Episiotomy Question

[ChetMC]

When exactly is an episiotomy medically necessary?

[LiLStar]

maybe in an instance of true, severe fetal distress in a baby that is crowning, and 5 seconds could mean the difference between a healthy baby and dead/brain damaged one? I think I once also heard of a bandl's ring in the vagina that had to be snipped in order to allow the baby to pass through. But thats pretty much unheard of.

[elus0814]

A midwife of mine told me that in 22 years she had only cut one once and it was on a woman who was very athletic and her skin was tight and after a lot of pushing just wasn't stretching.

[Trac]

I had one at my midwife-attended HB. I had been pushing for 4.5 hours, 9lb.6oz. DS had his little fist up beside his head, and I was pushing, and he just wasn't moving. She cut on the side, and apologized profusely. I was glad to get off that birthing chair that she had. Exhausted!

[AlexisT]

They may also have to cut for forceps and to do certain maneuvers, depending on their skill, the baby's position, etc. There's a big judgment call element, which makes it really difficult. That said, you can ask your provider about his/her philosophy (some will still come out and say things like "first timers usually need one"--it's nonsense, but at least they're being honest).

[nashvillemidwife]

Originally Posted by LiLStar

I think I once also heard of a bandl's ring in the vagina that had to be snipped in order to allow the baby to pass through. But thats pretty much unheard of.

Bandl's ring forms at the meeting up the upper and lower uterine segments, not in the vagina. I have seen two very tight vaginal bands. With the first the mom suddenly pushed right through it and tore into her rectum; with the second we considered episiotomy might be necessary/preferable but ended up transporting with a c-section so we don't know how it would have turned out.

[Sileree]

Originally Posted by ChetMC

When exactly is an episiotomy medically necessary?

According to the WHO:
- If the mother is circumcised
- For fetal distress
- For complications (breech, forceps, etc.)

[lifeguard]

Forceps is not necessarily an automatic episiotomy. I had a forceps delivery. I tore like crazy but doubt the damage would have been much better with an episiotomy.

[kcparker]

According to the WHO:
- If the mother is circumcised
- For fetal distress
- For complications (breech, forceps, etc.)

In the first case, isn't always necessary - it depends on what type of circumcision and how much the mom has been sewn up.
In the last instance, I think a lot of it depends on the skill and training of the provider and whether or not the baby is in distress. I have seen a vacuum extraction that didn't involve an episiotomy, but I think forceps might be more invasive. And somebody who is trained to attend breech births probably would not find it necessary to cut a woman birthing a breech baby.