When is an Episiotomy Medically Necessary?

[Turquesa]

The World Health Organization states that hospitals should make it their goal to lower episiotomy rates to 5%. I hear childbirth reform advocates denounce them as "unnecessary," but I'm reluctant to reduce a process as unpredictable as childbirth to a simplistic series of "always-always" and "never-evers."

I know that concerns of a woman tearing naturally or that she's "just too small" do not constitute scientifically valid reasons for the practice. But is there a situation when it could save a woman or baby's life? Surely the WHO has something in mind if it's not recommending a 0% rate....???

[Spark]

There are numbers out there that an Episiotomy reduces the birth process by 2 minutes on average (I think, I can't recall the exact minutes but it's SHORT). In very very few cases those 2 minutes mean a lot.

[Belle]

I can't see any situation where it would save the mother's life. They don't do episiotomies until the baby is already at the perineum. There are a few situations where it could possible save the baby's life but not many. It doesn't prevent tearing either. If they don't give you the skills you need in medical school to prevent tearing you have to use the only skills you know how. Doctors are taught how to cut, so they cut.

My midwives had an 5% Cesarean rate. Understandable. Sometimes they are necessary. Their episiotomy rate was 0%. They've never needed to do one.

[Astraia]

If it's the kind of situation where baby needs to come out FAST- like everything looks great the whole time and then heart rate crashes, say.

Or everything looks great then right before crowing the water breaks and there's thick meconium, it's advisable to have baby born quickly.

I've heard some things where the care provider needs extra room to maneuver inside you- like, say, shoulder dystocia so they can get their hands in to free the shoulders.

Otherwise.... nope, not useful. SOME doctors say that it's useful in preventing "blow outs" (where you have a lot of severe tears) but really, a slow delivery of the head and a position other than lithotamy is your best prevention against that (from what I've read, at least...I could be talking out of my bum here)

[mbhf]

I think they are sometimes helpful. I had an episiotomy during my oldest's birth, and I was really upset about it for a long time. Thinking back, though, I think it was probably a good call. He was posterior and asynclitic, I had been pushing for close to four hours in several different positions. Maybe he would have been born fine without it in two minutes, but who knows.

[tzs]

i've heard you can tear the "other way" like towards the front (i.e. clitoris)...then you would want one

[Sileree]

The WHO says its a legit procedure for fetal distress, female circumcision (not to do the actual circ, but because of scar tissue and the opening being small, etc.) and for complicated deliveries ONLY.

[mysticmomma]

Originally Posted by sileree

the who says its a legit procedure for fetal distress, female circumcision and for complicated deliveries only.

what?

[MeepyCat]

Originally Posted by mysticmomma

what?

SOme extreme forms of female genital mutilation include sewing the vaginal opening shut to some extent. In these cases, sex is difficult and painful for the women, and episiotomy may be required to make room for vaginal childbirth.

[billikengirl]

Originally Posted by mysticmomma

what?

My understanding is that female circumcision (and infibulation if they do that too) can leave such scarring that I can see how the tissue would be inelastic.

[mysticmomma]

oooooh. I read it as performing female circ.

[Astraia]

Originally Posted by MeepyCat

SOme extreme forms of female genital mutilation include sewing the vaginal opening shut to some extent. In these cases, sex is difficult and painful for the women, and episiotomy may be required to make room for vaginal childbirth.

Oh, lol. I understood the earlier post to mean that epis were used as a FORM of genital mutilation and was seriously confused.




And regarding tearing into the clitoris- yes, well... anything is possible when it comes to tearing. It's REALLY hard to predict where it might happen. I've heard of very pro-epi dr's ("I do them on all my patients, you don't have a choice" type dr's) not doing them because they didn't think the woman would tear, and then they did <shrug> It's tricky.

I'd rather take the risk of small/no tear than an episiotomy.

[Spark]

Originally Posted by Astraia

I'd rather take the risk of small/no tear than an episiotomy.

My intact perineum is one of the best gifts i ever gave myself.

[tzs]

for sure...a tear is better than an episiotomy...BUT they can tell if you are beginning to tear towards the front...it's rare. then by all means go for the episiotomy. this type of tear actually happened to my doula.
just saying...that would be a medical reason in my book.

[mom2reenie]

I've given birth 3 times and my first two births I had an episiotomy. My first performed by a doctor who could count on one hand the number of episiotomies and the second by a midwife who throughout my pregnancy told me that she would not do an episiotomy and instead would rather me tear.

I never got the exact reasons for my episiotomy, but not once have I questioned if they were needed. I did all the research, asked all the questions, chose care providers who were known for not performing episiotomies and I still had two.

I agree it is probably a procedure still overused, but I don't know if there is a way to easily say when it is absolutely needed and when it isn't.

[Astraia]

Originally Posted by Spark

My intact perineum is one of the best gifts i ever gave myself.

I had 3 small tears- stupid midwives had me doing directed pushing in lithotomy

[seeing_stars]

I tore upward during my first delivery and had to have it surgically repaired more than a year postpartum. I have nerve damage to my clitoris. In that instance, I would have preferred an episiotomy.

My second delivery I did not tear, we had lots of counter pressure on the vulnerable spot near my clitoral hood.

My third delivery I had a 2nd or 3rd degree episiotomy for a shoulder dystocia. I am at peace with the episiotomy, the doctor followed procedure and only cut as a last resort when she needed to access his arm ad shoulder for quick delivery.

[mwherbs]

I could see controlling the direction of the tear if it looked like it was going to be upward- or if someone is sewn shut/ or has scar tissue where the skin does not thin out or open enough to let a baby out
another reason would be in case of shoulder dystocia and you cannot get your hand into move the baby's shoulders-

[AlexisT]

As someone posted above, they can be necessary for complicated deliveries--forceps and some shoulder dystocia maneuvers come to mind. The problem here is that when you're at this stage, the baby has to come out or it will die; you're past the point of no return with options. So you can be forced into a situation where an episiotomy is the best option.

It's rare, but that's why WHO says 5% and not 0%. Sometimes the OB/MW needs the extra room.

[siobhang]

I had an episiotomy with my second - natural vaginal breech delivery of a 9 lb baby when I had bad scarring with my first (a third degree tear) - oh, and I went from 9 1/2 c to baby delivered in 30 minutes and it would have been less if they hadn't made me wait for the doc to arrive.

Basically the doc said that I needed more room to deliver him - and my son had a HUGE butt. My son just wasn't going to come out without some serious tearing on my part without an episiotomy.

And I gotta say, the healing from the episiotomy was much easier than the third degree tear. In this particular case, I think it was 100% justified,