A Rant on Episiotomy - Page 3

[minkajane]

Originally Posted by MegBoz

Besides, I have to wonder, if the tear starts happening, would it really be possible for a cut in another direction to STOP that tear from continuing further? I have to think it's unlikely.

I can totally see how it would help. If you're starting to tear upward, a cut on the perineum can relieve the pressure and can stop it from getting worse. I still don't agree with it, but it makes sense to me.

[dayiscoming2006]

I also hate episiotomies!

I had an unnecessary one with my first and it didn't heal quite right. I was unable to have mostly pain free sex until around a year after my son's birth and I still have a tightness there that was never there before.

I successfully birthed my second in a hands and knees position during pushing until I was forced onto my back by the doctors at the very end but he was nearly out by then so I didn't tear and no skid marks.

***
Wanted to add my birth plan stated that I didn't want an episiotomy and I didn't consent to it. She just did it without even telling me. I only pushed for 40 minutes and I'm convinced if I wasn't on my back it could have gone quicker.

[3xMama]

[QUOTE=minkajane;16015141]I was watching a birth on TV the other day and right as the baby was about to come out, the doctor says all nonchalantly, "We'll just make a little room..." and snip snip snip! There was no consent, no question, just "a little room"!!!! QUOTE]

This happened to me w/ my DD. I had been pushing for three hours and she was having minor decels, but not to the point anyone had said anything to me about it or done more than put an oxygen mask on my face. (The only reason I even know she was having decels is because of the research I've done since and know the oxygen mask is used for that.) The dr was concerned of her size, too, and her getting stuck. When DD was really close to finally being born and the ob said "I'm going to help things along a little, look away" (I was using a mirror to watch the birth). Poor DH didn't know what she was going to do soon enough and apparently the "look away" came after she made the cut, luckily I got it and missed that. I highly doubt that I needed that epis. She was crowning and the way the dr did it makes it sound, to me, like a totally routine procedure for her.

I went through a lot of pain and discomfort that lasted a good year, year and a half pp, all for a routine procedure that was unnecessary. Its the one part of that birth I'm really not at peace with.

[jengacnm]

In my 10 years of midwifing, I've done ONE episiotomy that was necessary. I was involved in a few where, seriously, I was gowned and catching but the doctor reached around me and cut. I still feel sick over that.

Anyway, this was a hospital birth that was unusually high risk. The hospital & my employing doctors were pretty great about midwives doing the births while they managed things like insulin drips and magnesium for preeclamsia by phone.

This particular patient was both-she was an insulin dependent diabetic AND had severe preeclampsia. She had every sign of diabetic ketoacidosis except for the actual acidosis. Her labor went well, her pushing went well, and in the last half hour the baby's heart rate steadily drifted down. No decels (I rmember that clearly), just a progression from 160 to 90, in a really smooth line-which is scary in the world of fetal monitoring. The baby was almost but not quite crowning when it started to stay below 80. EVERYONE in the room was holding their breath-me, nurses, the pediatrics team, the mom and her husband. (Well, ok, mom was pushing.)

I cut the tiniest of cuts and the baby came tumbling out.

I haven't done one since, and that was over 8 years ago. I hope I never have to do one again. If I do, I hope it's as well timed as that one. And I take no credit for how well timed that one was. I guess those prayers to the birth dieties work.

[babygirlie]

I was not asked if I was ok with an episiotomy. Baby was 5.1#. I had not been "pushing" for very long. There was talk of baby not getting enough oxygen and it was my fault for not breathing right and I couldn't understand wth they wanted. Breathing deep made them irritated breathing faster they said was wrong. I'm not sure what they wanted but I was told she wasn't getting enough oxygen and had to come out now. Not sure why she wasn't. She was ok for 7 months in there and 3 days of inducing. I just don't k now. I don't even know what degree tear, no one told me.

I thought swelling and extreme pain was normal. Maybe it was the episiotomy. I remember thinking... your butthole moving to your lower back was not in the pregnancy books and it was really tripping me out...

[pregnant@40]

I thought it was now standard of medical care to not do episiotomies? The MDs who do are not current w/ the latest research & guidelines.

[MegBoz]

Originally Posted by pregnant@40

I thought it was now standard of medical care to not do episiotomies? The MDs who do are not current w/ the latest research & guidelines.

I do believe it's the current "standard of care" not to do routine epis (so, for a doc to not have a 100% epis rate.) But with the US rate being over 30%, I'm guessing a lot still believe they can make a cut that is better than a tear - I've heard that some OBs claim all first-time-Moms need a cut -- which makes NO SENSE WHATSOEVER - if my vagina is incompetent & unable to adequately stretch the first time, why is it suddenly OK the second time - especially if you've now made it LESS stretchy thanks to the addition of a piece of scar tissue - which is not stretchy.?!

Anyway, and we know American OBs are always RUSH RUSH RUSHING birth - what with inductions, augmentation through pitocin, AROM, purple pushing, so I suppose it's par for the course in a "pushed" birth - to HURRY UP everything - even if baby isn't in distress. Heck, I know many hospitals put a time limit on pushing - for some it's 2 hours and I think I've even heard of a one-hour limit, which seems totally insane to me.

So it makes sense that if they legitimate believe >1 or 2 hours of pushing is dangerous, then epis to speed up 2nd stage is warranted.

So while you are correct that really no HCPs do routine / 100% epis, there do still seem to be enough reasons remaining in the opinions of American HCPs - and clearly TOO MANY reasons since the rate's way too high.

[Youngfrankenstein]

Okay, picture the pelvic floor. Then picture a woman flat on her back. Now raise her legs up into stirrups...Can you picture that "back" of the perineum being stretch and forced taut? No wonder they "needed" epis.....

I have never been close to an epis. situation but I did have a SD at my homebirth and mw could reach up and dislodge her.

She was 10# 4oz and I had no tearing whatsoever...I never even needed an ice pack after that birth.

[AlaaJ]

One doctor I went to said that she regularly performed episiotomies because all that pushing from the baby is gonna cause the vagina to become enoromous and leave the mama with big flapping balloon for the rest of her life. So instead of letting baby keep pushing and pushing, you snip the mama and let baby slide out, thereby letting vagina retain its original size.

I'm just wondering if there is any validity at all in that bs? I've given birth twice, episiotomies both times, and the area "down there" is forever changed, episiotomy or no. (Not that it -- the change -- is a bad thing.)

I've also been told that doctors here (Lebanon) also perform some kind of constructive surgery post vaginal births so that the woman's vagina regains it's pre baby/virginal tightness. Has anyone ever heard of that? My friend studying at the American Uni of Beirut once heard a doctor coming out of a delivery room wink at a new dad and say, "Your wife is now better than before." Huh??? From what I understand, they sew up the tear or episiotomy and then go on to sew something from "inside" as well. My knowledge about this topic is really fuzzy; it's all hear-say -- just wondering if anyone can shed any light on this topic.

[Comtessa]

I've heard of this. They used to call it the "husband knot." It is supposed to make the woman "tighter" than before. It also has the added benefit of making sex excruciating for the woman. Because, you know, sexual pleasure is only for men anyway, so who cares what kind of genital mutilation you do on the woman to improve the man's experience? I don't know about you all, but if sex is excruciating for me, my husband's experence is nil.

I didn't know anyone still did this -- it's something I remember reading about from the 50's.

[Turquesa]

Originally Posted by Comtessa

I didn't know anyone still did this -- it's something I remember reading about from the 50's.

50s? After my mom had her last baby in 1977, a doctor was trying to sell her on this.

ETA: And this was in the U.S. This surgery has been around for awhile, and it's probably still lingering in some more patriarchal cultures.

[caned & able]

Allaaj: That is called a "husband's knot", and it should not be done.

An episiotomy has its place in obstetrics. Otherwise, it is a form of sexual mutilation or a weird form of sexual initiation.

It should not be done on every mother in the world.

[msmiranda]

Count me in as another woman who is irrationally (or maybe not) angered by episiotomy. I categorically believe that absent an emergency, it is a form of sexual assault. And even in the case of emergency, consent should be obtained if possible.

My mother was cut both times -- this was the 70s and it was routine. With my younger brother, they used forceps and their cut tore into the rectum. She had to have additional surgery when he was a few months old because it was not healing properly, and has had painful intercourse and incontinence (urine and fecal) ever since. She is in her 60s now. I don't think she's ever had an accident with the latter, as such, but she cannot be far from a bathroom ever. And she doesn't like to travel because of it. It makes me sick to my stomach. Those f-ing butchers.

If I had to have a vaginal hospital birth for some reason, my DH would be under orders to stand over me and to knock the *&%# out of anybody who even thought about picking up a pair of scissors.

ETA: In my state, you can obtain the c-section and episiotomy rates for most OBs from a few years ago. I scrolled down the whole list and the rates varied WIDELY. There was one doc with a 70-something percent rate. I think the average was 20% or so. It is absolutely a litmus test for me. But surprisingly it did NOT seem to correlate with c-section rates very much, and my guess is that the older docs are the ones more likely to still do epis, but not as likely as younger docs to jump to a section. And, the one doc around my area who is the hero of the natural birth community because he will do vaginal breeches and twins and lets moms push for a long time and have broken waters for a long time, has a pretty high epis rate given his otherwise stellar reputation. So, it's all a mixed bag.

[MyFullHouse]

Originally Posted by AlaaJ

One doctor I went to said that she regularly performed episiotomies because all that pushing from the baby is gonna cause the vagina to become enoromous and leave the mama with big flapping balloon for the rest of her life. So instead of letting baby keep pushing and pushing, you snip the mama and let baby slide out, thereby letting vagina retain its original size.

I'm just wondering if there is any validity at all in that bs? I've given birth twice, episiotomies both times, and the area "down there" is forever changed, episiotomy or no. (Not that it -- the change -- is a bad thing.)

I've also been told that doctors here (Lebanon) also perform some kind of constructive surgery post vaginal births so that the woman's vagina regains it's pre baby/virginal tightness. Has anyone ever heard of that? My friend studying at the American Uni of Beirut once heard a doctor coming out of a delivery room wink at a new dad and say, "Your wife is now better than before." Huh??? From what I understand, they sew up the tear or episiotomy and then go on to sew something from "inside" as well. My knowledge about this topic is really fuzzy; it's all hear-say -- just wondering if anyone can shed any light on this topic.

I've never had an episiotomy, but I've gone with no tear, and I've had a serious tear (don't really know what degree, but the repair was hell!).

At my 6wk check up with #2, my not-so-tactful OB smiled, and said it was as though no babies had ever come through there. Uh... thanks?
Through all 4, dh and I have never noticed a difference after an appropriate amount of healing time. Of course it's possible that dh is just too smart to say anything, but I don't know if he really deserves that much credit.

So, ime, that whole thing is a crock. I have a feeling it's more of a YMMV thing though.

[Smokering]

I've heard of this. They used to call it the "husband knot." It is supposed to make the woman "tighter" than before. It also has the added benefit of making sex excruciating for the woman. Because, you know, sexual pleasure is only for men anyway, so who cares what kind of genital mutilation you do on the woman to improve the man's experience? I know know about you all, but if sex is excruciating for me, my husband's experence is nil.

I didn't know anyone still did this -- it's something I remember reading about from the 50's.

Eugh. You know Bridget Jones' Diary? It was originally a newspaper column (fictional, of course), and in the column she got pregnant by Daniel Cleaver (the Hugh Grant character in the films) and had a baby. In the column where she recorded the birth, she said she pushed the baby out and was taken to be stitched up (and put under, I believe?) - and heard the doctor asking Daniel how tight he wanted her to be stitched up. He said something like "How tight? 17? 16?" and Daniel smirked and said "15", and Bridget's comment on this was something like "Hmph" or "Oi", but she didn't take any further issue with it than that. The whole Bridget Jones saga ended immediately after she had the baby, so we never got to hear of any repercussions from it.

Anyway, it made me sick. I know it's fiction and that Daniel Cleaver's supposed to be a shallow, womanising jerk; but still. This was written in, what? The nineties at the earliest. I can't remember if she actually had an episiotomy or just tore, but the "husband stitch" thing was just repellent.

[3xMama]

One of the times I went into the hospital for contractions with my first (hey, I was young, had never been around a pregnant woman and had no idea what was going on!! ), I was walking the halls trying to get the contractions to start again (they didn't). While we were walking I over heard an OB talking to a woman obviously in labor, trying to get her to agree to an epis when the time came. His logic was that it was easier to stitch up a cut after birth as opposed to a tear because it was a straight, smooth cut as opposed to having jagged edges... Even I, pregnancy/birth novice, knew that was a crock of bull. Not to mention the fact that he waited until she was in labor to bring the topic up instead of weeks before at a prenatal.

(Incidently, that was also when I knew it was time to pack up and head home. After hearing that poor woman trying to talk during labor and I finally knew what a woman in labor sounded like, I knew I was no where near labor!! )

ETA: The idea of a "husband knot" makes me sick. Seriously, how depraved do people have to be to do that? Although I am curious, I've heard of a revirginization plastic surgery, is that essentially the same thing just by choice and done in a more "humane", for lack of a better term, way? Off topic, sorry!

[caned & able]

OT, to 3x Mama:

The husband's knot is an extra knot to tighten the vagina during repair of an episiotomy. REVIRGINIZATION plastic surgery is to replace the hymen or build one where there never was on.

I suppose the two could be done together. I know that some women have a second repair done after child birth when the episiotomy does not heal well, is not done well, or in the case of a prolapse in which pubococcygeal muscles have the organs have fallen and are not doing their job.

[MissE]

Originally Posted by Marissamom

see my earlier post, I had scar tissue that wouldn't stretch, wouldn't tear. babies heart-rate was not good. There is also the occasional time when the baby is in distress and can't wait until mom has stretched .

DD heart rate was down to 60 beats for almost seven minutes. I had nurses screaming at the OB that 'we have to get her out" and I believe I HAD to be cut. It was necessary or maybe DD would not have made it. Her Apgar was 3, she was blue, not breathing. She came back almost immediately but it was close I guess.

I had a C/S with my first one and that was a horrible experience (long labor, long pushing, OP baby etc). I take an episiotomy anytime. I didn't have any problems with it other than being sore for a few days.

HOWEVER. My friend gave birth about 7 months ago. The nurses were saying "we're not emptying your bladder (she had an Epidural) because the baby will probably come really fast (they actually said 'fall out')" and then the OB comes in, has her push twice and CUTS HER. I was standing there not even being able to understand what just happened. Now my friend keeps complaining that something is different down there. Apparently the OB didn't do so well sewing her up which really upsets my friend.

[suzysprite]

After pushing for three and a half hours with my daughter, there was a band of tissue that simply would not give. I was exhausted, and had hit a wall. When the doctor said the word episiotomy, I freaked out for a moment, and then I was like, "just do whatever you have to do." my doula and midwife were supportive of the decision, and the dr made the cut. My daughter arrived immediately afterward. It was a very small cut, and healed exceptionally well. The worst part of my recovery was how sore my arms were from hanging on to various things while pushing.

So, in my case, I'd say the epi was beneficial.

[nia82]

My mom had epis at all her births, and her mom told her back then that it must be so much better than the horrible tears that tear so not straight... Hmm!

I didn't have an epi, but I specifically said no to it on our birth plan - I would only have consented if DS's heartbeat was like crazy low. I pushed for 2.5 hours and DS had a nuchal hand and wasn't completely anterior, I had two 2nd degree tears and only felt sore for a couple of days. (The obgyn in her practice would have wanted to cut me because I was a first timer, DH had strict instructions to yank scissors out of his hands on sight)

My sisters both had epis. I know otherwise Germany is very natural birth friendly, but so far all people I know had epis. My oldest sister had a vaccum extraction for big baby with epi, I don't know how long she had been pushing, not long though I think, I don't want to give her bad feelings about the epi and vaccum (baby's head was 35cm, it is not that big, DS was 33cm but he had his hand there which makes for a bigger head in the end). My other sister said her son's heartbeat was bad and he had the cord wrapped around the head. I don't know how low the heart rate was or if the cord was truly tight, but it was long enough for her DS to be on her chest immediately and having the cord stop pulsating. Anyways, I have to look up stats, but I have a feeling it varies widely from HCP to HCP. The midwives I'm seeing right now have a super low rate. One told me she has been a midwife for 10 years and did one epi in those 10 years...