Volume 16 Number 4, SUMMER 1999

from books to babies

First-year medical students leave the classroom and enter the labor and

delivery room.

BY HEATHER ROCK WOODS

A CLASS OF NEW MEDICAL STUDENTS WATCHES JANE MORTON, MD, COMFORT HER TINY PATIENT DURING AN EXAM; SHE LIGHTLY RESTS HER HAND ON THE NEWBORN'S FACE, SLIPPING ONE FINGER IN THE BABY'S MOUTH FOR SUCKING. The warmth and closeness of her hand simulates the womb, and sucking is a satisfying, familiar activity. * "It's a useful little trick for pediatricians trying to listen to a heartbeat or examine a baby," Morton later explains. "A lot of what I learned didn't come from medical school, but from being a mother," says Morton, a member of the medical school's voluntary clinical faculty and a pediatrician at the Palo Alto Medical Foundation.

The observing students won't encounter this calming technique in the required medical school curriculum. Nor would they have seen a mother breastfeeding her infant in their classroom, which occurs in another lecture Morton gives.

These Stanford students are taking the elective course affectionately known as "The Mommies and Babies Class." Morton is one of the many lecturers who give first-year medical students a view of pregnancy, birth and newborn care not normally glimpsed during medical school.

Each person in Peds/OB 282 spends winter and spring quarters paired with a local pregnant woman, attending her prenatal appointments, exams, childbirth classes, the birth itself and the infant's early pediatric appointments. The class offers a welcome opportunity to gain clinical experience in the first, classroom-based year of medical school and to see the medical world from a patient's perspective.

"It gives pre-clinical students an opportunity to get a sense of what it's like to be a patient before they go off and be doctors," says Lisa Navracruz, a fourth-year medical student who took the class and then was one of the teaching assistants (TAs) for two years.

Advanced medical students shadow doctors, flitting from one patient to the next. In this class, students follow the patient, watching her weighty progression, waiting with her in medical offices and through sometimes-lengthy labors.

The willingness of women to share their experiences of pregnancy provides the students with a valuable learning experience, says Navracruz. "There's so much hard-core science in the curriculum. We need to have this humanitarian bent too."

Navracruz clearly found the class inspiring; she is expecting her first child this summer and is deciding between a career in pediatrics or in family practice, which includes obstetrics. (It's too early to tell, except anecdotally, whether the course has influenced career choices.)

Students tend to form strong connections with their matched moms. One of Navracruz's classmates stayed up all night with his "mom" as she gave birth, instead of cramming for the big neurobiology exam that day (he passed). Some moms invite their students to the baby's first birthday party. Third-year student Sarah Morgan, a TA this year and last, taught her matched mom a breastfeeding trick -- learned from a Morton lecture -- that helped the new mom nurse comfortably.

The class is modeled on a well-established program at Ohio's Case Western Reserve Medical School, where new students are assigned a pregnant woman or an elderly person to follow throughout all four years of medical school.

Stanford's much smaller version is distinguished because students have a large say in course structure and content, says course director Lawrence Mathers, MD, PhD, an associate professor of pediatrics and chief of human anatomy. TAs spend fall quarter organizing the class; their responsibilities include choosing lecture topics and lecturers, recruiting expectant women to participate and matching them with students.

"The student organizers are a remarkable group. They get credit for doing the legwork and providing the heart and soul of the course," says Mathers. The course is jointly supported by the anatomy division, the pediatrics department and the gynecology and obstetrics department.

A student, Klaus See-Tho (now a surgeon), collaborated with Mathers about 10 years ago to start the class, which struggled in its early years due to difficulties matching students and mothers. Renewed student interest and increased participation on the part of the ob-gyn department resurrected it four years ago. The class is more popular each year, growing from about 10 students four years ago to 35 this year, representing 40 percent of freshman medical students.

The lectures are designed to com-plement the match experience and the school's required curriculum. Topics include social services available to low-income women, substance abuse and HIV during pregnancy, teen pregnancy, domestic violence, and being a parent while in medical school. The lecturers themselves also represent a broad spectrum, featuring ethicists, family practitioners, mothers, midwives, obste-tricians, pediatricians, psychiatrists and social workers.

To set up matches, organizers recruit women who are looking for a support person or who want to support medical education by sharing their experiences.

"We make it clear to both students and moms that the student is primarily an observer," says Morgan. "The goal isn't for the student to learn procedures; it is to listen, observe, ask questions and support the woman."

During the 1998-99 academic year, Kristin Clague Reihman was a participating mom and, as a student in the class, was matched with another mom. Both chose Stanford's midwifery service. Reihman found her match's birth experience extremely instructive, she says. The mom's third labor unexpectedly took far longer than her first two. Exhausted, she decided to change her plan against taking pain medication.

"It was interesting for me to see her make the decision in the throes of labor," Reihman comments. "It went from no intervention to most interventions in three seconds. I saw that and realized that's OK -- it's still your birth, even if it's not how you envisioned it."

To Mathers, the reason the class deeply touches students is simple: "I can't think of anyone interested in medicine without some curiosity about birth, one of the most fascinating parts of what we do as doctors." SM