Episiotomy question

[ShelleyMom2in2]

I had an epi 13 mos ago-it still hurts and I have numbness/nerve damage and lots of muscle damage so Id really like to avoid another one. My DR left it open part of the way, telling me Id be more likely to NOT need another epi this way (I didnt know he was leaving it open at the time!) So my question- do I have the right to refuse an episiotomy? I had in my birth plan that I did NOT want one unless I was going to rip end to end. Well I ended up with a massive epi so Im guessing I would have ripped end to end? Who knows. I really would rather just rip down my old scar so I dont have MORE nerve and muscle damage. there will be 15.5 months between my labours.

[LianneM]

If you don't want it done, no matter what, make sure they know that. Have it with you in writing, and ask them to read/sign if you want to. Make sure they know that it is extremely important to you that they not cut. I don't see how they could after that, KWIM? Good luck!!

[cottonwood]

I hate to break this to you but tearing is *more* likely with an episiotomy. As is muscle and nerve damage. And yes, you absolutely do have the right to refuse any procedure you don't want, however, if the doctor really wants to do something to you, s/he can always claim that it's an "emergency" situation. So probably the first thing you want to do is find a birth attendant who is practicing evidence-based care.

And there are LOTS of things you can do to avoid tearing! (I'll let others elaborate as I'm nakking...)

[ctdoula]

Hi! I also had an epis (by an OB who 'didn't do them' because my dd's HR was tanking) and ended up w/a 4th degree from her shoulders popping out of me. I've spoken with the MW about this issue & she knows I DON"T want a repeat. What she said to me is she doesn't cut (unless absolutely necessary, which is what most providers will tell you), but that the scar tissue is not as flexible as my regular tissue & I may tear. I'm okay with that. Anything is better than another 4th degree.

[gottaknit]

I just do not understand how taking a knife to a woman's vagina when she says "No" can even be legal. Sounds like assault to me.

[liawbh]

Originally Posted by blueviolet

I hate to break this to you but tearing is *more* likely with an episiotomy. As is muscle and nerve damage. And yes, you absolutely do have the right to refuse any procedure you don't want, however, if the doctor really wants to do something to you, s/he can always claim that it's an "emergency" situation. So probably the first thing you want to do is find a birth attendant who is practicing evidence-based care.

And there are LOTS of things you can do to avoid tearing! (I'll let others elaborate as I'm nakking...)

Wierd. I asked b/c I was really worried, have a long scar, and My midwives said that they don't see any more tears on epis scars than otherwise.

As far as avoiding a second, I'd seriously consider switching providers. My doc also told me he only does them if necessary. I later found out that by necessary he meant first time moms

Good luck

[PapayaVagina]

My doc also told me he only does them if necessary. I later found out that by necessary he meant first time moms

Yeah, that's how sooooo many of them word it. "Only if you need it." "Only if it's necessary."

Most of them think that "medically necessary" applies when a baby is coming out of a vagina.

[plantmommy]

I was cut with my first... all 6lb 12oz of him. Didn't tear at all, on the scar or otherwise with either of his younger sibs, both nearly 1lb larger than he.

[2+twins]

The thing about tearing is it's not a sure thing. Yes, you *might* tear. But then again, you might not. With an epi, well, you *will* be cut and it will likely be to a more severe grade than you would have torn naturally. My thinking on this topic is to decline an epi and take the chance with a tear. And while you're at it, get your body into a position that minimizes the risk (such as a squatting position). Being in water helps soften the tissue a lot too - even if you just stay in the hospital's shower while you labor. Hope this helps.

[georgia]

i was fearful i would tear with my second after having a terribly long-healing episiotomy with my first (it took about 12 months for things to even start feeling somewhat normal). my second was 2 full pounds bigger than my first, and i didn't tear. i attribute this to being in the water, in control of my positioning and doing what my body needed to do w/o anyone telling me what to do or anyone being anywhere near me with a knife!

you know that old saying don't see a surgeon if you don't want surgery......

best wishes to you and congratulations!

[Keeper]

Actually, it IS illegal for a doctor to do a procedure after you have told him/her you don't consent. It's called medical battery. The trick is removing the exceptions. In my birth plan (in case I birth in the hospital this time) I wrote, "NO EPISIOTOMY (No compromise)." and I made it very clear that I did not believe there was any situation in which I would consent. Also, my husband and midwife (who would act as my doula) will keep an eye out, and we'll have a code word for scissors, at which time I would state, with plenty of witnesses, "I do not give my consent for an episiotomy." I would absolutely press charges if I got one anyway.

Sarah

[liawbh]

I like that idea. The problem I had was that, in the thick of things, when all i wanted was to concentrate on pushing, my OB said "I;m goingto do a little snip now, OK?" and I automatically said "OK", meaning "anything as long as you shut up and let me push."

And in that situation, they can say you gave verbal consent, which, for some reason, in OB circles always overrides whatever you may have said or written before labor. KWIM?

[candiland]

I would find an attendant who has a very, very, very low episiotomy rate and is proud to share it with you.

It would most likely be a midwife.

I tore with my first and refused stitches. The end of the tear never came together. I didn't tear with my second, who was 9.4oz.

If you birth again in the hospital, I would make sure I brought an attentive doula with me. Make sure she knows that NO MATTER WHAT, you do not want to be cut.

Also choose upright, active positions and refuse "purple pushing" (pushing until the count of ten). Choose an attendant who knows how to ease a baby over an intact perineum.

Episiotomies are very, very rarely done for the benefit of the mothers. It's just easier and quicker for the OB because the cut is straight and easy to mend. But tissue is like cloth.... try pulling a cloth apart when it's intact. Then snip it and pull again. That's how tissue reacts... if it's already cut it's more likely to tear even deeper.

[cottonwood]

Originally Posted by liawbh

Wierd. I asked b/c I was really worried, have a long scar, and My midwives said that they don't see any more tears on epis scars than otherwise.

What I meant was that at the time that you are cut you will then be more likely to tear further and deeper than you would have without the cut. But definitely, having an old episiotomy scar does *not* mean that one will tear down it. Keeping the tissues hydrated and warm will help (dry, cold tissue is less flexible), as will being in a situation where you don't feel inhibited, as that hinders the release of hormones that make the tissue nice and stretchy. Finally, don't push when you're told to (or because you just want to get it over with,) let your body push the baby out -- it won't do so until it's ready.

[Galatea]

I didn't get an episiotomy, but I have heard that some women who had one the 1st time, when they birthed the 2nd time, the old scar tore and it was actually a good thing b/c it undid the bad scar tissue from the first.

[PapayaVagina]

I may open up a huge can o worms with this, but I wanted to mention it since doula support has come up a couple of times.

As a very experienced former doula I can say that many, many providers don't care at all about what doulas have to say. I personally think that the idea of doulas as an advocate (meaning speaking to the staff and getting results) is a bunch of bunk. When I first started I carried that definition with me and it caused a lot of problems. I've been to several births (when I first started) where I would speak to the staff and tell them about what the mom wanted during the birth and most of the time it went no where. I'm not talking about options as far as labor, but more of the actual birth. I can only speak from my own experience in saying that most of the time they flat out didn't care what I had to say at all. It mattered more when the partner spoke up than anything else (even over what the women said themselves). I would usually have a code with the partners or a special "look" to let them know that something was coming and to be hyper aware. That's the ONLY time that I've EVER seen providers actually be ok with refusal. It may be because of obvious disrespect for laboring women and thinking that they won't remember or they're not in their "right" mind, I don't know, but I've seen it a lot (not everytime of course though).

When I first started I went to a birth where not even 2 minutes after the mom told the doctor that she refused an episiotomy, her doctor cut one. I blamed myself for a long, long time that I should have stopped him somehow until I realized that no matter what, most of the time they're going to do whatever they want to. It's amazing to me how many providers will say the afore mentioned "I won't give you one unless you need it" or "Only if the baby is having some distress," and then amazingly every SINGLE woman "needs" one and every SINGLE baby is in "distress." That's how they always seem to weave around it. We have one of the big unnamed insurance companies that has serious control issues in my town. They tell women those same things, but I have a friend who works at their hospital who says in the 8 years she's worked there, never has she seen them NOT cut an episiotomy.

[candiland]

What I meant was, the doula could say something to the mom and the mom could immediately refuse.

As a doula, I was actually taught to NEVER directly communicate with the staff. To explain things to parents and let them do the talking instead.

[PapayaVagina]

I totally agree. I just wanted to mention it because I think that there's a huge amount of incorrect info out there about what doulas do and what they don't. I've run into many families that expected me to speak to staff and to "save" them from unecessary interventions, and that just isn't what happens. I always spent a lot of time talking with them about what my role was, etc. and what I cannot do. My communication with staff usually consisted of passing on the birth plan (highly detailed but very easy to read for staff) and usually having several of them available in case in of them got "lost" . There are a lot of books out there about doulas that talk about them as the person who will make your wishes known when you can't speak for yourself, etc. etc. that I think are extremely misleading about what doulas can truthfully provide KWIM?

I think that the point I wanted to make was that the bottom line is that if a family is choosing to have a hospital birth, everything is kind of fair game and there are no guarantees (even with the family speaking up for themselves and/or having a doula in the room) about low intervention. Why? One word: malpractice.