# Can you say no to an episiotomy?



## kblackstone444 (Jun 17, 2007)

I woke up thinking about episiotomies. I don't want one at all! I have a good doctor and I'm delivering in one of the best hospitals in the area, and, by some miracle, both take my insurance, so I don't want to go switch things around, if I do find out my OB likes giving episiotomies.

When I had my son 15 years ago, I had to be induced, and then when things finally started happening, things happened so fast, that the OB never had a chance to do one (don't know if he would have). I tore with my first son. Hurt like the dickens, but I prefered that to being cut. I'd rather tear with this baby, also, than be cut.

Is there EVER any legitimate reason for needing an episiotomy? What "arguments" might I be given by the doctor if I absolutely refuse? Can the doctor force me to have one (unless, of course, the baby's life is in danger if I don't)? What do I need to do in order to avoid an episiotomy?

There's gonna be so much to remember while I'm giving birth- I'm gonna be constantly telling them not to circumcise the baby and constantly telling them to keep the baby with me for all procedures and constantly telling them no bottles and pacifiers and constantly telling them to screen my visitors (the baby's father was abusive and threatened to take the baby) and now it occured to me that I will also be constantly telling them not to cut me (in any way!) unless it's a life or death situation. I'm worried that I will be unable to keep up with denying their demands, and I'm also aware of the fact that, even if they mean well, and even if they really do try to do everything my way, it's alot for the doctor and the nurses, etc. to remember.

(I will be delivering without a labor coach or any kind of advocate for me, so there's a very good chance that I will literally be going it alone from being dropped off at the hospital to being given a ride home when all is said and done. The more I think about it, the more uncomfortable I feel about it.)


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## WifeofAnt (May 2, 2010)

You could try to find a doula-in-training. They're usually on the cheap (or free) side.

You can refuse an episiotomy but I've heard stories of doctors who really didn't care, one even cutting one for the placenta when he missed the birth! BUT when you're in labor and having a baby you should not have to fight for what you want.


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## Galatea (Jun 28, 2004)

You can refuse anything but that doesn't mean they will listen.


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## kalamos23 (Apr 11, 2008)

The on call OB was going to cut one on me and I started yelling my head off at him that I'd rather tear (I was yelling in general, but that pissed me off). So I tore instead. My MIL was shocked I was yelling at the OB lol!


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## laohaire (Nov 2, 2005)

I don't think they usually even announce it, much less get your permission. Or they might just mutter something like "let me help this along" while they're doing it.

You can say no, absolutely, but they don't necessarily listen.

Some good reasons to have one might be:
- If forceps or vacuum extraction are NEEDED for some reason, they are going to want to make more room for the tools
- To reach in to deal with shoulder dystocia
- If mom really has been pushing a long time (and a long time is not, like, 10 minutes... I pushed for 6 hours, myself) with baby's head engaged but no SD, I dunno, maybe it could help. I had such a situation but ultimately I chose to tear on purpose, and it was done. I don't think anyone could know if the tear would have been better or worse if I had an episiotomy (I didn't). It probably could go either way, sometimes it's better and sometimes it's worse.


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## CherryBomb (Feb 13, 2005)

Yes, you can refuse. If they ignore your refusal you may be able to take legal action.

I had an episiotomy with my vba2c. My OB doesn't do them much (she's pretty hands off in general), but I had been pushing for 2 hours and she was sitting *right there* on my perineum for a good 7 or 8 pushes and not budging. I was just losing steam from the 2 hours of pushing. Anyway, my OB said that she would recommend an epi at that point and i said yes, got cut and 2 pushes later (one for head, one for shoulders) she was out. I did tear and had to get 2 stitches in my rectum, but surprisingly it seemed to heal really well. I never had much pain from it.


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## WifeofAnt (May 2, 2010)

Quote:


Originally Posted by *CherryBomb* 
Yes, you can refuse. If they ignore your refusal you may be able to take legal action.

The problem with that is episiotomy lawsuits are said to be some of the hardest medical suits to win and many lawyers won't take the case because of that.


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## kittywitty (Jul 5, 2005)

I absolutely denied one. I had to reiterated it a lot and they actually numbed me to do one against my consent or desire and my mom caught them and made them stop. I highly recommend someone there to hold your ground.


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## kalamos23 (Apr 11, 2008)

The problem with episiotomies is that you can actually tear worse once you have one, think of a piece of cloth - it's hard to rip, but if you make a slight cut in it, you can tear the whole thing. That being said, I do think there are times for them, absolutely. Mine was not one of them, I had only been pushing for 10 minutes and she was crowning. She was out 5 minutes later.


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## Amatullah0 (Apr 7, 2009)

There are reasons an episiotomy might become necessary, but they all involve sticking something else up there, an arm(the OB's), or tools(forceps/vacuum) But thats about it.

I would really suggest you get a doula.

Have you spoken with your OB about this? Ask him about episiotomies. If he feels like most women need one, or that you will probably need one, consider switching providers.

I had an OB that told me that most moms need an episiotomy(along with a ton of other BS that I just wasn't interested in having as a part of my birth), so I switched to a MW that I felt comfortable with. (And, BTW, I was 33 weeks when I switched) I've even heard stories about women switching at 42 weeks. What I mean is, its never too late


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## Galatea (Jun 28, 2004)

One OB I saw said if he didn't do an episiotomy, my labia would rip off. !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

We dumped him that day.


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## EmilyA874 (Dec 8, 2009)

In refusing things you should make sure you phrase it as "I do not consent to ____" because from everything I have read that is the onlylanguage that gives you legal power over them and that will actually be heeded. So if you are strongly against having them do an episiotomy, I would tell them "I do not consent to an episiotomy", As long as you say "I DO NOT CONSENT" they can't do anything without fear of legal reprucussion...if you use any other language though they could thoretically go ahead and do it anyway without risk to themselves. Make sure you use the "I do not consent" for the other things you are not wanting as well, like telling them not to take the baby from you and all that.
Also, like a PP, it may be helpful to you to find a doula in training to be with you.
Good luck!


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## kcparker (Apr 6, 2008)

I agree with the advice to get a doula, or bring a close female friend or relative to come help you be an advocate and watch for scissors in hands at the end. You can also bring a sign to post in the room, write it in Sharpie on your thigh (jk), tell the nurse and whoever is attending you that you don't want one and will cow-kick anybody who gets near your bottom with scissors if it isn't an emergency (like the baby is crashing and needs to be born right away), whatever you think you need to do to get that point across.

I think they are seldom necessary unless there is a concern that baby will suffer imminent harm (persistent low heart rate would be the best indicator that babe isn't tolerating pushing and needs to be born quickly). I have even seen a vacuum extraction that did not require an episiotomy. Standard of care is NOT to do one just because or just to speed things up in the absence of an emergency. Talk about it with your doc before the birth - ask if your OB and the other OBs he/she shares call with do them as a matter of routine.

Also, you can always play the "patient advocate" card on your nurse. Part of her job is to be YOUR advocate, and if you tell her when you come in that this is _very_ important to you, have her read your birth plan, and say, "I am asking you to be my advocate in this matter," she is supposed to step up to the plate and help make sure that your decisions are honored.


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## closedaccount15 (Dec 25, 2007)

Quote:


Originally Posted by *kcparker* 
I have even seen a vacuum extraction that did not require an episiotomy.

I had an attempted vacuum extraction, not sure if they do it before or after the baby starts to come out, but I didn't get one. I did have a c-section though : (

I did feel a lot of intense sharp pain when she started using it.


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## lifeguard (May 12, 2008)

You can definitely refuse. As others said they may or may not listen.

As for the reasons for one I had a forceps delivery without an episiotomy so it's not absolutely necessary.


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## kittywitty (Jul 5, 2005)

Quote:


Originally Posted by *Amatullah0* 
There are reasons an episiotomy might become necessary, but they all involve sticking something else up there, an arm(the OB's), or tools(forceps/vacuum) But thats about it.

Really? I pushed 3 hours with my first with a swollen cervix that left a lip and doc had both hands in pulling it back while I pushed. No episiotomy and no tear-just a slight "skid mark". Forceps or vacuum I can see, but not always and I don't see why it'd be necessary for hands/arms in the canal.


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## WifeofAnt (May 2, 2010)

According to Ina May a breech baby presenting testicles first is a reason for episiotomy. Although I do doubt that any doctor who does them routinely would even attempt a vaginal breech birth.


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## kblackstone444 (Jun 17, 2007)

Quote:


Originally Posted by *WifeofAnt* 
You could try to find a doula-in-training. They're usually on the cheap (or free) side.

I'm looking into it, no luck yet. Only free would be "affordable".

Quote:


Originally Posted by *kalamos23* 
The problem with episiotomies is that you can actually tear worse once you have one.

Can you tear worse, in the same place as before, if you had a previous tear from a previous delivery, that was previously fixed? That's also a concern of mine (though I'd still rather tear than be cut).

Quote:


Originally Posted by *Amatullah0* 
Have you spoken with your OB about this? Ask him about episiotomies. If he feels like most women need one, or that you will probably need one, consider switching providers.

No, actually. I feel kinda dumb, but the thought only occurred to me this morning. It never came up (15 years ago) when I had my first son and quite honestly, I've had so much bigger things on my mind. I plan on asking her asap.


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## jeminijad (Mar 27, 2009)

I just wanted to mention that IME, these are becoming less and less common. Every OB I interviewed w/my last pregnancy stated that they "did not do routine epis." And I have never heard a peep of one, in either live birth I've had.

I think you are more likely to be fighting a section than an episiotomy!


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## MamaMonica (Sep 22, 2002)

Moved to Birth and Beyond


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## MaerynPearl (Jun 21, 2008)

in my experience, its been the same. less and less routine.

The hospital I delivered my first two at does not do them at all unless medically necessary. I ended up tearing with both... but both times WAY less than I would have been with an epi. My doctor said that was a huge reason why... they actually perform less stitches if they leave a womans body to do what it has to to get the baby out.

As for tearing worse if you have already torn before... i dont know if its a risk but it certainly did not happen for me! I tore worse first time than I did second time... even though it was in the same spot (because obviously that was the weakest place to begin with, since it tore the first time too)


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## kblackstone444 (Jun 17, 2007)

Quote:


Originally Posted by *jeminijad* 
I think you are more likely to be fighting a section than an episiotomy!

I've thought about that, too, but it's not like you can be surprised to suddenly find yourself in the middle of a c-section, know what I mean? I've been hearing horror stories about women who did not want an epi, only to have the doctor begin cutting before they had a chance to stop them.


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## Honey693 (May 5, 2008)

I brought this up at the prenatal appt where we went over my birth plan. I thought I'd have to fight not to get one b/c from the boards here it seems like doctors are episiotomy happy. My doctor looked at me like I'd grown another head and said they hardly ever do them anymore. I screamed I'd rather tear during pushing at some point and the doctor laughed and said she doesn't even remember the last time she cut one.

So basically my advice is bring it up at a prenatal appt and stop worrying until then since you might be surprised.


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## NewMoonMum (Aug 18, 2010)

I SO hope you can find somebody to support you,








If you have not done so already, have you thought about writing up a birth plan? Obviously there's still no guarantee-but that way you can go over what things you are and are NOT ok with, point-by-point, with your doc beforehand.
We did with our ob, she kept a copy, we printed several and had one in our hospital suitcase, one at home, one in the car, one in my purse and one in DH's work bag!! First thing we did at check-in was get it to the nursing staff and saw it was put in my chart. It can't hurt.

good luck!!


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## creillysheehan (Oct 21, 2009)

Quote:


Originally Posted by *lifeguard* 
As for the reasons for one I had a forceps delivery without an episiotomy so it's not absolutely necessary.

Same here!

I was terrified of the idea of an episiotomy. When I asked my OB under what circumstances she would do one, she looked down at me and said, in no uncertain terms: "I trained with midwives in New York. I only do an episiotomy in the rare case that it's medically necessary."

When we got to the need for forceps (after 5 hours of pushing, with an OB, in a hospital birthing center), my first question was "are you going to do an episiotomy?!?" And she smiled and said "oh no. You might tear a little." I did end up with a pretty good size tear (my son had enormous head & shoulders at birth).

To address your 2nd time around tearing question, my daughter was born in the same hospital birthing center with the same OB, no forceps (whew!), and I did tear but it was much much smaller.

On the other hand, a friend of mine gave birth with midwives in a freestanding birthing center. She pushed for 7 hours before they did an episiotomy, and then her son popped right out. Turned out his head was turned at a wonky angle.

So. . .check with your OB! Tell her your fears and discuss what she may deem "medically necessary."
You'll do great, good luck!


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## etsdtm99 (Jun 19, 2009)

in my experience (2 episiotomies, 1 very epi happy doc) I had time to refuse both times, though she still argued her way into cutting me - both times. - the time i fought more, was a lot smaller cut.. i could have said absolutely not but the scare tactics were too much for me she said.. 'you're going to tear in every direction and i won't be able to fix it" - as DS was crowning and of course it felt like i was going to tear in every direction ..after when she was stitching me up she basically thanked me for letting her cut and making her job easier..









To prevent cutting without you noticing - i would ask for a mirror when you start to push, then you'll see what is going on.. and tell the nurse - in my experiences the nurse was with me the entire time i was pushing and the doctor doesn't come in until the baby is nearly crowning the nurse would have told me what was going on had i told her i REALLY didn't want one..

My midwife said i am more likely to tear on my scar tissue from my previous epi's .. she also says epi's are only necessary in rare 'baby needs to come out NOW' situations..


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## Banana731 (Aug 4, 2006)

Quote:


Originally Posted by *jeminijad* 
I just wanted to mention that IME, these are becoming less and less common. Every OB I interviewed w/my last pregnancy stated that they "did not do routine epis." And I have never heard a peep of one, in either live birth I've had.

I think you are more likely to be fighting a section than an episiotomy!

I think this is definitely true, however...

Quote:


Originally Posted by *etsdtm99* 
in my experience (2 episiotomies, 1 very epi happy doc) I had time to refuse both times, though she still argued her way into cutting me - both times. - the time i fought more, was a lot smaller cut.. i could have said absolutely not but the scare tactics were too much for me she said.. 'you're going to tear in every direction and i won't be able to fix it" - as DS was crowning and of course it felt like i was going to tear in every direction ..after when she was stitching me up she basically thanked me for letting her cut and making her job easier..









...she also says epi's are only necessary in rare 'baby needs to come out NOW' situations..

If a doc likes to do epis, he's going to find a reason to do an epi most of the time. he's going to say things that are designed to make you say "do it." You have to be prepared for that. Crowning feels crazy, and you may start tearing, and heart decels are common during pushing, and while none of this is usually emergent an epi pushing doc will make it seem to be.

Stay upright when you give birth, if you don't give him the access he can't cut. It's better for you anyway.


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## mamabadger (Apr 21, 2006)

Quote:


Originally Posted by *Banana731* 
If a doc likes to do epis, he's going to find a reason to do an epi most of the time. he's going to say things that are designed to make you say "do it."

This is the bottom line. Episiotomies are seldom truly necessary, so in the end, you are likely to get one if your doctor likes to do them, and less likely to get one if your doctor avoids them.
I have seen women argue, yell, and even try to kick the scissors out of the doctor's hand. Sometimes they were successful.
I also coached a woman whose #1 birth plan item was avoiding an episiotomy; she said she would much rather tear. When her OB prepared to cut her, I told him she had wanted to avoid an epis. at all costs. He said, "Well, she's getting one anyway," and cut her. Later on, he called me out into the corridor and told me off for mentioning it to him. This is an OB who prides himself on his low episiotomy rate - but still likes to be the one who decides. In cases like that, there is not much a doula can do.
I agree with Banana: push upright, so he will not be able to get at you.


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## nia82 (May 6, 2008)

The obgyn in CA told me that all first time moms require an epi. I disagreed, ended up with his midwife on call who didnt do them.
A birth plan is good, but I do think you need to bring someone to the birth. Low cost doula, friend, mom. Be firm and yell. I wish I had a doula with ds, I was forced on my back by a nurse so pushing upright is out of question. You need someone who tells the birth attendant we do not consent to bla and we will sue you.


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## SubliminalDarkness (Sep 9, 2009)

I had one with DS1 and wasn't even told until after it happened.


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## MegBoz (Jul 8, 2008)

OP,

I implore you to seek some help. Post in your tribal area - I'm sure some doula (or doula in training) would be willing to help you out free. Please don't go in with no support! Heck, I'd be tempted to help you out if you were in my area & I'm not really interested in being a doula - I just hate to think of someone all alone & worried like that.









You sound really uncomfortable & anxious with this hospital. If you aren't going to switch to another care provider (whether home birth, free-standing birth center, hospital-based MWs,) Then I think you really need to find out what you're in for here. Is it really that bad? I had a hospital birth & it was great! They didn't take DS out of my room, didn't bat an eyelash at my requests like no vax, no eye goop, delay cord clamping, etc. etc. The nurses were awesome, my MWs were awesome. Yeah, I say that modern American maternity care is an "atrocity" - but that is _on the whole._ There are a lot of great HCPs out there

If you really believe you're going to have to fight this much, then do you really believe they are "good" HCPs? Because it doesn't sound like that's how you sincerely feel.

Have you taken the tour of the hospital? That was reassuring for me. There were at least 3 or 4 other mamas on my tour & few of us asked Qs - so I know the nurse wasn't trying to "tell us what we wanted to hear." She was telling us HOW THEY NORMALLY PRACTICE - and it was consistent with what the MWs had told me & what my 2 friends who had birthed there had said. (i.e. she said they encourage rooming in, she showed us how to work the beds but said, "We don't you in bed though! We want you up & moving." etc.)

As for screening visitors, they had an option at my hospital where you could be "unlisted." So if someone came in & said, "I'd like to visit MegBoz." They'd reply, "Sorry, nobody here by that name."







Hospital L&D wards are big on security because of the paranoia of baby-napping. While I'm not gonna say it's "fort knox" secure, it ISN'T easy to just wander in. It's not like the rest of a hospital. (Again, not saying it's not worth reminding them, just that they are likely accustomed to helping screen visitors - since many people don't want visitors during the labor process.)

Again, go take the tour & it may help ease some of your anxiety.

So try to find out if you really will need to fight. You may not! & If you don't have to fight, don't expect to. In other words, relax a bit. Put some degree of trust in the HCPs. Sure, speak up if they start to wheel your DC out of the room, but don't feel that you must constantly be on guard. Feeling so upset & anxious is not conducive to labor. (Have you read any Ina May?)

I'm not a trusting person & I wasn't comfortable with the idea of a hospital birth so I totally & completely understand this anxiety, but try to do the best you can to make your birth experience a positive one - and I think at this point the most important thing to do, after getting a labor support person, is to work towards greatly reducing this anxiety somehow.

Quote:


Originally Posted by *laohaire* 
Some good reasons to have one might be:
- If forceps or vacuum extraction are NEEDED for some reason, they are going to want to make more room for the tools
- To reach in to deal with shoulder dystocia
- If mom really has been pushing a long time (and a long time is not, like, 10 minutes... I pushed for 6 hours, myself) with baby's head engaged but no SD, I dunno, maybe it could help. I had such a situation but ultimately I chose to tear on purpose, and it was done. I don't think anyone could know if the tear would have been better or worse if I had an episiotomy (I didn't). It probably could go either way, sometimes it's better and sometimes it's worse.

Actually there's no need for epis to accompany vacuum - the vacuum doesn't increase the circumference of the 'presenting part' - in other words, there is absolutely no need to make 'extra space'. (Although, yeah, can be needed with forceps, but I believe forceps are relatively rare in the US these days anyway.)

Most hospitals won't "let" mom push more than like 2 hours anyway before moving to CS, so I'd find out what the policy is there.

Yes, if the doc needed to _reach in to make adjustments_ in the case of SD, it can be necessary.

& I believe tearing is always preferable to epis. Period. Epis just leads to even WORSE tears than without epis. Like the cloth analogy as someone already posted.

As others have said, almost no OBs do them "Routinely" anymore - i.e. with every single solitary birth. It's just not that way anymore. HOWEVER - the rate nationwide, I believe is 20% & evidence-based is nearly like 5%! So I'd ask the docs rate of epis - then I'd ask under what circumstances he does them. If he says anything other than "baby in distress" I'd worry. I.e. if he says, "If I see a mama about to tear upward, I'll do one to prevent that." Then I'd worry - that's not evidence based either.

But, again, if you hear "only if medically necessary b/c baby is in distress" and "5% rate" then try to relax & trust that these really are good HCPs.


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## babyjelly (Jan 12, 2008)

Re: your q about tearing worse with subsequent births...I tore quite a lot with my first- I needed stitches in half a dozen locations (although none of the tears individually were really big). Anyway, I didn't tear at all with either of my others.
_Posted via Mobile Device_


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## kblackstone444 (Jun 17, 2007)

Quote:


Originally Posted by *MegBoz* 
You sound really uncomfortable & anxious with this hospital.

Actually, this is the one hospital within 45-60 miles that I am comfortable with. It's the going it alone and nobody "in charge" besides the OB is what scares me. (For the record, I like my OB as well.) I may have a nice, easy birth, or, I might have so many other situations where I need to make decisions and am unable to make decisions (think emergency c-section when they have to put me under). Even if my wishes are made very known beforehand, there's no guarantee that they will be carried out, unless someone I can trust, if not myself, is there to "supervise" the OB.

Quote:


Originally Posted by *MegBoz* 
I'm not a trusting person & I wasn't comfortable with the idea of a hospital birth so I totally & completely understand this anxiety, but try to do the best you can to make your birth experience a positive one - and I think at this point the most important thing to do, after getting a labor support person, is to work towards greatly reducing this anxiety somehow.

The best I've got, is if I can't find anyone until the very last minute, I "might" be able to talk my soon-to-be ExHusband into sticking around in case something happens. Out of all the people in my life, besides my Mother, and she is unable to be there, he'd be the one I'd trust most on this situation, on what I'd want for myself, what I'd want for the baby, etc, plus, the divorce is still not final, so technically I'm his legal Wife and he's the baby's legal Father (not biological). But I don't know if I could talk him into it, even at the last minute- we've got a weird married-but-not married friendship and he would be very uncomfortable being there in that situation.

Quote:


Originally Posted by *babyjelly* 
Re: your q about tearing worse with subsequent births...I tore quite a lot with my first- I needed stitches in half a dozen locations (although none of the tears individually were really big). Anyway, I didn't tear at all with either of my others.
_Posted via Mobile Device_

Okay, good to know.


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## OkiMom (Nov 21, 2007)

My first was born in a military hospital and I was scared to death about what would happen. I was active duty at the time and the attitude of a lot of doctors was "you do what we tell you since your active duty".. I told the nurse I had that I didn't want to be cut at all, Id rather tear and she told me "Oh we only do that by request and if he tries anything Ill body slam him.." The doctor (he was an intern so not really an ob) laughed and told me he would take the scissors and knives out of the room if it would make me more comfortable." They were an amusing pair, made birth interesting. Of course he would have made a great OB, he also asked if I wanted a mirror to see the birth or if I wanted to catch the baby. I said no to both since first I didn't want anything distracting me and second I started shaking REALLY bad right before birth and didn't think Id be able to hold anything. To bad he wanted to work with kids instead and was trying to go the Ped route.

I tore pretty bad with my first (40 stitches, but the midwife commented he was acting like he was doing plastic surgery I guess he made the stitches really small), with my second I had around 20.. in a different spot. I guess I tear really easily.


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## Lady Lilya (Jan 27, 2007)

Quote:


Originally Posted by *Galatea* 
One OB I saw said if he didn't do an episiotomy, my labia would rip off. !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

We dumped him that day.

Have you submitted that to MyOBSaidWhat.com ?


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## Lady Lilya (Jan 27, 2007)

Quote:


Originally Posted by *kittywitty* 
Really? I pushed 3 hours with my first with a swollen cervix that left a lip and doc had both hands in pulling it back while I pushed. No episiotomy and no tear-just a slight "skid mark". Forceps or vacuum I can see, but not always and I don't see why it'd be necessary for hands/arms in the canal.

Our vaginas are all different.

TMI ALERT: A girlfriend of mine tells me her boyfriend has no trouble getting both of his (huge) hands into her without taking any time to stretch her. Yet my husband finds it a very tight fit for 2 or 3 fingers.

So, I can't imagine a doctor having both hands in me without having to either take hours to stretch me, or having to cut me.


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## tireesix (Apr 27, 2006)

Ob said he was going to do an epi for a vacuum extraction, I said no way (it was the only time I stood up for myself in that labour), he didn't do it but he treated me like crap after I said no. He literally went from kinda ok to jerk.


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## luvmybaby333 (Nov 13, 2009)

I didn't want one with my first. I was young (18), but I'd done my research and knew that the vast majority of episiotomies either weren't necessary, or they caused more damage than they were intended to prevent. My own mother had an episiotomy that had torn through to her anus. That's something I wanted to avoid. I told my OB as much, and he seemed very agreeable. Of course, he'd seemed very agreeable to pretty much every natural childbirth idea I'd presented... all the way up until he talked me into an unnecessary induction. The interventions cascaded from there.

In the end, he informed me that he was about to perform an episiotomy. I told him "No!" very firmly. I reminded him again that I desired not to have an episiotomy. He proceeded to perform the cut anyway, while telling me that if he didn't, then I was going to tear. Unfortunately, once my daughter's head was out, they realized her cord was wrapped around her neck and she was blue. So they had to quickly pull her out, which caused my episiotomy to transform into a 4th degree tear. The OB (who had insisted on the episiotomy presumably to save time, since surgical cuts are easier to repair than tears) had actually created a situation in which my injuries were so severe that he had to spend HOURS stitching me back up.

I will say that I suffered from back labor, and I'm fairly sure that my daughter was presenting face up, instead of down... So it could be that the OB was right, and I was about to tear. But as you seem to be aware of: while not fun, a natural tear is almost always preferable to a man-made cut... especially since that cut could very well end up tearing anyway.

I want to add that while I suffered from that 4th degree tear the first time, I delivered an 8lb 8oz baby (1lb 4 oz bigger than my first) all naturally the second time-- and didn't suffer from a single tear, skid mark, or ANYTHING. I kept asking them to check. LOL. It was funny because the OB I'd seen, prior to switching to that midwife team, had told me that in no uncertain terms I would tear again, and it would be worse. He had me in tears because he said that if I insisted on a vaginal delivery, then I would likely become severely incontinent for the rest of my life. Clearly he was an ass... as well as WRONG. If you've had once incidence of tearing, you still have every chance in the world of having a tear-free delivery. Honestly, I credit birthing position to the dramatic difference in condition of my vagina/ vulva after my births. My first was in a hospital where I was hooked up to an epidural and was lying in a hospital bed with my legs up in the air. My second was at the edge of a real bed, on my hands and knees, with a pushing stage that *I* was completely in control of.

I say stick to your guns. Tell your doctor and the rest of the staff ahead of time that under NO circumstances do you want an episiotomy to be performed. Not counting, of course, the event of it being necessary to save your child's life. Good luck to you. I hope your birth goes as you wish, and that your birthing team is able to respect your desires.


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## phathui5 (Jan 8, 2002)

Where in NY are you? I know a couple of people who will do births upstate for free. PM me if you're nearby.


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## kblackstone444 (Jun 17, 2007)

Quote:


Originally Posted by *phathui5* 
Where in NY are you? I know a couple of people who will do births upstate for free. PM me if you're nearby.

I'm in Lower Westchester, just North of the Bronx (the hospital I will be delivering in is in Greenwich, CT).


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## tankgirl73 (Jun 10, 2007)

Baby #1: Delivered lying on my side, dr cut an episiotomy, I had 4th degree tears and hours of stitching up. Overheard between the *two* doctors working on me, one my OB and the other a plastic surgeon: "Do you think this bit goes here?"

Baby #2, 8 years later. I had those fears of the scar tissue not stretching. Had a midwife, but delivered in hospital, induced, under OB care due to hypertension and possible pre-eclampsia.

Delivered squatting. No cuts, no interventions other than the induction. Baby was out in 3 pushes. Needed 3 tiny stitches - 3 separate, tiny, 1-stitch tears.

Here's the fun part. When I was trying to get up into a squat, the nurse on duty kept yelling at me to lie down, "for the sake of the baby". Hubby, love 'im, yelled at the nurse to let me get up and squat. Nurse, resident, other nurses, all imploring me to lie down, I'm refusing. Finally OB comes in and says it's okay, I'm allowed to squat, as long as I consent and acknowledge that I'm putting myself _at greater risk of tearing._

Yeah, whatever.

So a few weeks later my midwife showed me the birth report the OB had written up. "Patient delivered in a squat position. Patient was warned of the increased risk of tearing. Patient did tear and required several stitches."

ARGHHHHHH.... Talk about missing the point...

Anyway, that's my experience, despite my fears my first cut and tear and scar tissue did NOT create greater problems in the second birth. I was planning a waterbirth -- in part to help the scar tissue stay soft. If you can at all manage to labour at home in water and only go to the hospital at the last minute... or even just miss the chance entirely







-- it would give a chance to stretch a bit before the actual delivery. But even if you can't, just yell and boss them around, be in charge of YOUR birth, squat and refuse interventions you don't want unless they are really necessary, and an episiotomy is NOT.

I like the "I DO NOT CONSENT" phrasing idea. Perfect. I'd also go so far as to research some of the more recent studies on episiotomies that do indeed show that they are not only unnecessary but make tears WORSE. Make sure you have the journal publication information. Print out what you can. If your ob or the resident nutjob on hand tries to push one on you, hand them the documentation and ask them why they aren't keeping up with current research and knowledge related to their supposed profession. ;p


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## WifeofAnt (May 2, 2010)

Quote:

"Patient delivered in a squat position. Patient was warned of the increased risk of tearing. Patient did tear and required several stitches."
I guess you "learned your lesson" then.









Sometimes I think the women who just let pregnancy 'happen' ruin it for the rest of us who actually want to be aware and part of the process. I can't imagine not having at least a basic knowledge of something that is going to take up years of my life!!


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## caned & able (Dec 8, 2005)

Yes, that will learn you!

A woman can refuse any intervention to her body that she wants.

In the hospital, you are on the medical doctors' (surgeons') "turf", so to say, so they are in charge and may not listen to you.

An episiotomy, while not done as much as it used to be, is still considered the standard of care in obstetrics and a doctor can justify doing an episiotomy for any birth.


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## kblackstone444 (Jun 17, 2007)

Quote:


Originally Posted by *tankgirl73* 
If you can at all manage to labour at home in water and only go to the hospital at the last minute... or even just miss the chance entirely









The thought has crossed my mind, but around here, if, God forbid, I ended up going to the hospital AFTER the baby was born, I'd be on the 12 o'clock news.







I'm also concerned because I'm at greater risk of a complicated delivery, and it would be a completely unassisted homebirth. Not sure I like those odds.


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## Hannah32 (Dec 23, 2009)

Quote:


Originally Posted by *jeminijad* 
I just wanted to mention that IME, these are becoming less and less common. Every OB I interviewed w/my last pregnancy stated that they "did not do routine epis." And I have never heard a peep of one, in either live birth I've had.

I think you are more likely to be fighting a section than an episiotomy!

Just wanted to add that this was my experience. My OB never brought it up at all. She just kept massaging the area, which felt sort of unpleasant. I did tear though, second degree.


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## Wittyone (May 11, 2005)

Quote:


Originally Posted by *kblackstone444* 

*There's gonna be so much to remember while I'm giving birth- I'm gonna be constantly telling them not to circumcise the baby* and constantly telling them to keep the baby with me for all procedures and constantly telling them no bottles and pacifiers and constantly telling them to screen my visitors (the baby's father was abusive and threatened to take the baby) and now it occured to me that I will also be constantly telling them not to cut me (in any way!) unless it's a life or death situation. I'm worried that I will be unable to keep up with denying their demands, and I'm also aware of the fact that, even if they mean well, and even if they really do try to do everything my way, it's alot for the doctor and the nurses, etc. to remember.


Not exactly on topic here, but wanted to try to ease your mind about the bolded part above. Circumcision is an elective procedure that requires your consent prior to the surgery - there should be no fight to protect your baby from this!


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## Lady Lilya (Jan 27, 2007)

Jessica, haven't you heard about baby Mario who was circed against his parents' wishes in a Miami hospital last month? The parents said again and again they didn't want him circumcised. He was in the NICU. They went home for one hour to get a change of clothes, and during that time he was circed.


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## kblackstone444 (Jun 17, 2007)

Quote:


Originally Posted by *Wittyone* 
Not exactly on topic here, but wanted to try to ease your mind about the bolded part above. Circumcision is an elective procedure that requires your consent prior to the surgery - there should be no fight to protect your baby from this!


Quote:


Originally Posted by *Lady Lilya* 
Jessica, haven't you heard about baby Mario who was circed against his parents' wishes in a Miami hospital last month? The parents said again and again they didn't want him circumcised. He was in the NICU. They went home for one hour to get a change of clothes, and during that time he was circed.

Yeah, that's part of my concern- it happens, and I do know people who have had close calls, as in baby taken and prepped, only to have the nurse notice there was no consent signed, literally seconds before the baby was to be cut. I don't want my main concern giving birth to be to keep everyone's genitals safe, I want to concentrating on bonding on my new baby!


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## Lady Lilya (Jan 27, 2007)

My friend in Seattle had his son cut against his wishes too. If I were him I would have made a big noise about it.


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## listipton (Jun 26, 2008)

Quote:


Originally Posted by *Galatea* 
One OB I saw said if he didn't do an episiotomy, my labia would rip off. !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

We dumped him that day.

WOW.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *Lady Lilya* 
Jessica, haven't you heard about baby Mario who was circed against his parents' wishes in a Miami hospital last month?

Sure, things like this happen, but I would agree with Jessica that it really isn't a big concern. Besides, AAP doesn't recommend routine circ (sure, they don't explicitly recommend _against_ it, but they don't recommend it either.) It's not so unusual to decline.

Besides, if your baby is always in your sight, you don't have to worry about it. If you're really concerned & maybe baby is in NICU, you can always put a sign on the bassinet or talk to the nurses & make sure they all know.

I agree with others about episiotomy - if a doc wants to do one, he'll find an excuse to do one. Even if you decline, sometimes they do it anyway. It would be difficult to find a lawyer to take the case to court even though it IS medical battery and IT IS A CRIME.

But I think circ without consent is much, much more rare & not something I'd really worry about much.


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## kcparker (Apr 6, 2008)

Quote:


Originally Posted by *kblackstone444* 
Yeah, that's part of my concern- it happens, and I do know people who have had close calls, as in baby taken and prepped, only to have the nurse notice there was no consent signed, literally seconds before the baby was to be cut. I don't want my main concern giving birth to be to keep everyone's genitals safe, I want to concentrating on bonding on my new baby!

If you are seriously, seriously concerned about this sort of unauthorized cutting being done to you or to the baby, I would really consider going elsewhere to give birth. You are right, this should not be an issue you have to deal with during birth or postpartum. "Don't cut me, don't cut my baby" is not that hard to understand. If you must give birth at this place, I would advise you to contact the patient representative before you give birth, talk to them about your desire and fears ahead of time, deliver this in writing, make sure it's in your charts, have signs posted in large print in your room and on the door spelling out your wishes. I was kidding before, but now I am serious - write "I do not consent to an episiotomy" in sharpie on your thigh for the birth, and have the baby outfitted in onesies that say something to the effect of, "Don't even think about circing me." Talk with your OB though about practice protocols - maybe you are worrying needlessly?


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## Lady Lilya (Jan 27, 2007)

I have heard again and again about things being done to babies against parents' wishes. Whether it is circ, vaxes, giving formula or sugar water or pacifiers.

I've also heard again and again about doctors doing unwanted things to mothers during a birth. Sometimes without them even knowing (ie putting something in the IV). Sometimes too fast for them to say no. Sometimes even while they are saying no.

I don't think the fear of unwanted episiotomy is unfounded. That is why I am planning my second homebirth.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *Lady Lilya* 
I have heard again and again about things being done to babies against parents' wishes. Whether it is circ, vaxes, giving formula or sugar water or pacifiers.

I do personally think the fears of unwanted vaxes & pacifiers are warranted. First of all, both are so common & routine - MORE common & routine than circ.

Second of all, it's thought of as "dangerous" to NOT vax!







but I do believe most medical professionals are aware there is no "danger" in not circing! (Again, AAP doesn't recommend it as routine.)

& HCPs do things to a birthing mama without (or even in spite of a lack of) her consent because of habit (remember, most mama's never question anything a doc says anyway!) or because they legitimately believe they know best and it's "necessary." Again, with circ, there's no issue of 'blanket consent' which gives an HCP more legal freedom to do things to a birthing mama- it's an optional thing, it's not viewed as dangerous to forgo & even it's not covered by all insurance some places.

I still say the fear of unwanted circ isn't that warranted - and no where near as much as the fear of unwanted epis or other procedures in labor (I agree - that fear is warranted.)

But, again, all this being said, I still think it's worth going on the hospital tour, chatting with the nurses, finding out what common rates are for things like epis, nursery-stays, etc. If only 50-60% of all boy babies are circed in the hospital anyway, I'd be a LOT less nervous about unwanted circ than at a place where 99% of the boys are. That's not to say I still wouldn't put it in the birth plan & remind the OB & the nurses, but I wouldn't let it stress me. Again - I wouldn't let it stress me - just like every time I get on the highway, I'm not stressed about an accident.

As I wrote before, it seems to me this OP is very stressed & anxious about this hospital birth - and all the responders only seem to be affirming that she has legitimate reason to be terrified & expect constant battles.







In that regard, this thread is kinda making me sad.

Again, I believe I already wrote it - but while it's true that _only the whole_ American maternity care is an "atrocity" - there are plenty of great hospitals & HCPs out there. *It's absolutely ridiculous to paint them all with the same brush!* Just as it's ridiculous to say, "You pick a hospital birth, you take the hospital ride."







. Yeah, whatever. Just like every Homebirth midwife is caring, & consistently provides woman-centered, evidence-based, competent, & patient care. Right? There are no great hospital births & no horrible HB MWs?


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