Originally Posted by AlaaJ
Can anyone recommend some good anti (routine) episiotomy articles that I could pass on to my OB? Thanks.
You could start with the book, 'Thinking woman's guide to a better birth." it summarizes LOTS of scientific studies - all of which are referenced in the back. I've heard docs will often scoff at & dismiss such books, so you could go look up the exact studies that Henci Goer sites & then share those. That book is getting a bit old now though (1999, I think?), so you could look for newer stuff here too:
Although I wouldn't be too hesitant to share research from the 1980s and 1990s. Research showing that routine epis leads to WORSE perineal tears & trauma vs. risking natural tears is still good & valid decades later.
But most importantly, the fact that you feel the need to share anti-routine epis articles with your OB tells me you probably ought to look at getting a new HCP. :( It seems the biggest predictor of whether or not you'll have one is your HCP's practice style. The articles I quote above list the astounding variations in rates between older OBs, younger residents, and MWs. I think even still in the past decade, some older OBs were having rates near 60%. I've read on MDC that generally if an HCP thinks they are good, that HCP will find a reason to do one- so it can be hard to avoid.
Personally, if I had even the slightest suspicion an HCP didn't have an accurate, evidence-based view of epis, I wouldn't let him or her anywhere near my genitals. It's just a chance I'd try not to take - and if I really had no other choices, I'd have BOTH my DH and a doula hovering over his shoulder. I told DH if my HB ends in transfer and a doc is about to cut me, he is to yank the scissors out of the doc's hands & stab him in the eye with them! DH replied, "I'm not going to do that!" I said, "Ok, yeah, obviously not the stab-in-the-eye part! But I'm NOT kidding when I say I expect you to STOP IT and yank the scissors out of his hand!"
ETA - yeah it was the last link I posted:
"A study published last year in the Journal of Reproductive Medicine showed that physicians in practice 15 years or more perform episiotomies 50 percent more often than those in practice less than 15 years....
The JAMA article found that although episiotomy rates have consistently declined over the past 20 years, wide variation in practice indicates that its use is driven by local professional norms, training and practitioner preference rather than the needs of individual women at the time of birth. A study conducted by researchers at the University of Ottawa, Ontario, published in the April 2000 issue of Obstetrics and Gynecology, also found factors such as time pressures, malpractice concerns and lack of experience with clinical alternatives to episiotomy.
The article also mentioned:
"Dr. John R. Scott, a Spartanburg, S.C., obstetrician-gynecologist who advocates against routine episiotomy, thinks it's hard to retrain older doctors.
"You can read and understand the literature, which shows that you should let nature take its course, but it's so ingrained in you to cut a small episiotomy," Scott said in an interview."
Yes, it strikes me as a near-impossible, unrealistic goal for one patient to attempt to educate an OB & get him to change the way he practices. Much better to just find an HCP who always practices evidence-based medicine, and whose philosophy matches yours.
"In Listening to Mothers II, a national survey of more than 1,500 women who gave birth in 2005 conducted by Childbirth Connection, a New York-based nonprofit working to improve maternity care, 73 percent of those who had an episiotomy stated that it was done without their prior consent.I think hoping to educate an OB to get him to change his ways is an extremely unrealistic goal. So much better to just find an HCP who both practices evidence-based care in all cases, and has a philosophy that matches up with yours."
Finally, regarding the above stated, "clinical alternatives to episiotomy" I'd still worry about an HCP with a high-epis rate. Even if s/he agreed to restrict use of epis to only fetal distress for me personally, clearly this is an HCP who has no clue about physiological birth. For an HCP to sincerely believe that it is better off (or outright necessary) to CUT the perinium the majority of the time definitely proves they are severely ignorant of the normal, natural processes of birth. Therefore... they view their own actions as beneficial and/or necessary as opposed to letting the baby's head just naturally stretch out the perinium. So if they were asked NOT to do epis, I'd think they would be very likely to try to manually stretch you. :( Not good either to do that vaginal "wrenching" & yanking it apart.
Just saying again, a pro-epis HCP is someone I wouldn't want near my genitals.