Michelle Clark ForstingUpon graduation, I am joining a group of physicians that provide truly full-scope family medicine in rural Wisconsin. Since I can remember, this has been my dream. That dream has always included bringing babies into the world and sharing in the joy, anxiety and, even sadness, that sometimes comes with that honor. As I near the end of my training at UW Health Eau Claire/Augusta Family Medicine Residency Program, I have never been more certain that I will be well-prepared to practice full scope medicine, including obstetrics. However, in Eau Claire, we are providing primarily low to moderate risk obstetrics to Caucasian women. I wanted more exposure to high risk obstetrics in a population with greater diversity. Toward that goal, I decided upon an elective rotation at West Suburban Medical Center in Oak Park, Illinois.

Our program does have at least one strong tie to the West Suburban Family Medicine Residency Program. One of my current faculty members graduated from that residency, completed the family medicine obstetrics fellowship there and, for a short time, was co-director of the fellowship. He recommended this rotation as a way to get the additional obstetrics experience for which I was hoping. He was right; this was a fantastic month with lots of learning!

I joined the Maternal Child Health (MCH) service for my elective rotation. Very soon into my month there, I learned this service would be very different from our own obstetrics service. I joined a large team at West Suburban that included two fellows, two senior residents (one third year and one second year), three interns and two medical students. Our own service has only two senior residents rotating days, with one intern. We started our first day, as was done every day, with sign out from the night team. I was astonished by sheer numbers of our service. My first sign out was three pages of patients - moms and babies for which we were providing labor, postpartum and newborn care, respectively.

We were caring, almost exclusively, for African American and Spanish speaking patients. It was surprisingly common for patients to have fragmented, little or no prenatal care. The obstetrical care was moderate to high risk. It seemed like nearly every patient had some sort of hypertensive disease of pregnancy. Pre-eclampsia was very common, as was chorioamnionitis. There was less substance abuse than I had expected, although marijuana use was the most common. The mother-baby pair I can remember most clearly was a 30 something year old woman in her eighth pregnancy who came into the hospital in very active labor with cervical dilation of 8 cm after having had no prenatal care. Her last five deliveries had all been cesarean. Had she had prenatal care, her provider would never have wanted her anywhere near active labor. The stress that contractions put on a uterus that had seen five cesarean deliveries was a great risk for the uterus rupturing. As it was, this patient was taken back for a "stat" cesarean delivery, with uterus intact. I am happy to say that mom and baby were both beautifully healthy and needed only routine care.

Another wonderful aspect of the MCH service at West Suburban is that we were caring not only for moms, but also babies. As family physicians, we are uniquely placed to care for the whole family in the birthing process. We had many newborns needing routine care; however, we also lead the team caring for babies needing extra care in the special care nursery. For example, we cared for premature babies, needing help with feeding and growing, babies with neonatal sepsis needing intravenous fluids and antibiotics and babies with jaundice needing bili-light therapy. While we do take care of newborns during our pediatric rotation in Eau Claire, we don't provide full family care while on our obstetrics service. This truly was a Maternal Child Health service experience.

My role on the service was that of an extra senior resident. I supervised deliveries and circumcisions. I delivered babies. I went back and scrubbed in to first-assist fellows during cesarean deliveries. I cared for very sick babies. I personlly logged 36 newborn exams, six normal vaginal deliveries, nine cesarean assists and eight circumcisions. While my delivery numbers were not as high as I was expecting, the quality of my experience was incredible. And I ultimately realized that deliveries are deliveries, babies are babies and it is a joy to be part of that initial meeting between mom and baby no matter where I am providing obstetrical care. Without the Glenn P. Clifford Memorial Scholarship, I would not have been able to have such a memorable and learning-packed month of maternal child health. Although our residency program encourages away electives, there is no financial support. I am honored and grateful to be selected as this year's recipient. I am excited to put my learning to good use in my rural Wisconsin practice in the very near future!

Michelle Clark-Forsting, MD, MPH PGY3
Eau Claire/Augusta Family Medicine Residency
Augusta, Wisconsin

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