A Rant on Episiotomy

[MegBoz]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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"

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

& from Childbirth Connection

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]

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]

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]

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]

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]

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]

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.)