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Photos by Nash Baker

Barbara Kimmons, PA-C

The author worked in the ob/gyn department at the Sadler Clinic, Conroe, Tex, when she wrote this article. She has indicated no relationships to disclose relating to its content.

I would never have guessed that when I graduated from PA school, I would find myself practicing obstetrics and urogynecology. I enjoyed my rotation in ob/gyn, but my focus at the time was cardiology and cardiovascular surgery. When it came time to look for work, though, I could find no local openings in cardiology, so when an ob/gyn position was offered, I accepted the challenge. I practiced as a PA in ob/gyn for 6 years, and I loved it. It is a happy specialty—and definitely not boring or routine, as I thought it might be. My schedule varied depending on surgeries, clinic appointments, and other practice-related obligations, but a typical day went like this:

6:30 AM

I arrive at the hospital for a scheduled c-section early enough to visit with the patient, answer lingering questions, and reassure her about the procedure. Our patient has had a c-section before, but this time she is expecting twins. The ultrasound shows two healthy females. Twin A is in vertex position, and Twin B is in frank breech position. They are not identical, so each has her own placenta and amniotic sac. The patient’s husband is there with his video camera, and Grandma is beaming, as anxious as everyone else to see her two new granddaughters. After talking with the patient and her family, I fill out our preprinted postoperative orders and the op note before the surgeon arrives.

7:00 AM

I meet our patient in the OR, where I assist in positioning her during the administration of the spinal. Providing comfort and reassurance at this time is a part of my job that I particularly enjoy. I love being first assistant at c-sections because the occasion—bringing new life into the world—is so joyous. Our patient is draped and comfortable with her husband at her side, and the surgeon moves swiftly with the incision, while my job is to retract and suction. Soon the amniotic sac appears, and we see a small head of dark hair inside as we prepare to deliver Twin A. A flood of amniotic fluid helps us to extract the infant; I barely have to push on the mother’s abdomen before the baby slips into the world. I clamp and cut the umbilical cord while the surgeon suctions the mouth and nostrils, holds her up for the mother to see, and then passes her off to the neonatal nurse. Now for Twin B. First the surgeon feels for the position of the baby. Once this is assured, the sac is broken and the tiny feet of Twin B appear. Grasping these feet proves to be a challenge—Twin B seems to be crawling back inside where she has been safe and warm for the past 38 weeks. But in an instant, the surgeon uses a towel to dry the feet and get a good grasp. Maneuvering the baby’s shoulders and head, the surgeon soon delivers her and holds her up for her mother to see before sending her to join her sister with the neonatal team. Cord blood is obtained, placentas are delivered, and the uterus is lifted from the abdominal cavity to have its interior wiped clean before we suture it closed. Once hemostasis is achieved, the uterus is returned to its home and the various abdominal layers are closed. The skin is neatly sutured, Steri-Strips are applied, and we are finished.

8:00 AM

While the surgeon completes the notes, I help to clean up the patient and move her to recovery. Next, I’m off to round on other postpartum and post-op patients. I see all postpartum patients, whether they have had vaginal deliveries or c-sections. These visits are a time for congratulations to the family and gushing over the new baby, but I also check the patient’s physical recovery, breastfeeding plans, and H/H to be sure of hemodynamic stability. I write progress notes and discharge orders, and then I go to another floor to see our gynecology patients, where I check incisions, review labs, check vitals, and write care plans. If there are any consults from other services, I see these patients and dictate histories and physicals for the chart, as well as initiating any diagnostics that may be required.

8:30 AM

I arrive in my clinic office, where I review labs, sign charts, and answer urgent phone calls. Today I have to calm a distraught older patient who had an abnormal Pap test result. We discuss human papillomavirus, and I answer her questions and reassure her as gently as possible. It’s almost 9 AM when I meet with my MA to go over the day’s patient list.

9:00 AM to noon

Depending on the day, I may be seeing prenatal and postpartum patients or doing procedures such as colposcopy, endometrial biopsy, or cryotherapy. I spend most clinic days treating various gynecologic complaints and performing annual well-woman exams. I have the luxury of meeting my new patients in my office, where we can discuss their health concerns in a more relaxed atmosphere than in the exam room. Establishing rapport is crucial in women’s health because I may be the only person these patients can come to for support and guidance. I see nervous young couples on the threshold of starting a family, quiet young girls with their anxious mothers, and women of all ages concerned with a myriad of issues. After we have talked, we move to the exam room.

The author reviews a chart with Dr. Ferenc Markos, a supervising physician.

Noon to 1:30 PM

This time is supposed to be my lunch break, but more often than not another surgery is on the schedule. Once a month, our office manager holds a lunchtime meeting for all the providers in our practice. We discuss new ideas, patient satisfaction, and of course the bottom line. I am also the director of our biofeedback program for urinary incontinence, so at least once a month I use this time to meet with my MA and our biofeedback technician to discuss the program and review the progress of patients currently enrolled in therapy.

Biofeedback is a patented, FDA-approved, noninvasive program for rehabilitating and strengthening weakened pelvic floor and urethral muscles, thus helping to restore continence, healthy living, and an active lifestyle. Biofeedback translates the contraction from the pelvic floor muscles into a signal that can be seen on a computer monitor. It teaches women how to control these muscles. The program has been very successful for women of all ages suffering with urinary incontinence resulting from a variety of causes, including pregnancy, childbirth, obesity, smoking, estrogen deficiency, and pelvic organ prolapse. We have enjoyed an 85% success rate in treating incontinence with our biofeedback program.

1:30 to 5:00 PM

The afternoon offers more opportunities for patient education. The topics are varied and include smoking cessation, preventing sexually transmitted diseases, hormone replacement therapy, oral contraceptive use, osteoporosis, and urinary incontinence.

Besides offering the biofeedback program, our clinic performs urodynamic studies. My job is to evaluate the results of these studies and make recommendations before final surgical plans are made. Recently we have begun screening for interstitial cystitis and performing potassium sensitivity testing for selected patients. In women with interstitial cystitis, the bladder lining is no longer watertight; it has become porous and permeable to the potassium and acids in the urine, setting up an inflammatory process in the muscle of the bladder. Interstitial cystitis can cause chronic pelvic pain, urinary frequency, pain with intercourse, low back and leg pain, and bladder pressure. Subsequent treatment and monitoring of patients with this condition is another gratifying part of my job. I feel a tremendous sense of accomplishment when a patient’s condition responds to therapy and she lets me know how this has improved her life.

5:00 to 5:30 PM

When the last patient leaves, I check my planner for the next day, look at the call schedule to see if I’m on call, clean off my desk, and head home, only a short drive away.

My days are full and very gratifying. I am so glad I became a PA, and I’m even happier that I found a niche in women’s health. I make a difference in someone’s life every day, and at the end of the day, that is what satisfies my soul.