Night Float as an OB/GYN Intern
Written by Bianca Georgakopoulos, MD
OB/GYN applicants always ask me what life is like an intern. So in another blog post, I discussed the life of an intern on a gynecology rotation. Below is an outline of a sample evening on night float as an intern on the obstetrics floor.
3:00PM: Wake up and get ready for the night.
3:30-5:20PM: Eat a large meal in case the night is busy. I usually hang out with my dogs and catch up on television shows. On Thursdays at my program, we do a “family dinner” for the night team where each resident brings in a potluck item. I made an egg frittata for a “Breakfast for Dinner” theme.
5:50PM: Arrive at the hospital to get sign out from the day team.
6:00-6:45PM: Get sign out from the day team. During check out, a nurse wanted one of the laborettes to have a cervical exam because she was feeling a lot of pressure. I quickly responded, but the patient’s exam was unchanged from the last check two hours ago.
6:45-8:30PM: Obstetrics triage is full. As an intern, I am responsible for seeing all the triage patients, working them up, and figuring out their plans. My chief resident oversees my actions and helps with plans. I am working with the medical students during this time and they are typically the first to interview the patient. I help the medical students with their presentations, assessments, and plans.
-The first room has a term patient with loss of fluid (so we have to rule out rupture of membranes)
-The second room has a patient with preterm contractions.
-The third room has a patient with contractions and no prenatal care.
-The fourth room is a patient at ~14 weeks gestational age who has bleeding.
8:30-8:45PM: After having a plan for the triage patients, I sign them out to my chief resident so we can have a final plan with the attending.
-The workup for the first room is negative so she was sent home with return precautions.
-The second room is kept for observation.
-The third room is also kept in the hospital because her cervix is dilated and she is approximately at term gestational age.
-The fourth room is also sent home after her workup. Her bleeding has severely decreased. There was a fetal heartbeat on the exam and her cervix was closed. Close follow-up is scheduled, outpatient.
8:45PM: I go into a labor hall room to do another cervical exam on a different patient and she is complete (10cm dilated) and ready to push!
8:45-9:30PM: The multiparous patient that I just called “complete” pushes for 4 contractions and has her third baby! I show the medical student how to remove the placenta. I then work with my attending to repair her perineal tear.
9:45-10:00PM: We have a few minutes to eat the food we brought to share as the night team.
10-10:40PM: Two new triage patents arrive. The first one is here for a preeclampsia rule out because she has gestational hypertension and a severe headache that is not relieved by Tylenol. The second patient has opioid use disorder in pregnancy and wants help so we plan to do a suboxone induction for her.
11PM: I perform another cervical exam on a patient who has been unchanged over several hours. Her exam is still unchanged. We start discussing with her the possibility of a cesarean section. She is amenable and decides she wants to pursue that option at her next check if she is still unchanged.
12:00AM: A midnight induction of labor checks in. I have to her H+P, do a cervical exam to determine her baseline and what agents we can use to induce labor, make sure her baby is vertex (or head down), and do her consent form. This patient is 1cm and has had multiple other children. I place a foley bulb for mechanical dilation and we start Pitocin.
1:00AM: One of our laboring patients starts to have non-reassuring fetal heart rate tones so I help change her position, start oxygen, and the baby’s heart rate goes back to baseline.
2:00AM: That patient from earlier is unchanged on another cervical exam and meets the criteria for arrest of dilation. After shared decision-making with the patient, she opts to have her primary cesarean section.
3-4:30AM: The patient is all prepped in the OR. We go back for her cesarean with the attending, chief resident, and medical student. First-year residents at my program are allowed to be the primary assist if the patient hasn’t had a cesarean in the past. The surgery was uncomplicated and the patient had a 9lb baby boy!
4:45AM: Out of the OR. I have to put in orders and write her op note before rounds. I start pre-charting all the patients I have to see for rounds.
6:00AM: I go with my medical student to postpartum rounds. We have seen all of the patients who delivered vaginally or via C-section. I will often also have patients that I admitted overnight from triage.
7:00AM: Morning sign out with the day team. I prepared the list of inductions and surgeries for the day so I present those at the end of sign out.
8:00AM: Drive home, let my two rescue dogs outside, and go to sleep!
