Bringing new life into psychiatry

I recently spent my elective doing psychiatry in a world-renowned hospital in the USA. I went hoping to confirm my interest in psychiatry as a career, but also as a way of avoiding the practical nature of most placements in low- and middle-income countries. I am not a ‘hands-on’ person, much preferring talking therapies to actually doing anything practical.

During my time on the in-patient unit, a patient with bulimia nervosa was admitted with hypokalaemia secondary to thrice-daily purging. This was not an unusual scenario, but this lady happened to be 34 weeks pregnant. One morning, having arrived on the ward at 6.40 am to prepare for the daily rounds, I was asked to review the patient as she was having abdominal pain. From the end of the bed I could see she was sweaty, pale, and looked to be in severe discomfort. I was concerned, and asked the nurse to contact an obstetrician urgently. Moving closer I saw there was bloody fluid on the bedclothes, and the patient starting yelling she could ‘feel something coming out’. I took the plunge and asked for permission to examine her. After the usual psychiatric ward struggle to find some equipment, I performed a vaginal examination. I was alarmed to feel a head pushing down on my hand, and immediately went into thepush…stop….push mode Ihad learnt during obstetrics. A few moments later and I had delivered the baby, which thankfully started to breathe by itself. I put the baby onto the mother's chest, and then started to panic as to what to do next. I was saved by the arrival of a paediatrician, swiftly followed by someone with a pair of umbilical cord scissors. Now all I had to do was to sort out the fourth year resident – obstetrics was optional in her training, and witnessing her first delivery left her collapsed in a heap on the floor.

While I hated obstetrics as a student, and complained about most practical specialties, I am extremely glad the UK training system remains for the most part general and all-inclusive. I'm still heading for psychiatry, but perhaps will put a little more effort into honing my practical skills, and encouraging other psychiatrists to do the same.

Rebecca McKnight is academic foundation trainee at the Department of Psychiatry, Oxford University.