# A Rant on Episiotomy



## MegBoz (Jul 8, 2008)

I was looking for birth videos & landed on "My Best Birth." There was a video titled "hospital birth" & I decided to watch. <sigh> Stupid, but I've read a lot about totally unnecessary** episiotomy & now I've had the chance to see one.

It was every bit as horrifying, infuriating, & nauseating as I'd anticipated-- because I watched this cut knowing full well that it was not only _not necessary_, not only _not helpful_, but completely and utterly _damaging_. *He might as well have stuck those scissors up her nose & made a cut there, for all the benefit episiotomy provides* - or cut the soft webbing on her hand between index finger & thumb.

Actually, come to think of it, if given the choice, I'd personally rather be cut at the nose or hand than have an unnecessary episiotomy. At least those cuts don't have the substantial risk of extending into something much worse (i.e. 3rd or 4th degree tear through the rectum.) & then there's that whole painful sex thing to be concerned about.

Am I way off on the nose/hand thing? It sounds wacky at first, but the more I ponder it, the more I do think a cut in either of those places would be the lesser evil.

**Yeah, I'm nearly certain it was totally unnecessary (there was NO reason to suspect the baby was in distress and needed to be born NOW - so, therefore, epis was 100% unnecessary!)


----------



## lynsage (Jul 13, 2004)

That just makes me nuts. Just this morning I was looking for info on fetal positioning for my mom because we were chatting about whether the baby was head down yet, and the web page I was looking at said the position my daughter was born in (posterior) was likely to require forceps AND an episiotomy "to ease delivery". My mom and I both flipped out when I read that to her- not only did I NOT tear at my easy, fast home birth of a baby in this position, I remarked on how GOOD it felt when she came out! No way would that have happened if someone had taken a pair of scissors to my body.

My daughter had a nuchal hand, too...I bet they would have wanted to cut me six ways from Sunday in an average hospital birth in the area I was living in back then!


----------



## mamabadger (Apr 21, 2006)

Quote:


Originally Posted by *MegBoz* 
Am I way off on the nose/hand thing? It sounds wacky at first, but the more I ponder it, the more I do think a cut in either of those places would be the lesser evil.

It would certainly be preferable to the woman who was cut. Unfortunately, cutting the hand or nose would not fulfill the more central purpose of ritually mutilating the female body parts, so it could never catch on in the medical community.
Yes, yes, I am angry and hyperbolic.


----------



## SashaBreeze (Apr 18, 2009)

I was cut with my first and am a survivor of the 4th degree tear through the rectum that resulted afterwards. I would have to say, having lived through it, that yes, yes I would have rather had my hand or nose cut. The pain and swelling is horrendous and it takes what feels like forever to recover from it, I dont even remember how long it took for me to be able to walk around like a normal human being again after that.

I hate episiotomies.









My third child had a nuchal hand, and he was also my first natural birth with a midwife. Not a single tear, not so much as a skid mark. Beautiful blissful birth.

I hate episiotomies.


----------



## Smokering (Sep 5, 2007)

Yep. I came close to tearing up when I heard Mum had been given one with my eldest sister, just as a routine thing. She wasn't too enthusiastic about it herself, but having read so much about them, I just found it horrific.

And I'm another one who gave birth to my first child with a nuchal hand (not tiny either, 8 pounds 7) with only "skid marks" to show for it and NO CUTTING. I'm so glad they do it more rarely here. I would totally kick a doctor in the face with all the force I could muster, if it came down to it.


----------



## jen&james (Oct 27, 2005)

I also had a episiotomy with my first and had a 4th degree tear thru the rectum. It took forever to heal. My baby was only 7lbs 9oz. my second birth was at home and I was afraid of tearing in the smae spot so I massaged with EPO a week or so before. My second was 9lbs 8oz and I had the tiniest tear.


----------



## Brittee (Jan 28, 2010)

I was talking about this with my mom the other day. I was explaining how I think that I am pregnant and am leaning toward a home birth. She was all, "Can a midwife do an episiotomy? You'll want her to do one if you need it."
I was all, what the heck? No!!
And then she explained that I was so BIG that she had to have an episiotomy and forceps used when I was born. My birth weight was 8lbs, 13 oz. And my mom, she's 6 feet tall. I managed to get off the phone but on the inside I was so sad for my mom. The only good thing for her is that she thinks it was necessary and saved baby me.


----------



## AutumnAir (Jun 10, 2008)

I'm with you!!

I was cut too with my first DD - very much as a way to ritually mutilate, humiliate and establish power over me. I was transferred in from a planned homebirth in a country where doctors are seen as near-gods and don't take kindly to having their authority questioned. It was a huge episiotomy and I suffered fecal incontinence for nearly a year afterwards as a result. (Oh, I hadn't even started pushing at the time, and was given no anesthetic at all - not a pleasant sensation to say the least







)

I also tore this time around (UC birth - lovely, easy and fast) right along the scar line, though not as severely this time, thank goodness. So it even impacts your subsequent births.

I'm also not convinced that they're ever really necessary - it seems to me that they really are a tool in the general practice of ritually humiliating pregnant/birthing women and convincing them (and society) that they are incapable of birthing without such awful interventions.


----------



## TeaJunkie (May 18, 2008)

I was at my sister's hospital labor and birth (really my nephew's birth!) in July.

To give you an idea how fast he came, she was 4cm at 2:00 and he was out at 2:35. The doctor did an episiotomy! Her 7lb 8oz boy was out in 4 pushes!!! Why on earth did the doc do an episiotomy?!

I was seething for her because it was SO unnecessary but even though she wishes it wasn't done, she was okay and at peace with it. Most likely because her DD was 9lb 11oz and tore her up pretty badly, so she felt a lot better even with the episiotomy!

I love my MWs...


----------



## ursusarctos (Dec 16, 2008)

Quote:


Originally Posted by *mamabadger* 
Unfortunately, cutting the hand or nose would not fulfill the more central purpose of ritually mutilating the female body parts, so it could never catch on in the medical community.
Yes, yes, I am angry and hyperbolic.









I'm with you!

My good friend had a medicated hospital birth with a (sounds like from her story) totally unnecessary episiotomy. While she was happy with her birth, I'm still seething that her midwife cut her







The same midwife gave her pitocin without asking and told her not to make noise because it wouldn't help














I live in a country with one of the lowest maternal and fetal mortality rates in the world that consistently ranks in the top 5 of the "most equal countries for women" and yet 50% of first time mothers still get episiotomies!









My mom had an episiotomy with me, resulting in a fourth degree tear that required 100 stiches. That made me tear up just to hear. But at least it sounds like it was necessary - apparently it was a situation when I needed to come out immediately and it wasn't happening. This was a homebirth in the 80s.


----------



## Super~Single~Mama (Sep 23, 2008)

You know, I think an episiotomy would have LESSENED the degree to which I tore with my ds. I tore REALLY weirdly - in a semi-circle, so it had to be cut so he could be born anyway - and it took FOREVER to heal. Seriously, FOREVER - I was in EXCRUCIATING pain for 12 weeks after the birth, literally the ONLY time I wasn't in pain was when I first woke up in the morning and hadn't moved at all.

An episiotomy would have been neater, and the scar probably would have actually healed rather than still being gaping open at 21mo pp. I will NEVER have ANYTHING that even resembles a perineum ever again, unless I go through incredibly painful reconstructive surgery.

So, to say that they are always the devil, and always bad, is not accurate. It's just impossible to tell when it would make it better, until its too late to change anything.


----------



## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *ursusarctos* 
I live in a country with one of the lowest maternal and fetal mortality rates in the world that consistently ranks in the top 5 of the "most equal countries for women" and yet 50% of first time mothers still get episiotomies!


















Get out of here! FIFTY PERCENT of FTMs get epis? Wow! I think the nationwide rate here in the US is like 30%, so I'm shocked that it's even worse in Finland! (Of course, that's not to say US maternity care is better, but I'm just saying _on this particular issue,_ I'm shocked that we're better.)


----------



## mamabadger (Apr 21, 2006)

Quote:


Originally Posted by *MegBoz* 








Get out of here! FIFTY PERCENT of FTMs get epis? Wow! I think the nationwide rate here in the US is like 30%, so I'm shocked that it's even worse in Finland! (Of course, that's not to say US maternity care is better, but I'm just saying _on this particular issue,_ I'm shocked that we're better.)

Could it be that the U.S. episiotomy rate is lower than it might be because its C-section rate is higher?


----------



## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *mamabadger* 
Could it be that the U.S. episiotomy rate is lower than it might be because its C-section rate is higher?

Hm, interesting Q. I assumed when I read the US epis rate is "30%" than that is "30% of all vaginal births." Not much point in listing the epis rate of ALL births when over 32% of births are CS.

Here's the 1st link when I Googled, "US episiotomy rate"

Quote:

One in three mothers who delivered vaginally in the U.S. from 1995 to 2003 had episiotomies.
& from Childbirth Connection

Quote:

The episiotomy rate has been falling off for some time in the U.S. However, when Childbirth Connection carried out its national U.S. Listening to Mothers survey among women who had given birth from 2000 to 2002, 35% of mothers with a vaginal birth had experienced episiotomy.


----------



## jeminijad (Mar 27, 2009)

I am quite surprised by that 30ish% number, honestly.

Amongst the roughly two dozen women with whom I have discussed their births, not one had an epis. This is between the Houston area, the Philadelphia area, and the northern NYS area.

It is at the very bottom of my birth concerns, because I do not perceive it to be a current threat. But it must be in at least some places!


----------



## branbran54 (Jun 16, 2010)

I live ein the sticks of TN and I can't name one person who has had one. I do know that the OB/Midwife practice that I have gone to for the past 10 years does not do them. I heard someone ask my midwife about them and she said that it is part of their policy. All research showed that it was better to tear so they go with that.


----------



## mrs_mandolini (Feb 23, 2007)

I live in the central midwest and know at least 3 women who have had them in the last 5 years. I can't comment on how "necessary" they were in each case, all 3 were first time moms with epidurals.


----------



## AlexisT (May 6, 2007)

I remember seeing hospital level stats for NYS. The variation from hospital to hospital was amazing. Like, from 10% to 40%. It doesn't entirely correlate to other stats, either--the high epis hospitals had high epi rates, but the converse was not true. There were very interventionist hospitals with episiotomy rates from 10-15%.


----------



## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *AlexisT* 
I remember seeing hospital level stats for NYS. The variation from hospital to hospital was amazing. Like, from 10% to 40%. It doesn't entirely correlate to other stats, either--the high epis hospitals had high epi rates, but the converse was not true. There were very interventionist hospitals with episiotomy rates from 10-15%.

That's interesting. Yeah, it seems that, on the whole, American OBs realize that it's best NOT to do an epis - but they still think induction, purple pushing, CS for FTP, VBAC-bans, AROM & pit to speed things up are all great ideas.









I did read in one of the articles that there were big regional differences. The West was listed as higher.


----------



## MegBoz (Jul 8, 2008)

While we're discussing it, *has anyone else ever SEEN an unnecessary episiotomy on video or in person?* Just wondering if you all would be as furious & haunted by it as I was.

(& yes, I know, sometimes they ARE necessary, which is why is wrote the "unnecessary" one made me furious.)


----------



## Turquesa (May 30, 2007)

It's too bad that this info isn't recorded on birth certificates. Unnecessary epis are very much a public health issue, so it would be nice to pin down some raw data on how often epis in general are happening.

By the way, this pamphlet says that hospitals shouldn't do epis more than 20% of the time, and they "should be working to bring that number down." 20% seems like a lot, and why does bringing that number down have to be such an incremental process? That's not a rhetorical question. I'm curious if I'm missing something....


----------



## eclipse (Mar 13, 2003)

They did one on me for no apparent reason and I was SO pissed. Iw as actually saying "No, Don't!" and the guy did it anyway. It was so hard to recover from that birth compared to my later two, when I didn't have one - it even made things like breastfeeding harder because I was in so much pain that I had a hard time sitting up for long enough and was taking strong pain meds to help get through it. It still makes me angry when I think about it. My husband was understrict orders on my second two births to yell and grab the hand of anyone picking up scissors.







Thankfully, no one tried with those births.


----------



## Marissamom (Dec 17, 2009)

I'm going to say that there are *VERY* rare situations where it's preferable to have an episiotomy. I had a band of scar tissue from horrid, disposable tampons when I was a teenager, and it would*not* stretch DD was so stuck and would get down to that point and then I could feel her slid back up in between contractions. maybe if I had been able to use gravity I could have forced it to tear, but after about 15 pushes where we were completely stuck, and DD's heartbeat going way lower than the hospital was comfortable with, I was given the choice of c-section or episiotomy. I chose the episiotomy. maybe, in a different environment, or with a different doctor (I was stuck with the one on call) I could have torn instead. The thing I'm actually madder about then the episiotomy was that she did a crappy job stitching me up. now, I really don't think that the more routine perinial episiotomy is ever truly necessary, there are some times when the episiotomy is not the worst choice.


----------



## AuroraPolaris (Jul 26, 2010)

I`m glad this have changed through the years.
My mother gave birth to 4 girls, all of them average size. She gave birth laying straight on her back, feet in stirrups, and she was cut every time.

I have given birth 3 times, the last time twins. Every time I have written in my papers that I would not accept an episiotomy.
And I never had one! The midwife told me straight after the birth of number two that she nearly had to cut, because the babys hart rate was dangerously low the last contractions. If I didnt tell her I didn`t want one several times during labour, I guess I would have one. But she tryed her best to meet my wishes, and thankfully it turned out ok.

From what I could google midwives here try their best to avoid episiotomy these days. They only cut for the baby, if he/she _really_ need to come out as quickly as possible.


----------



## minkajane (Jun 5, 2005)

I was watching a birth on TV the other day and right as the baby was about to come out, the doctor says all nonchalantly, "We'll just make a little room..." and snip snip snip! There was no consent, no question, just "a little room"!!!! She only pushed for like half an hour, so there was no reason for it. It was obvious the doctor does them as a matter of routine. And the fact that he was so laid-back about it even on camera makes it so clear that he sees no problem with it.

I hate watching those shows, I don't know why I do it. The abuses that you see ON CAMERA are so bad. It shows you that they're so widely accepted that they're not even considered at all. And if they're that bad on camera, what's happening when the cameras are off???


----------



## karanyavel (May 8, 2010)

My ex-OB told me she performs episiotomies "as needed". She didn't cut me, but I didn't give her a chance -- I pushed the baby out in one hard shove because I was so adamant that she not cut me. As a result of the "superwoman push", I had a 3rd degree tear. I bet if I'd been able to push at my own pace, I wouldn't have had nearly as much tearing. Ugh.

She repaired my tear very poorly, too.

Luckily, this time I am using a midwife practice & freestanding birth center.









--K


----------



## Storm Bride (Mar 2, 2005)

I've never had one. It's the _only_ plus I see to having had all c-sections.


----------



## ursusarctos (Dec 16, 2008)

Quote:


Originally Posted by *MegBoz* 








Get out of here! FIFTY PERCENT of FTMs get epis? Wow! I think the nationwide rate here in the US is like 30%, so I'm shocked that it's even worse in Finland! (Of course, that's not to say US maternity care is better, but I'm just saying _on this particular issue,_ I'm shocked that we're better.)

Yep. At least that's what they told my friend at her birth preparation class and she told me. It scared her, too, she kept telling me how she really hoped she didn't need one and I kept trying to tell her that she probably didn't and that they couldn't cut her if she told them not to (I have the impression that they are generally respectful of your wishes if you let them know) but she didn't seem to believe me







There is just no way a 50% rate is necessary. But they pass it off as if it is.









Quote:


Originally Posted by *mamabadger* 
Could it be that the U.S. episiotomy rate is lower than it might be because its C-section rate is higher?

Maybe. Last time I checked Finland's was 17%, but the hospital where my friend gave birth has one of 9%.


----------



## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *minkajane* 
I was watching a birth on TV the other day and right as the baby was about to come out, the doctor says all nonchalantly, "We'll just make a little room..." and snip snip snip! There was no consent, no question, just "a little room"!!!!

<snip>

The abuses that you see ON CAMERA are so bad. It shows you that they're so widely accepted that they're not even considered at all. And if they're that bad on camera, what's happening when the cameras are off???













































So, yeah, that little smiley lineup sums up my feelings on those mainstream birth shows as well. I totally feel the same way - if that's how they act on camera, what's it like off?
















Although I suppose the doc feels that since the patient has accepted his care, then she has left it up to the doc to "manage/ guide/ direct/control/ protect" the situation as the doc sees fit.









Maternity care in America makes me insane enough as it is - so I do try to avoid the temptation to look at any of those shows for even an instant since odds are very high that it will make me crazy (well, crazier - ha!).


----------



## Smokering (Sep 5, 2007)

So... I'm having a hard time seeing how episiotomy is EVER necessary. Some of you seem to accept a low (but not zero) rate as inevitable - how come? Aren't they usually done when the baby is quite far down in the birth canal? And if it had got that far, doesn't that prove that the vagina is big enough to birth it? (Er, it... him or her, you know.)
 






I mean, I know some mothers tear, even with good positioning - not that most of them get that chance in mainstream hospitals! - but isn't tearing considered to be a better deal, as it _might_ be superficial, whereas epis _always_ cut through all the tissue? I mean, tears can just be on the surface of the perineum, which would be analogous to the doc "scoring" the perineum like slashing a loaf of bread... but they don't do that, they cut all the way through, deeply into the muscle.

Can anyone enlighten me?


----------



## Mamatoabunch (Sep 23, 2007)

Episiotomy angers me so much I can barely talk about it. I have never had one, although I have a cut on my womb, b/c supposedly it was too dangerous to deliver a breech twin. I also have never torn, but have only pushed on my own terms w/ all my HB's.

A few months after I gave birth to my twins I was present at a friend's birth, her second, so this was 16 years ago. The OB, w/o asking, just got scissors and cut. I was so horrified, the sight of that has never left me. It was so incredibly wrong. I viewed it as a direct assault. It surprises me that more women do not. It is almost as if most women are some how conditioned to just accept assault if it happens in the birth climate.


----------



## ursusarctos (Dec 16, 2008)

Quote:


Originally Posted by *Mamatoabunch* 
I viewed it as a direct assault. It surprises me that more women do not. It is almost as if most women are some how conditioned to just accept assault if it happens in the birth climate.

This. And then when you mention, even gently, that things like episiotomy aren't really necessary and can be refused, you are not believed.


----------



## Marissamom (Dec 17, 2009)

Quote:


Originally Posted by *Smokering* 
So... I'm having a hard time seeing how episiotomy is EVER necessary. Some of you seem to accept a low (but not zero) rate as inevitable - how come? Aren't they usually done when the baby is quite far down in the birth canal? And if it had got that far, doesn't that prove that the vagina is big enough to birth it? (Er, it... him or her, you know.)







I mean, I know some mothers tear, even with good positioning - not that most of them get that chance in mainstream hospitals! - but isn't tearing considered to be a better deal, as it _might_ be superficial, whereas epis _always_ cut through all the tissue? I mean, tears can just be on the surface of the perineum, which would be analogous to the doc "scoring" the perineum like slashing a loaf of bread... but they don't do that, they cut all the way through, deeply into the muscle.

Can anyone enlighten me?

see my earlier post, I had scar tissue that wouldn't stretch, wouldn't tear. babies heart-rate was not good. There is also the occasional time when the baby is in distress and can't wait until mom has stretched .


----------



## eclipse (Mar 13, 2003)

Quote:


Originally Posted by *Smokering* 
So... I'm having a hard time seeing how episiotomy is EVER necessary. Some of you seem to accept a low (but not zero) rate as inevitable - how come? Aren't they usually done when the baby is quite far down in the birth canal? And if it had got that far, doesn't that prove that the vagina is big enough to birth it? (Er, it... him or her, you know.)







I mean, I know some mothers tear, even with good positioning - not that most of them get that chance in mainstream hospitals! - but isn't tearing considered to be a better deal, as it _might_ be superficial, whereas epis _always_ cut through all the tissue? I mean, tears can just be on the surface of the perineum, which would be analogous to the doc "scoring" the perineum like slashing a loaf of bread... but they don't do that, they cut all the way through, deeply into the muscle.

Can anyone enlighten me?


Well, I think I read that an episiotomy can help a baby come out an average of a couple of pushes sooner than no episiotomy. So, in a case where there's an emergency, I can see where a doctor might decide that the fastest way to get a baby out is the best way in that moment. Everyone I've ever known that had a forcep or vacuum extraction has had one - I'm not sure if that's because it's actually necessary to get the tools in or just for the convenience of the doctor.


----------



## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *Smokering* 
So... I'm having a hard time seeing how episiotomy is EVER necessary. Some of you seem to accept a low (but not zero) rate as inevitable - how come?

The only reason I know of is shoulder dystocia (SD) - IF there is not enough room for the HCP to reach in - to get their fingers in to help manipulate the baby to help dislodge him. That's it, so far as I know.

Although I read an interesting thread on a MW discussion forum where pretty much all agreed that SD was a bony problem - NOT a fleshy one - i.e. baby is stuck in the pelvis, NOT stuck behind a brick-wall-like perinium. Therefore epis really doesn't make sense as a solution to resolve it.

HOWEVER - many said they'd cut an epis anyway for liability purposes.







It's considered a "standard of care" to do epis in case of an SD, so failure to do so would leave them extremely liable. Sad, but I can understand it from the MW's point of view.

But, again, if there's an SD & the HCP can't reach in to help dislodge baby, the epis could legitimately be necessary to make room.

Quote:


Originally Posted by *Mamatoabunch* 
Episiotomy angers me so much I can barely talk about it.

I'm glad I'm not the only one. I feel like I must be a little crazy for how much it infuriates me! I had a profound _physical reaction_ when I watched the video I mentioned in my original post. (The way he was talking to her was also horrible - it sounded JUST LIKE he was coaching his buddy through a heavy set of bench presses at the gym. Perfectly appropriate choice of words & tone for the gym, but um, yeah, not so much for a birthing mama.)

My heart rate jumped to probably well over 100 (& being a fit person, my normal resting HR is around 60) & I'm sure my blood pressure spiked as well.

Quote:


Originally Posted by *Mamatoabunch* 
It was so incredibly wrong. I viewed it as a direct assault. It surprises me that more women do not.

Sadly, even those who DO view it as "medical battery" -which is a CRIME, and it IS the crime of medical battery to do epis without consent - even women who DO view it that way have no legal recourse.







Epis lawsuits basically never win. I think it was in the book "Pushed" that I read an interview with a lawyer who takes pro-bono maternity cases, such as against VBAC-bans. She said she gets calls for epis all the time & just can't take the cases because it just almost always fails.

So, yeah, I guess that's a reflection of the view of our society on the whole.

Quote:


Originally Posted by *Marissamom* 
There is also the occasional time when the baby is in distress and can't wait until mom has stretched .

I wonder about that one though - so if baby is in distress - and low enough in the birth canal that rushing a vaginal birth is the better route than emergency CS - in that case, I would imagine they might reach for the vacuum or forceps (if just asking mom to push with all her might was insufficient.)

STILL - in that case, isn't it better to still just tear naturally? I know epis isn't necessary with vacuum, so I would imagine if mom hasn't stretched yet, it STILL might be better to just let tearing happen naturally.

Quote:


Originally Posted by *eclipse* 
Everyone I've ever known that had a forcep or vacuum extraction has had one - I'm not sure if that's because it's actually necessary to get the tools in or just for the convenience of the doctor.

I read here on MDC that the vacuum doesn't increase the circumference of the presenting part. So it's not necessary to accompany vacuum. Makes sense to me when you think about it.
I've also read here that it doesn't need to accompany forceps, but I can see some logic there since the forceps DO increase the circumference of the vaginal canal beyond the size of the baby, so I can maybe see more need there to make room to get the tool in. But I don't know. Besides, I think forceps are relatively rare in the US today anyway.


----------



## Smokering (Sep 5, 2007)

Hmm. In terms of shoulder dystocia, isn't that usually resolvable by the Gaskin manoeuvre? Would doctors do both?

Even if a HCP had to "force" his fingers inside to help the baby out, there's a possibility the resulting tear would be more superficial or smaller than an epi cut, right?

The scar tissue things makes sense, though.


----------



## Storm Bride (Mar 2, 2005)

With respect to when they're necessary, I'm wondering about the "steering" of a tear? I've heard medpros say that if a woman starts to tear, an episiotomy can guide the tear in a different direction, making it less likely to extend into the rectum, for instance. Does anybody know if that's valid?


----------



## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *Smokering* 
Hmm. In terms of shoulder dystocia, isn't that usually resolvable by the Gaskin manoeuvre? Would doctors do both?

Even if a HCP had to "force" his fingers inside to help the baby out, there's a possibility the resulting tear would be more superficial or smaller than an epi cut, right?

The scar tissue things makes sense, though.

Well, I think Gaskin maneuver (Hands & knees, right?) would be really tricky with someone who's had an epidural. Maybe not impossible, but potentially too time-consuming to manage when it's a true SD & time is of the essence. & most women in American hospitals have epidurals. (& most American women give birth in hospitals - like 92% or so.)

Of course, there's McRoberts too - which IS possible with an epidural (on back with knees up).

Good point on tearing still being better in case of reaching into the vagina.

Yes, agreed, scar tissue makes sense. Although my MW just told me she had a 4th degree tear! Which I would imagine results in lots of scar tissue, and perinial massage throughout late pregnancy allowed her to birth in the future - I think she said - with NO tearing! (or maybe very minimal, I forget) But she is a big fan of perineal massage.


----------



## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *Storm Bride* 
With respect to when they're necessary, I'm wondering about the "steering" of a tear? I've heard medpros say that if a woman starts to tear, an episiotomy can guide the tear in a different direction, making it less likely to extend into the rectum, for instance. Does anybody know if that's valid?

Interesting Q.

I read that medio-lateral epis (angled cut) results in less rectal trauma vs. mid-line epis (straight down). IIRC, medio-lateral is much more common in Europe, but is rare in the US - so at least as far as the USA is concerned, a medio-lateral epis being done to avoid rectal trauma is rare & is not what contributes to our way-too-high rate.

I know I read, I think in "Thinking Woman's Guide" that docs will cut if they think a tear is 'impending' - but only because they think the cut is better - not to take it in another direction. (I think Henci Goer commented on how that was idiotic - tears happen or they don't. They don't "impend!")

I did have one friend say her OB said he'd do epis if a woman was about to tear upward. I thought that sounded interesting, I certainly would rather have a 2nd degree cut in the perinium (& I think epis are generally 2nd degree by default) than some tears up near the urethra & clitoris! So that made some logical sense to me, but others on MDC said that's not evidence-based either.

Besides, I have to wonder, if the tear starts happening, would it really be possible for a cut in another direction to STOP that tear from continuing further? I have to think it's unlikely.


----------



## Smokering (Sep 5, 2007)

Quote:

Well, I think Gaskin maneuver (Hands & knees, right?) would be really tricky with someone who's had an epidural.
Oh yeah... good point.

Quote:

I did have one friend say her OB said he'd do epis if a woman was about to tear upward.
How would he tell? Would the skin look really paper-thin and stretched or something? I agree I'd probably rather be cut downwards than tear upwards... but like you said, tears happen or they don't, they don't impend. I'm not sure how you'd get prior notice of tearing upwards.


----------



## minkajane (Jun 5, 2005)

Quote:


Originally Posted by *MegBoz* 
Besides, I have to wonder, if the tear starts happening, would it really be possible for a cut in another direction to STOP that tear from continuing further? I have to think it's unlikely.

I can totally see how it would help. If you're starting to tear upward, a cut on the perineum can relieve the pressure and can stop it from getting worse. I still don't agree with it, but it makes sense to me.


----------



## dayiscoming2006 (Jun 12, 2007)

I also hate episiotomies!

I had an unnecessary one with my first and it didn't heal quite right. I was unable to have mostly pain free sex until around a year after my son's birth and I still have a tightness there that was never there before.

I successfully birthed my second in a hands and knees position during pushing until I was forced onto my back by the doctors at the very end but he was nearly out by then so I didn't tear and no skid marks.

***
Wanted to add my birth plan stated that I didn't want an episiotomy and I didn't consent to it. She just did it without even telling me. I only pushed for 40 minutes and I'm convinced if I wasn't on my back it could have gone quicker.


----------



## 3xMama (Oct 14, 2010)

minkajane said:


> I was watching a birth on TV the other day and right as the baby was about to come out, the doctor says all nonchalantly, "We'll just make a little room..." and snip snip snip! There was no consent, no question, just "a little room"!!!! QUOTE]
> 
> This happened to me w/ my DD. I had been pushing for three hours and she was having minor decels, but not to the point anyone had said anything to me about it or done more than put an oxygen mask on my face. (The only reason I even know she was having decels is because of the research I've done since and know the oxygen mask is used for that.) The dr was concerned of her size, too, and her getting stuck. When DD was really close to finally being born and the ob said "I'm going to help things along a little, look away" (I was using a mirror to watch the birth). Poor DH didn't know what she was going to do soon enough and apparently the "look away" came after she made the cut, luckily I got it and missed that. I highly doubt that I needed that epis. She was crowning and the way the dr did it makes it sound, to me, like a totally routine procedure for her.
> 
> I went through a lot of pain and discomfort that lasted a good year, year and a half pp, all for a routine procedure that was unnecessary. Its the one part of that birth I'm really not at peace with.


----------



## jengacnm (Oct 26, 2006)

In my 10 years of midwifing, I've done ONE episiotomy that was necessary. I was involved in a few where, seriously, I was gowned and catching but the doctor reached around me and cut. I still feel sick over that.

Anyway, this was a hospital birth that was unusually high risk. The hospital & my employing doctors were pretty great about midwives doing the births while they managed things like insulin drips and magnesium for preeclamsia by phone.

This particular patient was both-she was an insulin dependent diabetic AND had severe preeclampsia. She had every sign of diabetic ketoacidosis except for the actual acidosis. Her labor went well, her pushing went well, and in the last half hour the baby's heart rate steadily drifted down. No decels (I rmember that clearly), just a progression from 160 to 90, in a really smooth line-which is scary in the world of fetal monitoring. The baby was almost but not quite crowning when it started to stay below 80. EVERYONE in the room was holding their breath-me, nurses, the pediatrics team, the mom and her husband. (Well, ok, mom was pushing.)

I cut the tiniest of cuts and the baby came tumbling out.

I haven't done one since, and that was over 8 years ago. I hope I never have to do one again. If I do, I hope it's as well timed as that one. And I take no credit for how well timed that one was. I guess those prayers to the birth dieties work.


----------



## babygirlie (Jun 4, 2009)

I was not asked if I was ok with an episiotomy. Baby was 5.1#. I had not been "pushing" for very long. There was talk of baby not getting enough oxygen and it was my fault for not breathing right and I couldn't understand wth they wanted. Breathing deep made them irritated breathing faster they said was wrong. I'm not sure what they wanted but I was told she wasn't getting enough oxygen and had to come out now. Not sure why she wasn't. She was ok for 7 months in there and 3 days of inducing. I just don't k now. I don't even know what degree tear, no one told me.

I thought swelling and extreme pain was normal. Maybe it was the episiotomy. I remember thinking... your butthole moving to your lower back was not in the pregnancy books and it was really tripping me out...


----------



## [email protected] (Sep 7, 2010)

I thought it was now standard of medical care to _not_ do episiotomies? The MDs who do are not current w/ the latest research & guidelines.


----------



## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *[email protected]* 
I thought it was now standard of medical care to _not_ do episiotomies? The MDs who do are not current w/ the latest research & guidelines.

I do believe it's the current "standard of care" not to do _routine_ epis (so, for a doc to not have a 100% epis rate.) But with the US rate being over 30%, I'm guessing a lot still believe they can make a cut that is better than a tear - I've heard that some OBs claim all first-time-Moms need a cut -- which makes NO SENSE WHATSOEVER - if my vagina is incompetent & unable to adequately stretch the first time, why is it suddenly OK the second time - especially if you've now made it LESS stretchy thanks to the addition of a piece of scar tissue - which is not stretchy.?!
















Anyway, and we know American OBs are always RUSH RUSH RUSHING birth - what with inductions, augmentation through pitocin, AROM, purple pushing, so I suppose it's par for the course in a "pushed" birth - to HURRY UP everything - even if baby isn't in distress. Heck, I know many hospitals put a time limit on pushing - for some it's 2 hours and I think I've even heard of a one-hour limit, which seems totally insane to me.

So it makes sense that if they legitimate believe >1 or 2 hours of pushing is dangerous, then epis to speed up 2nd stage is warranted.

So while you are correct that really no HCPs do routine / 100% epis, there do still seem to be enough reasons remaining in the opinions of American HCPs - and clearly TOO MANY reasons since the rate's way too high.


----------



## Youngfrankenstein (Jun 3, 2009)

Okay, picture the pelvic floor. Then picture a woman flat on her back. Now raise her legs up into stirrups...Can you picture that "back" of the perineum being stretch and forced taut? No wonder they "needed" epis.....









I have never been close to an epis. situation but I did have a SD at my homebirth and mw could reach up and dislodge her.

She was 10# 4oz and I had no tearing whatsoever...I never even needed an ice pack after that birth.


----------



## AlaaJ (Nov 5, 2010)

One doctor I went to said that she regularly performed episiotomies because all that pushing from the baby is gonna cause the vagina to become enoromous and leave the mama with big flapping balloon for the rest of her life. So instead of letting baby keep pushing and pushing, you snip the mama and let baby slide out, thereby letting vagina retain its original size.

I'm just wondering if there is any validity at all in that bs? I've given birth twice, episiotomies both times, and the area "down there" is forever changed, episiotomy or no. (Not that it -- the change -- is a bad thing.)

I've also been told that doctors here (Lebanon) also perform some kind of constructive surgery post vaginal births so that the woman's vagina regains it's pre baby/virginal tightness. Has anyone ever heard of that? My friend studying at the American Uni of Beirut once heard a doctor coming out of a delivery room wink at a new dad and say, "Your wife is now better than before." Huh??? From what I understand, they sew up the tear or episiotomy and then go on to sew something from "inside" as well. My knowledge about this topic is really fuzzy; it's all hear-say -- just wondering if anyone can shed any light on this topic.


----------



## Comtessa (Sep 16, 2008)

I've heard of this. They used to call it the "husband knot." It is supposed to make the woman "tighter" than before. It also has the added benefit of making sex excruciating for the woman. Because, you know, sexual pleasure is only for men anyway, so who cares what kind of genital mutilation you do on the woman to improve the man's experience? I don't know about you all, but if sex is excruciating for me, my husband's experence is _nil_.

I didn't know anyone still _did_ this -- it's something I remember reading about from the 50's.


----------



## Turquesa (May 30, 2007)

Quote:


Originally Posted by *Comtessa* 
I didn't know anyone still _did_ this -- it's something I remember reading about from the 50's.

50s? After my mom had her last baby in 1977, a doctor was trying to sell her on this.









ETA: And this was in the U.S. This surgery has been around for awhile, and it's probably still lingering in some more patriarchal cultures.


----------



## caned & able (Dec 8, 2005)

Allaaj: That is called a "husband's knot", and it should not be done.

An episiotomy has its place in obstetrics. Otherwise, it is a form of sexual mutilation or a weird form of sexual initiation.

It should not be done on every mother in the world.


----------



## msmiranda (Apr 22, 2009)

Count me in as another woman who is irrationally (or maybe not) angered by episiotomy. I categorically believe that absent an emergency, it is a form of sexual assault. And even in the case of emergency, consent should be obtained if possible.

My mother was cut both times -- this was the 70s and it was routine. With my younger brother, they used forceps and their cut tore into the rectum. She had to have additional surgery when he was a few months old because it was not healing properly, and has had painful intercourse and incontinence (urine and fecal) ever since. She is in her 60s now. I don't think she's ever had an accident with the latter, as such, but she cannot be far from a bathroom ever. And she doesn't like to travel because of it. It makes me sick to my stomach. Those f-ing butchers.

If I had to have a vaginal hospital birth for some reason, my DH would be under orders to stand over me and to knock the *&%# out of anybody who even thought about picking up a pair of scissors.

ETA: In my state, you can obtain the c-section and episiotomy rates for most OBs from a few years ago. I scrolled down the whole list and the rates varied WIDELY. There was one doc with a 70-something percent rate. I think the average was 20% or so. It is absolutely a litmus test for me. But surprisingly it did NOT seem to correlate with c-section rates very much, and my guess is that the older docs are the ones more likely to still do epis, but not as likely as younger docs to jump to a section. And, the one doc around my area who is the hero of the natural birth community because he will do vaginal breeches and twins and lets moms push for a long time and have broken waters for a long time, has a pretty high epis rate given his otherwise stellar reputation. So, it's all a mixed bag.


----------



## MyFullHouse (Apr 23, 2010)

Quote:


Originally Posted by *AlaaJ* 
One doctor I went to said that she regularly performed episiotomies because all that pushing from the baby is gonna cause the vagina to become enoromous and leave the mama with big flapping balloon for the rest of her life. So instead of letting baby keep pushing and pushing, you snip the mama and let baby slide out, thereby letting vagina retain its original size.

I'm just wondering if there is any validity at all in that bs? I've given birth twice, episiotomies both times, and the area "down there" is forever changed, episiotomy or no. (Not that it -- the change -- is a bad thing.)

I've also been told that doctors here (Lebanon) also perform some kind of constructive surgery post vaginal births so that the woman's vagina regains it's pre baby/virginal tightness. Has anyone ever heard of that? My friend studying at the American Uni of Beirut once heard a doctor coming out of a delivery room wink at a new dad and say, "Your wife is now better than before." Huh??? From what I understand, they sew up the tear or episiotomy and then go on to sew something from "inside" as well. My knowledge about this topic is really fuzzy; it's all hear-say -- just wondering if anyone can shed any light on this topic.

I've never had an episiotomy, but I've gone with no tear, and I've had a serious tear (don't really know what degree, but the repair was hell!).

At my 6wk check up with #2, my not-so-tactful OB smiled, and said it was as though no babies had ever come through there. Uh... thanks?
Through all 4, dh and I have never noticed a difference after an appropriate amount of healing time. Of course it's possible that dh is just too smart to say anything, but I don't know if he really deserves that much credit.









So, ime, that whole thing is a crock. I have a feeling it's more of a YMMV thing though.


----------



## Smokering (Sep 5, 2007)

Quote:

I've heard of this. They used to call it the "husband knot." It is supposed to make the woman "tighter" than before. It also has the added benefit of making sex excruciating for the woman. Because, you know, sexual pleasure is only for men anyway, so who cares what kind of genital mutilation you do on the woman to improve the man's experience? I know know about you all, but if sex is excruciating for me, my husband's experence is nil.

I didn't know anyone still did this -- it's something I remember reading about from the 50's.
Eugh. You know Bridget Jones' Diary? It was originally a newspaper column (fictional, of course), and in the column she got pregnant by Daniel Cleaver (the Hugh Grant character in the films) and had a baby. In the column where she recorded the birth, she said she pushed the baby out and was taken to be stitched up (and put under, I believe?) - and heard the doctor asking Daniel how tight he wanted her to be stitched up. He said something like "How tight? 17? 16?" and Daniel smirked and said "15", and Bridget's comment on this was something like "Hmph" or "Oi", but she didn't take any further issue with it than that. The whole Bridget Jones saga ended immediately after she had the baby, so we never got to hear of any repercussions from it.

Anyway, it made me sick. I know it's fiction and that Daniel Cleaver's supposed to be a shallow, womanising jerk; but still. This was written in, what? The nineties at the earliest. I can't remember if she actually had an episiotomy or just tore, but the "husband stitch" thing was just repellent.


----------



## 3xMama (Oct 14, 2010)

One of the times I went into the hospital for contractions with my first (hey, I was young, had never been around a pregnant woman and had no idea what was going on!!

 






), I was walking the halls trying to get the contractions to start again (they didn't). While we were walking I over heard an OB talking to a woman obviously in labor, trying to get her to agree to an epis when the time came. His logic was that it was easier to stitch up a cut after birth as opposed to a tear because it was a straight, smooth cut as opposed to having jagged edges...







Even I, pregnancy/birth novice, knew that was a crock of bull. Not to mention the fact that he waited until she was in labor to bring the topic up instead of weeks before at a prenatal.









(Incidently, that was also when I knew it was time to pack up and head home. After hearing that poor woman trying to talk during labor and I finally knew what a woman in labor sounded like, I knew I was no where near labor!!







)

ETA: The idea of a "husband knot" makes me sick. Seriously, how depraved do people have to be to do that? Although I am curious, I've heard of a revirginization plastic surgery, is that essentially the same thing just by choice and done in a more "humane", for lack of a better term, way? Off topic, sorry!


----------



## caned & able (Dec 8, 2005)

OT, to 3x Mama:

The husband's knot is an extra knot to tighten the vagina during repair of an episiotomy. _REVIRGINIZATION_ plastic surgery is to replace the hymen or build one where there never was on.

I suppose the two could be done together. I know that some women have a second repair done after child birth when the episiotomy does not heal well, is not done well, or in the case of a prolapse in which pubococcygeal muscles have the organs have fallen and are not doing their job.


----------



## MissE (May 12, 2007)

Quote:


Originally Posted by *Marissamom* 
see my earlier post, I had scar tissue that wouldn't stretch, wouldn't tear. babies heart-rate was not good. There is also the occasional time when the baby is in distress and can't wait until mom has stretched .

DD heart rate was down to 60 beats for almost seven minutes. I had nurses screaming at the OB that 'we have to get her out" and I believe I HAD to be cut. It was necessary or maybe DD would not have made it. Her Apgar was 3, she was blue, not breathing. She came back almost immediately but it was close I guess.

I had a C/S with my first one and that was a horrible experience (long labor, long pushing, OP baby etc). I take an episiotomy anytime. I didn't have any problems with it other than being sore for a few days.

HOWEVER. My friend gave birth about 7 months ago. The nurses were saying "we're not emptying your bladder (she had an Epidural) because the baby will probably come really fast (they actually said 'fall out')" and then the OB comes in, has her push twice and CUTS HER. I was standing there not even being able to understand what just happened. Now my friend keeps complaining that something is different down there. Apparently the OB didn't do so well sewing her up which really upsets my friend.


----------



## suzysprite (Jul 18, 2004)

After pushing for three and a half hours with my daughter, there was a band of tissue that simply would not give. I was exhausted, and had hit a wall. When the doctor said the word episiotomy, I freaked out for a moment, and then I was like, "just do whatever you have to do." my doula and midwife were supportive of the decision, and the dr made the cut. My daughter arrived immediately afterward. It was a very small cut, and healed exceptionally well. The worst part of my recovery was how sore my arms were from hanging on to various things while pushing.

So, in my case, I'd say the epi was beneficial.


----------



## nia82 (May 6, 2008)

My mom had epis at all her births, and her mom told her back then that it must be so much better than the horrible tears that tear so not straight... Hmm!

I didn't have an epi, but I specifically said no to it on our birth plan - I would only have consented if DS's heartbeat was like crazy low. I pushed for 2.5 hours and DS had a nuchal hand and wasn't completely anterior, I had two 2nd degree tears and only felt sore for a couple of days. (The obgyn in her practice would have wanted to cut me because I was a first timer, DH had strict instructions to yank scissors out of his hands on sight)

My sisters both had epis. I know otherwise Germany is very natural birth friendly, but so far all people I know had epis. My oldest sister had a vaccum extraction for big baby with epi, I don't know how long she had been pushing, not long though I think, I don't want to give her bad feelings about the epi and vaccum (baby's head was 35cm, it is not that big, DS was 33cm but he had his hand there which makes for a bigger head in the end). My other sister said her son's heartbeat was bad and he had the cord wrapped around the head. I don't know how low the heart rate was or if the cord was truly tight, but it was long enough for her DS to be on her chest immediately and having the cord stop pulsating. Anyways, I have to look up stats, but I have a feeling it varies widely from HCP to HCP. The midwives I'm seeing right now have a super low rate. One told me she has been a midwife for 10 years and did one epi in those 10 years...


----------



## AlexisT (May 6, 2007)

Quote:


Originally Posted by *Smokering* 
Hmm. In terms of shoulder dystocia, isn't that usually resolvable by the Gaskin manoeuvre? Would doctors do both?

Even if a HCP had to "force" his fingers inside to help the baby out, there's a possibility the resulting tear would be more superficial or smaller than an epi cut, right?

The scar tissue things makes sense, though.

It's not always resolvable by Gaskin, even if the woman hasn't had an epidural (though that accounts for a lot). There's a series of maneuvers done for SD. (The "official" mnemonic has all-fours last on the list, but some providers try it earlier, which, in my unprofessional opinion, makes sense--it's a simple position change.) The original sequence had episiotomy as the 2nd step; now it's "evaluate for episiotomy" to see if one may be necessary. The episiotomy does not resolve the SD in and of itself. It's to allow the attendant room to do internal maneuvers.

Here's the sequence:
http://www.aafp.org/afp/2004/0401/p1707.html


----------



## Smokering (Sep 5, 2007)

AlexisT: Thanks for that! I love learning about this stuff.







Had a long conversation with Mum about episiotomies yesterday... she was a midwife in Australia and the US back in the 70s and 80s. Her perspective was that they are occasionally necessary, but that hers was done because she was "15 minutes over the allowed 12 hours" and it was just routine.


----------



## LiLStar (Jul 7, 2006)

I had SD with my birth, and ds was born over an intact perineum, all 10lbs of him. Even with gaskin, he still required a few minutes of internal maneuvering to get him out. Even with both a head AND an arm between my legs, I didn't tear. Really glad my midwife didn't view my perineum as a "liability"


----------



## Lady Lilya (Jan 27, 2007)

Quote:


Originally Posted by *AlaaJ* 
One doctor I went to said that she regularly performed episiotomies because all that pushing from the baby is gonna cause the vagina to become enoromous and leave the mama with big flapping balloon for the rest of her life. So instead of letting baby keep pushing and pushing, you snip the mama and let baby slide out, thereby letting vagina retain its original size.

I think this is one of those things that is soooo variable based on the woman. I pushed out a large-ish (for my frame and relative to other babies in my family) baby, and I have an extremely tight vagina. Tight like it is difficult to get 2 fingers in. A friend of mine had a c/s long before the baby was in the vaginal canal, and she is large enough that her boyfriend can comfortably get both of his large hands into her. I think it would take hours to stretch me to that point, and it would be very painful for me, and would involve a lot of healing time after. But for her its is nothing. We are both extreme examples of natural variation among women. Vaginal birth did not make me looser, and lack of vaginal birth did not make her tighter.

I was reading a thread on a sex forum where there was talking about the use of large toys, and whether they permanently stretched the vagina. And again, a wide variety of responses. Some found that even one use of a large toy would make a permanent impact. Others found that it took repeated frequent use to make a change. And still others found that they always returned to normal.

--------

Back to epis...I was born in 1980. When my mother was shopping around for OBs, every single one of them said they do routine episiotomies. Lucky thing that she walked in the door so last-minute that they didn't have a chance.

But for my sister's birth in 1984, she found the same story about routine epis, and in that case she was there at the hospital for a few hours and they did one against her will.

--------

I've heard stories about past decades when epis were hospital policy, and if a woman gave birth too fast the OB would go back and cut her afterwards, to avoid being punished for violating the policy.


----------



## mmaramba (May 17, 2005)

_One doctor I went to said that she regularly performed episiotomies because all that pushing from the baby is gonna cause the vagina to become enoromous and leave the mama with big flapping balloon for the rest of her life. So instead of letting baby keep pushing and pushing, you snip the mama and let baby slide out, thereby letting vagina retain its original size._

No way. How long is a baby in the vagina? For most women, less than an hour, but rarely more than a couple of hours. Episiotomy and PREGNANCY-related pelvic floor changes are much more to blame for any change in vaginal tightness than pushing a baby out.

And of course, let us not forget that 90-95% of women birth who birth vaginally do so in lithotomy with epidurals, which is more likely to lead to tearing with or without the episiotomy.

But I've heard it put this way-- why do we have no problem accepting that a penis can drastically change shape and size without permanent "damage." Why do we have such a hard time believing the same about the female equivalent organ, which is specifically designed for babies to pass through it?


----------



## caned & able (Dec 8, 2005)

The hormones of pregnancy help the vagina stretch and recover.


----------



## MissE (May 12, 2007)

Quote:


Originally Posted by *mmaramba* 
_One doctor I went to said that she regularly performed episiotomies because all that pushing from the baby is gonna cause the vagina to become enoromous and leave the mama with big flapping balloon for the rest of her life. So instead of letting baby keep pushing and pushing, you snip the mama and let baby slide out, thereby letting vagina retain its original size._

No way. How long is a baby in the vagina? For most women, less than an hour, but rarely more than a couple of hours. Episiotomy and PREGNANCY-related pelvic floor changes are much more to blame for any change in vaginal tightness than pushing a baby out.

And of course, let us not forget that 90-95% of women birth who birth vaginally do so in lithotomy with epidurals, which is more likely to lead to tearing with or without the episiotomy.

*But I've heard it put this way-- why do we have no problem accepting that a penis can drastically change shape and size without permanent "damage." Why do we have such a hard time believing the same about the female equivalent organ, which is specifically designed for babies to pass through it?*

Good point...so true and have actually never even thought about it.


----------



## AlaaJ (Nov 5, 2010)

Quote:


Originally Posted by *mmaramba*
Episiotomy and PREGNANCY-related pelvic floor changes are much more to blame for any change in vaginal tightness than pushing a baby out.

Hmm interesting.. what role does episiotomy play in this? If it's true, the doctors that routinely perform them in an attempt to avoid enlarging the vagina are achieving the exact opposite of what they were aiming for!


----------



## Turquesa (May 30, 2007)

Quote:


Originally Posted by *MegBoz* 
I do believe it's the current "standard of care" not to do _routine_ epis (so, for a doc to not have a 100% epis rate.) But with the US rate being over 30%,

Do you have a link or source on the 30% rate? I wouldn't be surprised, but I'm just curious. Since the rate is so variable by provider, it must be hard to get a good sample.

What freaks me out is how much of obstetric practice is based on personal anecdote and even superstition. There are records of episiotomies being practiced in the early 1700s, but Joseph DeLee really popularized it in the 1920s. He never had any science to back the practice, but doctors just started "believing" that it would speed things up. Guess what? There's still no science to back the practice.

DeLee, by the way, was one of the loudest voices of his time in the anti-midwifery and anti-homebirth campaign.

Sorry. I'm kind of wandering with this. But my point is that routine episiotomy is a _tradition_ and a _personal belief_ but not a science-based practice.

(This is all detailed in Tina Cassidy's book, btw).


----------



## AutumnAir (Jun 10, 2008)

Quote:


Originally Posted by *Lady Lilya* 
--------

I've heard stories about past decades when epis were hospital policy, and if a woman gave birth too fast the OB would go back and cut her afterwards, to avoid being punished for violating the policy.

My mom told me that she gave birth to me really quickly, no tearing, but that the doctor cut her 'to let the placenta out'. Because a woman who's just given birth to a 9lb 4oz baby needs to be cut open to birth a placenta...


----------



## jeminijad (Mar 27, 2009)

Quote:


Originally Posted by *mmaramba* 
_.

And of course, let us not forget that 90-95% of women birth who birth vaginally do so in lithotomy with epidurals, which is more likely to lead to tearing with or without the episiotomy.

_
_
_
_
I do not believe that this is accurate. The epidural, sure, but not lithotomy. I hear much more c-position or semisitting now._


----------



## 3xMama (Oct 14, 2010)

Quote:


Originally Posted by *caned & able* 
OT, to 3x Mama:

The husband's knot is an extra knot to tighten the vagina during repair of an episiotomy. _REVIRGINIZATION_ plastic surgery is to replace the hymen or build one where there never was on.

I suppose the two could be done together. I know that some women have a second repair done after child birth when the episiotomy does not heal well, is not done well, or in the case of a prolapse in which pubococcygeal muscles have the organs have fallen and are not doing their job.

Thanks for the clarification!


----------



## Youngfrankenstein (Jun 3, 2009)

Quote:


Originally Posted by *jeminijad* 
I do not believe that this is accurate. The epidural, sure, but not lithotomy. I hear much more c-position or semisitting now.

But really that c-position is a lot like lithotomy. I just don't think many women would naturally take that specific position to birth. It's only because, IMO, they are confined to bed most times and many have epidurals making other positions much harder.

Marsden Wagner says the C/S rate in Brazil is sky high is due to the culture of having women retain those virginal vaginas.

Oprah's sex guru, Dr. Laura Berman has c/s because: "Why ruin a perfectly good vagina?"


----------



## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *Youngfrankenstein* 
Oprah's sex guru, Dr. Laura Berman has c/s because: "Why ruin a perfectly good vagina?"

OMG...that sentiment makes me rage and cry at the same time. After I had ds2, I had _no_ sensation in my clitoris for almost a _year_. Yay - I had an intact vagina...did _me_ a whole lot of good. I still don't have normal pelvic sensation, and ds2 is five.


----------



## MegBoz (Jul 8, 2008)

Quote:


> Originally Posted by *Turquesa*
> 
> 
> 
> ...


(emphasis added)

Some of these are a little older, so it looks like it's closer to 25% now.

http://www.foxnews.com/story/0,2933,167196,00.html

"One in three mothers who delivered vaginally in the U.S. from 1995 to 2003 had episiotomies"

http://www.childbirthconnection.org/article.asp?ck=10004

"The episiotomy rate has been falling off for some time in the U.S. However, when Childbirth Connection carried out its national U.S. _Listening to Mothers_ survey among women who had given birth from 2000 to 2002, 35% of mothers with a vaginal birth had experienced episiotomy."

http://www.ajog.org/article/S0002-9378%2808%2902241-2/abstract

"The rate of episiotomy with all vaginal deliveries decreased from 60.9% in 1979 to 24.5% in 2004."

http://www.webmd.com/baby/news/20050826/episiotomy-rates-too-high-say-experts

"Aug. 25, 2005 - A study looking at episiotomy rates around the world shows that a third of American women get episiotomies during childbirth. Experts tell WebMD that's too many."

http://www.womensenews.org/story/health/070514/women-encouraged-ask-doctors-about-episiotomy

"Monday, May 14, 2007

Two years after a landmark study called for an end to routine episiotomies, the procedure is still performed in about one-quarter of vaginal births."

SO TRUE! Yes, the book "Born in the USA" by Dr. Marsden Wagner does an excellent job of outlining such ridiculous practices of just doing something "to try it out" or "because that's how my mentor did it" - with NO REGARD FOR SCIENCE! He talks about the practice of using X-rays to asses maternal pelvis in the 1930s, then DES and Thalidomide in the '50s and '70s, and finally Cytotec in the 1990s. He calls it "vigilante obstetrics" - the practice of assuming something is safe until it's proven , otherwise, whereas what OUGHT To be done is assume any intervention or drug is dangerous until proven safe. He also points out that this sort of practice is the same as experimenting on people without obtaining informed consent. If something is in an experimental stage, only people who consent to be experimented on should be experimented on!

Yeah, whenever an MD says something like, "In my experience..." I have to cringe!!!!! Since generally their own experience can't possibly be enough to be statistically significant, especially if they're only in the 30s or 40s & therefore having been practicing that long! (Not to mention the whole bias that OF COURSE thinking your own actions lead to the best outcomes!)


----------



## AlaaJ (Nov 5, 2010)

Can anyone recommend some good anti (routine) episiotomy articles that I could pass on to my OB? Thanks.


----------



## MegBoz (Jul 8, 2008)

Quote:


> Originally Posted by *AlaaJ*
> 
> Can anyone recommend some good anti (routine) episiotomy articles that I could pass on to my OB? Thanks.


You could start with the book, 'Thinking woman's guide to a better birth." it summarizes LOTS of scientific studies - all of which are referenced in the back. I've heard docs will often scoff at & dismiss such books, so you could go look up the exact studies that Henci Goer sites & then share those. That book is getting a bit old now though (1999, I think?), so you could look for newer stuff here too:

http://www.ncbi.nlm.nih.gov/pubmed/

Although I wouldn't be too hesitant to share research from the 1980s and 1990s. Research showing that routine epis leads to WORSE perineal tears & trauma vs. risking natural tears is still good & valid decades later.

*But most importantly, the fact that you feel the need to share anti-routine epis articles with your OB tells me you probably ought to look at getting a new HCP.*  It seems the biggest predictor of whether or not you'll have one is your HCP's practice style. The articles I quote above list the astounding variations in rates between older OBs, younger residents, and MWs. I think even still in the past decade, some older OBs were having rates near 60%. I've read on MDC that generally if an HCP thinks they are good, that HCP will find a reason to do one- so it can be hard to avoid.

Personally, if I had even the slightest suspicion an HCP didn't have an accurate, evidence-based view of epis, I wouldn't let him or her anywhere near my genitals. It's just a chance I'd try not to take - and if I really had no other choices, I'd have BOTH my DH and a doula hovering over his shoulder. I told DH if my HB ends in transfer and a doc is about to cut me, he is to yank the scissors out of the doc's hands & stab him in the eye with them! DH replied, "I'm not going to do that!" I said, "Ok, yeah, obviously not the stab-in-the-eye part! But I'm NOT kidding when I say I expect you to STOP IT and yank the scissors out of his hand!"

ETA - yeah it was the last link I posted:

http://www.womensenews.org/story/health/070514/women-encouraged-ask-doctors-about-episiotomy

"A study published last year in the Journal of Reproductive Medicine showed that physicians in practice 15 years or more perform episiotomies 50 percent more often than those in practice less than 15 years....

The JAMA article found that although episiotomy rates have consistently declined over the past 20 years, wide variation in practice indicates that its use is driven by local professional norms, training and practitioner preference rather than the needs of individual women at the time of birth. A study conducted by researchers at the University of Ottawa, Ontario, published in the April 2000 issue of Obstetrics and Gynecology, also found factors such as time pressures, malpractice concerns and lack of experience with clinical alternatives to episiotomy.

--------------------------------------------------

The article also mentioned:

"Dr. John R. Scott, a Spartanburg, S.C., obstetrician-gynecologist who advocates against routine episiotomy, thinks it's hard to retrain older doctors.

"You can read and understand the literature, which shows that you should let nature take its course, but it's so ingrained in you to cut a small episiotomy," Scott said in an interview."

--------------------------------------

Yes, it strikes me as a near-impossible, unrealistic goal for one patient to attempt to educate an OB & get him to change the way he practices. Much better to just find an HCP who always practices evidence-based medicine, and whose philosophy matches yours.

---------------------------
"In Listening to Mothers II, a national survey of more than 1,500 women who gave birth in 2005 conducted by Childbirth Connection, a New York-based nonprofit working to improve maternity care, *73 percent of those who had an episiotomy stated that it was done without their prior consent*.I think hoping to educate an OB to get him to change his ways is an extremely unrealistic goal. So much better to just find an HCP who both practices evidence-based care in all cases, and has a philosophy that matches up with yours."

WHHOAAAAAAAA!

Finally, regarding the above stated, "clinical alternatives to episiotomy" I'd still worry about an HCP with a high-epis rate. Even if s/he agreed to restrict use of epis to only fetal distress for me personally, clearly this is an HCP who has no clue about physiological birth. *For an HCP to sincerely believe that it is better off (or outright necessary) to CUT the perinium the majority of the time definitely proves they are severely ignorant of the normal, natural processes of birth.* Therefore... they view their own actions as beneficial and/or necessary as opposed to letting the baby's head just naturally stretch out the perinium. So if they were asked NOT to do epis, I'd think they would be very likely to try to manually stretch you.  Not good either to do that vaginal "wrenching" & yanking it apart.

Just saying again, a pro-epis HCP is someone I wouldn't want near my genitals.


----------



## AlaaJ (Nov 5, 2010)

Thanks a lot, MegBoz, much appreciated. Yeah my OB has definitely been in practice for a lot longer than 15 years, hence her antiqued views. I did try to discuss the issue with her before but realized right away that she wasn't one to be convinced. I am currently shopping around for another OB but I live in a part of the world where obstetricians are all pretty much of similar training and backgrounds and more natural-minded alternatives are yet nonexistent. I might just have to go your route and have someone grab the scissors out of doc's hands if they insist on snipping away.


----------



## AlaaJ (Nov 5, 2010)

So is it true that once an episiotomy, always an episiotomy? (And if not an epi, then definitely a tear?) I've been hearing that a lot when asking ppl about their birth experiences.

In the JAMA article mentioned above, they wrote:

"In seeking to establish an evidence base to support or refute the use of episiotomy, randomized clinical trials in the mid and late 1980s found that routine episiotomy compared with restrictive use was associated with higher risk of anal sphincter and rectal injuries and *precluded a woman from giving birth with an intact or minimally damaged perineum*."

Is my struggle to avoid an episiotomy all in vain? Any IPAEs (in-tact perineums after episiotomy) out there?


----------



## philomom (Sep 12, 2004)

I wasn't cut for any of my births. I did give birth in a hospital but my CNM didn't believe in cutting women this way.

I do know some of my girlfriend were. One of them swears her baby needed that cut cause he "plopped out" the minute she was cut by her OB. Insert big sigh here.


----------



## MegBoz (Jul 8, 2008)

Quote:


> Originally Posted by *AlaaJ*
> 
> So is it true that once an episiotomy, always an episiotomy? (And if not an epi, then definitely a tear?) I've been hearing that a lot when asking ppl about their birth experiences.
> 
> ...


The part you bolded to me just means "routine epis prevents a woman from giving birth over an intact or minimally damaged perineum." Which makes sense - I believe epis is always at least 2nd degree, so if you define "minimally damaged perineum" as 1st degree tear or less, then yes, it's impossible to do routine epis and have any women with minimally damaged perineum.

I do believe there is some truth that scar tissue is less 'stretchy' but I DON"T think that means you must always have an epis or tear if you've had past epis (or past 2nd degree tear or greater.) as a matter of fact, I'm fairly certain my MW told me she had a 4th degree tear with one of her children & thanks to perineal massage, subsequently gave birth over an in-tact perineum.


----------



## Smokering (Sep 5, 2007)

According to Ina May Gaskin, scar tissue is stretchy and a previous epi doesn't mean a woman will always tear or need to be cut. My mother had a biggish, routine epi with her first child, and went on to have five more (four vaginally). I'm pretty sure she didn't have any more epis, and I know she didn't tear at the last birth (I was there) - not sure about the others. So it's definitely possible.


----------



## Lady Lilya (Jan 27, 2007)

My friend had an epi with her first child because her OB did them routine. When she met the OB for her second birth, he asked her what she thought of her previous birth, and she said the worst part was the healing from the epi. That OB said "well, you don't have to have one." She was so excited "really!?!?!?" And she didn't have one with any of her later babies. Poor thing didn't know it wasn't always a part of birth!


----------



## SGVaughn (Nov 17, 2006)

I had a horrific epi with my first...but in fairness I had been pushing for literally hours by that point and was completely exhausted..to the point of passing out between contractions

but you know what? the OB rolled her %^&*($ eyes right before she did it, so I really question its need....I was so exhausted I passed out before I was stitched up..and was rather alarmed to find stitches about four days later

my oldest was also sunny side up though, so who knows

it took 3 months to heal..I hate that dr to this day,,,14 years later

my other two..one much smaller baby and one about the same size..not a single mark that Im aware of...felt great afterwards

and they were both epidural babies...so figure that out!


----------



## zuzunel09 (Mar 19, 2009)

With my first birth, I was completely unprepared and woefully naive, and just didn't question anything the doctor did because I had very strong painful contractions, and he also just surprised me with some of the interventions. He did a pressure episiotomy that was preemptive, but I believe he does it routinely in any case. He never talked about it or told me he was going to do it, then he didn't numb the site to stitch me up. I took a long time to heal.

I don't like episiotomies, either.


----------

