Episiotomy vs. Tearing ?! (rant)

[hawleyclan]

Sometimes it is really hard to walk away from discussions, and today I ran across a thread on episiotomy vs. tearing... They just kept talking about whether their tear or episiotomy was easier to recover from... :

It never occurred to any of them that perhaps there were other factors like STIRRUPS... LITHOTOMY POSITION... LIDOCAINE... EPIDURAL NUMBNESS... that would contribute to their chances of tearing...

I had to leave before I posted and got run off...

A whole board full of ladies, and it did not occur to anyone that something, other than a baby's head could be causing them to tear....

Thank God for this board...!

The Lord bless you all with a tear-free birth,
Zoie
http://groups.yahoo.com/group/Godsbabycatchers

[crazy_eights]

My own personal rant.....

I'm a nurse in L&D (Lord knows how I keep doing this!). Last night we had an un-anesthetised mom. I had her in hands & knees from 7 cm - to complete, when the OB walks in & tells me to put her in stirrups . When I encouraged him not to, the mom asked him what the reason not to deliver in lithotomy position were, he told her, "some women find it disempowering, but I really don't understandwhat the problem is." Grrrrrr - as if the only problem with lithotomy is "disempowerment"! So she politely flips over to her back. And then we went on to have an epis and 'shoulder dystocia' (this OB thinks *everyone* has a shoulder dystocia - except for the women he induces early so "she won't have a shoulder dystocia"). GRRRRRRRRRRRRRRRR!

[Gagesmom]

At least you helped her thru transition in a decent position. It makes me so sad to hear what women go thru birthing in a hospital. Even women who think that their experience was good can't know the beauty and joy of a beautiful home or natural birthing center birth. What a shame! Both of my births (one birthing center, one home) were the highlights of my life.

[cottonwood]

Mom2five, what an idiot that doctor is! When I read these kinds of stories I keep thinking, there must be some way to help these people... I mean, surely they are accountable to someone, maybe some anonymous letters and scientific backup to them? I mean, if he's WRONG, and he's HURTING women... surely something can be done?

[Eman'smom]

I had a tear - free birth

Some people just don't get it. I was talking with my SIL and she said something like, "well you know when they cut and then sew you up" I said that I didn't have an epis. she then asked why "they" let me tear. I said that I didn't and she looked totally confused. Like how could I have had a baby and no cutting and stiches. It totally floored her. The doctor told her when and how to push, when he was going to cut, ect.

I had a midwife delivery with none of that, tear free was wonderful I can't imagine it any other way.

[birthinglau]

I've been wanting to rant about this for a looong time.
Earlier this year I attended a birth as a doula, gratis as part of my training, was there for 30+ hours with the 18 year old mom and partner. she was doing great! So by the time the birth happens, she is determined still, but exhausted, and falls for the hospital staff coaching for pushing in modified lithotomy. (they had asked me to film the birth, something that I don't think I'd agree to again, since there was no opportunity to be close to mom, my whole focus was on the baby being born at the bottom end)
she pushes out a an 8 1/2 lb baby, no drugs but a big ole 3rd degree tear. I watched her perineum bulge, I watched the dr. "stretch" it manually, I watched her push to count of 10, not in time to the natural sensation of contractions. I watched her rip. I was so mad about that.
The family asked me not to film the stitching, but I confess I snuck a few glimpses of the needle going into her poor wounded perineum. I guess I was hoping maybe she'll see it someday, and think about WHY that happened and why it shouldn't. Probably that was very inappropriate, but then again, I really wanted to plant the seed that spares her from that happening again.
having said all that, I don't believe I want anyone near my perineum besides myself during my own birth. even my lay midwife, problems like sholder dystocia nonwithstanding. I've been doing alot of thinking and research, and it seems the best thing is to leave well enough alone. waterbirth is sounding more alluring too.

-Lau

Expecting #1 to be born over an intact perineum in march 2003

[Peppamint]

Don't even get me started.

I don't want to be cut, even if it means tearing! I'd rather take my chances, because hey I may not even tear and why be cut?

[Charmie981]

I had a hospital birth with an OB who was willing to let me "try" w/o an episiotomy. He was great, but said he hadn't had very good luck with moms who wanted to avoid being cut. I had a nurse who would make a great midwife (she provided wonderful perineal massage and support) and I birthed my 9lb 4oz son over an intact perineum in the side lying position. My doctor was on cloud nine after the birth! He even bragged about my son's birth to another patient of his (someone I knew, but he didn't realize that). Even the good doctors just don't see enough of natural birth to know how much of this work a woman's body can do on it's own!!

I had an aquaintence whose doctor cut episitomies on every single first time mom. My aquaintence at the beginning of her pregnancy briefly mentioned that she didn't want to be cut and he told her it wasn't an option. When her 7 pound baby was born, he cut her and then she tore past the cut to the 4th degree . Later she said she was so glad he didn't listen to her since her tearing past the cut meant she obviously needed an episitomy. Oh, we informed women have our work cut out for us, don't we?!

[Momx5]

WOW!! It's been a while since I've even given this a thought.

With baby #1 in 1989 I had a c-section. The doctor told me that I didn't have a "proven pelvis". (He had broken my water and I wasn't progressing after a very long time)

Baby #2 breach/c-section

Baby #3 (different dr.) VBAC in the hospital with an episiotomy from end to end. VERY painful healing.

Baby #4, Homebirth, 9 lb. 11 oz., with a tear. MUCH easier healing.

Baby #5, Homebirth, 11 lbs. 4 oz., (you read it right!), and NO TEAR!!!! Amazing midwifery!!

I'd like to get my hands on that doctors NECK, I guess it's PROVEN now!!

[Lucky Charm]

Hi Ladies,
I am in now way close to your league, but i did have 3 kids, my first 2 were automatic cuts...awful just awful. Especially my 2nd child, he was 9lbs and i wound up with a 4th degree tear, they had to repair my rectum. 12 years later, i am still not the same. finally, with my 3rd child, i went to a midwife. i told her what i wanted for my birth experience, and she gave me everything i wanted, and no cutting, no stitches, it was a wonderful experience (it was a hospital birth). my baby just came right out, i labored 2 hours, went from 7cm to birth in less than 10 minutes, and she was great. i wonder if this is the answer, having a midwife? I am thinking about having a 4th child, and am positive i will have my baby at home with a midwife and a few friends. i think today, people treat pregnant, laboring women as potential train wrecks, so out goes the birth process, and in comes all the technology, pitocin, epis, you name it.

[tnrsmom]

I consider myself very lucky. I have had 4 children. 4 Hospital Births. 4 Different Drs. And no epis. I was 19 when my first was born and not too informed. I just beleived everything the Dr told me to be fact. She did not do an epis and I tore just slightly, 1 stitch. With my second, I had a VERY small tear. A fraction of a centimeter, not even enough to stitch anyway. With #3 and 4 nothing. Our next birth will be at home. For a person having all hospital dr attended births, I have been very lucky. I have always made my intentions very clear to every dr I saw. It was always the *aftercare* that bugged me. But that is another story.....................

[homebirthing]

I have two girls. One hospital birth 8#11 ounces, episiotomy for no reason that I know of. I sat there fighting the midwife....healed ok, but then I noticed that whenever I would have sex or try and use a tampon or anything down in that area, it was very very painful. I realized that the midwife stitched me up too small. And I couldn't prove anything other then it hurt so bad. Then 2nd baby comes. Homewater birth, breathed her down and out, very gentle and wonderful. She was only 6#13 ounces and I tore. How is that possible...she stitched me too small. I feel so vindicated. As a doula, I always make sure to do a lot of prenatal on everything including how important it is to breathe your baby down. In two years I haven't had one done to my moms. Knowledge is so important in protecting your body.

[Nyubeta]

This is my first post. My story is similiar to all of YOURS. First Child at 18, Dr. did a Routine Epi. ENRAGED ME because I told him NOT TO, specifically, but of course, lithotomy position and being so damn numb i didn't know how to "push effectively"...so i pushed for two hours while he KNEADED my perineum (i do not believe in PERINEAL MASSAGE DURING Third stage...) because I then didn't get to hold my baby for the hour or two that it took him to stich me up, AND my labia was SOOO SWOLLEN from the massage from him supposedly trying to "avoid an epi" that I was in the hospital for 4 DAYS after that!! I believe in educating women about perineal massage after 36 weeks to have them apply pressure to their vaginal floor and learning how to relax with the pressure.

KID #2 Two years after my first, and after seeing a HOMEBIRHT, I had a midwife in the hospital. No monitor (other than the first 20 min) and Just a Skin burn... dimmed lights, etc. I told her "DOn't give me ANYTHING...even if I ASK for it!!!!) Much more fulfilling birth....breastfed withing the hour.

KID #3 7 years later and my second "green" husband. HOMEBIRTH all the WAY....why didn't I do this the FIRST TIME???
No tearing and I went from 7cm dilated to delivery in 20 minutes...NO shoulder dystocia, I was hands and knees for the head, then STOOD UP, HALF SQUATTED on my bed for his body. He weighed over a pound more than the first two! (9lbs 1oz) SO lets let our bodies TALK TO US WHEN WE BIRTH OUR BABIES!!!

SORRY THIS IS SO LONG..
As a volunteer doula, I feel sometimes that i just get frustrated with a woman's lack of self educating during the most important event in her life....I sometimes feel that whatever happens to her is her own problem for not educating herself...I just feel sorry for the babies of these moms

[MysticHealerMom]

I read in a local birthing mag that when the head is crowning, during the ring of fire, if you apply a hot wet towel to your perenium, it helps prevent tearing better than massage. To me, that explains the pot of boiling water in the movies

The cut is easier for the doc to fix than a tear? The word on the street is that a cut is easier to HEAL than a tear, that's just not the case, is it? Esp because with a sharp instrument you can cut way more than skin.

[*~*SewHappyNow*~*]

What I never realized before, until I read a book by Laura Kaplan Shanley, is that your pernium, like a piece of cloth, will tend to tear more easily at the cut. Its like making a starter cut in fabric and then it rips more easily. It is so frustrating that doctors in all their supposed wisdom are so clueless about such things.


A friend of mine had the epi for her first and ended up having a very painful 6 week recovery. The second time she told the doctor as he leaned towards her with the knife, "you cut me with that thing I will kick you in the head!" She didn't get the epi that time :LOL and her recovery from the small tear that resulted was so much easier.

[hawleyclan]

I would have loved to have seen the look on that doctor's face... LOL... only a laboring mother can affect someone's puckering factor enough to go against everything they have been taught... :LOL

The Lord bless you!!
Zoie

[BinahYeteirah]

I just wanted to share my joy over my own TEAR-FREE birth. I had my daughter (1st baby), at home with a CM, and everything was great! She was only 6lbs13oz, but I had always though of myself as "small down there", so I was overjoyed! I didn't even feel the "ring of fire" everyone talks about. I had planned to do perineal massage, but was too lazy during the end of my pregnancy to do it! To think I wouldn't even have know it was possible if I had been cut!

Yea!

[Peppamint]

Wow, Binah! Congrats! Unfortunately, I was induced due to PIH, so they were big time monitoring me. Saw her heartrate going down when I pushed so I got the cut.

THIS TIME, I don't want a cut and hopefully I won't tear either!

[Marlena]

Wow, I feel so uninformed! I just did a fair amount of medical research on whether there existed any justification for episiotomies, and found that the vast majority of studies in the last several years have shown NO justification for automatic episiotomies. The studies only found episiotomies to be useful in a few select circumstances (such as when one needs to get the baby out NOW, and forceps will assist in delivering the child immediately). I just thought, therefore, that most OBs would have kept up with the (copious) literature and wouldn't be doing routine episiotomies anymore. Heh. I guess I shouldn't be so ignorant, eh?

[MysticHealerMom]

I don't mean to sound like an ass, but a lot of folks think docs keep up with current info - heck, some of the info isn't current and they still don't know about it. It's like, once they pass their internship, they don't need to know anything new. Sure, you learn some on the job, everyone learns with experience, but - gr. it's a sore point for me that those that don't try to keep up or expand on their base of knowledge aren't at least required to prove competancy. It's not like being a truck driver, and they have to reapply for their licenses. (no offense to truckers...) it's their responsiblity to be as informed as possible, isn't that one reason they get the big bucks? first do no harm!! "If you think education is expensive, try ignorance..."

Marlena, you'd probably make a great doctor, not only did you look it up, but you admitted you didn't know something - wow

rant over...