Surviving birth suite as a medical student traditionally is regarded as a rite of passage, but evidence points to discrimination and bias being a common experience for undergraduate and prevocational students in obstetrics and gynaecology, particularly on delivery units, with males impacted disproportionately according to findings Kyaw et al.1 reported in this ANZJOG issue, corroborating previous studies.2-5 A career in obstetrics and gynaecology (O & G) is not that appealing, even less so for men, representing fewer than 20% in RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) specialist training, and only 35% of general practitioners undertaking the advanced RANZCOG diploma.6 It is time to address negative learning environments within our discipline,7 and part of the solution is confronting biases – conscious and unconscious – among patients, O & G clinicians, midwives and students themselves.2 Irrespective of gender, prevocational interest in an O & G career has a consistently low ranking, with about 5% in both New Zealand8 and Australia9 indicating it as first preference. The UK reports similar longitudinal data for postgraduates, with widening of the gender gap over a 40-year period, with more women favouring O & G as a vocation.10 Male membership of the Pre-Vocational Obstetrics and Gynaecology Society of Australia and New Zealand (PVOGS ANZ) closely mirrors the proportion in RANZCOG training positions, which lends support to the idea that interest in O & G as a career is seeded early in medical education years.11 The percentage of men selected for RANZCOG specialist training is proportional to numbers applying, suggesting bias at this point is not a major contributor to falling numbers in specialist training.5 Experience as a medical student during clinical O & G is one of the two most influential factors, along with workplace culture, that drives the intention to pursue an O & G vocation.8 A National Health Service (NHS) survey participant, a female medical student, described her positive experience with a labouring woman as ‘It was magic’.3 An O & G magazine article ‘Should medical students deliver babies?’ presents a persuasive argument for the role of the birth suite experience before graduation,12 recognising that learning about women's health conditions is invaluable, regardless of chosen medical vocation. One of the key objectives of the RANZCOG Gender Equity and Diversity Working Group (GEDWG), appointed in 2018, was ‘to identify and remove barriers to gender representation in training’, to determine if there were ‘significant barriers to all genders considering a career in O & G’.11 There was vociferous objection to the contention that decreasing numbers of men choosing a career in O & G was an example of inequity, with college members asserting that RANZCOG had ‘already lost its way’ on gender equity, particularly as gender parity was achieved only in 2018, reaching female fellowship representation of 50%.13 In fact, much progress has been made with the wider GEDWG agenda, after the publication of a report and action plan (2019)11 most significantly achieving the gender targets set for a minimum of 40% women elected to the board and council for the term 2021–2023. The ‘dystopia’ of a nearly all-male college in the 1980s (less than 5% were women) was vividly recalled by GEDWG member Caroline de Costa, warning against an all-female organisation, instead recommending striving for a membership which reflects the gender- and ethnically diverse society we live in.14 Angstmann et al.15 ask if the college should attempt to control gender balance through entry into specialist training with quotas, to ensure men are included and, if so, what representation would look like: set at 50:50, or a proportionally greater number of women? Under the direction of GEDWG, Kyaw et al.1 conducted qualitative interviews of two medical cohorts in Queensland: medical students in year 4 and doctors in their first five years of training. Their findings confirmed that medical student experience does influence the decision to pursue O & G as a career, suggesting a significant role in encouraging female students towards a career in O & G, but the opposite effect for male students. Women junior doctors did not experience discrimination but had concern about barriers for entry into the training program, and about the O & G specialist lifestyle, especially balancing pregnancy and childcare. A systematic review2 in a US setting found that male medical students more commonly reported exclusion from clinical opportunities, with real and perceived gender bias among female patients, as well as male medical students, proposing this was responsible for declining numbers of men entering O & G. An earlier US16 study found 78% of male students believed their gender counted against them, while a similar proportion (67%) of female students thought their gender was an advantage, and Zahid et al. reported 87% of male students felt their gender was a disadvantage for their O & G run experience.5 An Australian study found that only 62% of antenatal patients questioned were prepared to accept the idea of a medical student participating in intrapartum care and even fewer if the student were male (43%).17 Fully informed consent for a student to be involved in clinical care is mandated,18 but what if that decision is poorly informed or biased framing is used? This can be as overt as illustrated by the experience of an NHS student who participated in a midwifery-led UK qualitative survey.3 The midwife said to the woman, ‘He's a medical student, you don't want him in here do you?’. The authors found medical students described midwives as ‘gatekeepers with the power either to open or close the labour room door’ with teaching opportunities, describing the dynamic between medical students and midwives on labour ward as often linked to a wider multidisciplinary team culture.3 A suite of recommendations aiming to improve learning experience for both male and female medical students has been proposed, with three broad categories: earlier exposure in medical school, overcoming biases and open discussion of lifestyle factors.1, 7 Moves to reduce clinical O & G in undergraduate programs are concerning given the influence of early experience on future carer choices.8, 9 The prevocational group PVOGS, which is affiliated with RANZCOG, engages with junior doctors and medical students interested in O & G, filling the gap between finishing medical school and starting specialist training with an advocacy, supportive and educational role. Educational tools to introduce students to patients; helping patients feel more comfortable with medical students, especially for performing sensitive examinations7; upskilling preceptors to secure inclusion of students in clinical settings; and ‘opt-out’ consent forms are discussed.1 Collaborative efforts between RANZCOG and our respective midwifery colleges are suggested as good starting points to address discrimination against students,1 and improved communication between medical and midwifery educators is needed immediately to improve student learning experiences.19 Linking of medical students on birth suite to a specific midwifery mentor is suggested,7 a model that works well for midwifery students, also successful in an Australian setting whereby midwives are involved directly in the overall supervision of medical students' time in birth suite.12 Given there is a perception among applicants for possible bias against men applying to RANZCOG training, blinding of selectors to applicants’ gender is a possible tool, and although GEDWG recommended this, it has yet to be implemented.11 RANZCOG has further improved part-time training, with the restriction for first-year trainees lifted.20 Such initiatives, along with other solutions to address the challenges of working in a speciality with after-hours commitment, coinciding with the optimal years for pregnancy and child-rearing, need to be openly discussed if we are going to attract prevocational candidates into O & G. RANZCOG has released ‘Fostering Respect Action Plan 2022–2026’21 in response to evidence of omnipresent bullying, harassment and discrimination in O & G workplaces and training environments. With mounting evidence that male students feel unwelcome in O & G, described by one individual as being ‘at the bottom of the foodchain’,3 we should be striving to minimise gender discrimination and educational inequities. Collectively if this can improve the experience of all students, then more of them will have the opportunity to ‘catch a baby’ and hopefully the O & G bug, ultimately with benefits for the next generation of women and families. The author gratefully acknowledges the assistance of Dr Celia Devenish and Professor Ian Symonds. The author reports no conflicts of interest.