allow them to do obstetrics, so you may or may not come across them.

Residents

Residents go by many names, so they can sometimes be tricky to pin down.  Often they are called RMOs (resident medical officers), and in Queensland they are called JHOs (junior house officers – I think).  I’m not aware of any other different state-based names, but I have only worked in 2 states (and a territory) so far, so can’t guarantee that I haven’t missed something. Residents have finished their internship, they have full registration, and they generally get better with age.  As a doctor in Australia, if you aren’t yet ready to commit to a specialty (and nowadays GP is a specialty in its own right, and a very popular one), you will usually work as a resident for as many years as you care to.  Like interns, residents mostly rotate around the hospitals doing bits of different specialties for a time.  They still have plenty of supervision, but may need less and less as they gain experience.  There are a subset of residents that have decided that they want to deliver babies for a living and who stay in the one area for an extended period, and these have various names around the country – SRMOs in NSW, PHOs in Queensland, and I’m sure other names in other places.  There is also a training scheme whereby residents can undertake to do a 6 or 12 month diploma of obstetrics and gynaecology (aimed at those who are training to be GPs) which, once they gain the piece of paper, qualifies them to deliver babies and look after pregnant women independently.  People undertaking the diploma will have a quota of procedures that they need to fulfill in that time, and they are usually well supervised in the process.

Registrars

If there is anything out of the ordinary with your pregnancy or birth, and you are being cared for in the public system, registrars are likely to be the mainstay of your care team.  Registrars are doctors who have taken the plunge and committed to a specialty.  They will be somewhere along a sometimes long path of training to become a specialist in their chosen field (in your and my case, obstetrics and gynaecology).  They will almost always have an actual fair dinkum specialist at hand for tricky situations, although where that person is physically located will depend on the experience of the registrar, the time of day, and the situation itself.  Don’t be alarmed if a registrar does everything for you, even if that everything is something as big as an instrumental birth, or a Caesarean, without you seeing the specialist.  This is what we are trained to do, and if we ever feel out of our depth, be assured that we will phone a friend.

scrubs team

Specialists

Specialists are a bit like residents in that they can baffle you with a range of different names.  Most public hospitals will have staff specialists, or consultants, who are full time specialists in the public system.  Then there are VMOs (visiting medical officers), who work in the private system, but “visit” the public system (ie they work a certain percentage of their week as a public specialist, which often means running a clinic here and there, and operating a bit, and being on call to cover us registrars for a day and/or night every so often).  Regardless of what they are called or where they do most of their work, these people are the big guns, the gurus, the ones who have earnt their stripes.  They have finished medical school, made it through internship and often some years of residency, then specialist training and they have come out the other end.  You may or may not see them, but rest assured that they are there overseeing what happens in their hospital on their watch. If you’re in a smaller/regional hospital, you may be looked after by GP obstetricians.  These are amazing people who work as GPs AND are trained to attend births.  They will usually be proficient in many things, including instrumental deliveries.  Many of them will perform Caesareans (and some will be able to give you an epidural or an anaesthetic as well!), but some will refer you on if you need a Caesarean section. So that’s a long story, but hopefully next time a new person walks into your hospital room, or ushers you in to a clinic room, and introduces themselves, you’ll be able to instantly put them into your newly-found framework and know where they are coming from.  And remember, there are many instances where you may never see a doctor throughout your whole stay – this just means that everything is normal and hunky-dory.  It is definitely a good thing.   But sometimes we do like to just pop in and say hello (and congratulations!).

Bianca

(This article contains general information only and is not intended to replace advice from a qualified health professional. All information is written from the experience and knowledge of the person writing the post).