Can you say no to an episiotomy? - Page 2

[MaerynPearl]

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)

[kblackstone444]

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.

[Honey693]

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.

[NewMoonMum]

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!!

[creillysheehan]

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!

[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..

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..

[Banana731]

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...

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.

[mamabadger]

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.

[nia82]

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.

[SubliminalDarkness]

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

[MegBoz]

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.

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.

[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.
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[kblackstone444]

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.

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.

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.
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Okay, good to know.

[OkiMom]

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.

[Lady Lilya]

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 ?

[Lady Lilya]

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.

[tireesix]

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.

[luvmybaby333]

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.

[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.

[kblackstone444]

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).