Can you say no to an episiotomy? - Page 2 - Mothering Forums

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#31 of 54 Old 09-17-2010, 10:30 AM
 
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OP,

I implore you to seek some help. Post in your tribal area - I'm sure some doula (or doula in training) would be willing to help you out free. Please don't go in with no support! Heck, I'd be tempted to help you out if you were in my area & I'm not really interested in being a doula - I just hate to think of someone all alone & worried like that.

You sound really uncomfortable & anxious with this hospital. If you aren't going to switch to another care provider (whether home birth, free-standing birth center, hospital-based MWs,) Then I think you really need to find out what you're in for here. Is it really that bad? I had a hospital birth & it was great! They didn't take DS out of my room, didn't bat an eyelash at my requests like no vax, no eye goop, delay cord clamping, etc. etc. The nurses were awesome, my MWs were awesome. Yeah, I say that modern American maternity care is an "atrocity" - but that is on the whole. There are a lot of great HCPs out there

If you really believe you're going to have to fight this much, then do you really believe they are "good" HCPs? Because it doesn't sound like that's how you sincerely feel.

Have you taken the tour of the hospital? That was reassuring for me. There were at least 3 or 4 other mamas on my tour & few of us asked Qs - so I know the nurse wasn't trying to "tell us what we wanted to hear." She was telling us HOW THEY NORMALLY PRACTICE - and it was consistent with what the MWs had told me & what my 2 friends who had birthed there had said. (i.e. she said they encourage rooming in, she showed us how to work the beds but said, "We don't you in bed though! We want you up & moving." etc.)

As for screening visitors, they had an option at my hospital where you could be "unlisted." So if someone came in & said, "I'd like to visit MegBoz." They'd reply, "Sorry, nobody here by that name." Hospital L&D wards are big on security because of the paranoia of baby-napping. While I'm not gonna say it's "fort knox" secure, it ISN'T easy to just wander in. It's not like the rest of a hospital. (Again, not saying it's not worth reminding them, just that they are likely accustomed to helping screen visitors - since many people don't want visitors during the labor process.)

Again, go take the tour & it may help ease some of your anxiety.

So try to find out if you really will need to fight. You may not! & If you don't have to fight, don't expect to. In other words, relax a bit. Put some degree of trust in the HCPs. Sure, speak up if they start to wheel your DC out of the room, but don't feel that you must constantly be on guard. Feeling so upset & anxious is not conducive to labor. (Have you read any Ina May?)

I'm not a trusting person & I wasn't comfortable with the idea of a hospital birth so I totally & completely understand this anxiety, but try to do the best you can to make your birth experience a positive one - and I think at this point the most important thing to do, after getting a labor support person, is to work towards greatly reducing this anxiety somehow.

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Originally Posted by laohaire View Post
Some good reasons to have one might be:
- If forceps or vacuum extraction are NEEDED for some reason, they are going to want to make more room for the tools
- To reach in to deal with shoulder dystocia
- If mom really has been pushing a long time (and a long time is not, like, 10 minutes... I pushed for 6 hours, myself) with baby's head engaged but no SD, I dunno, maybe it could help. I had such a situation but ultimately I chose to tear on purpose, and it was done. I don't think anyone could know if the tear would have been better or worse if I had an episiotomy (I didn't). It probably could go either way, sometimes it's better and sometimes it's worse.
Actually there's no need for epis to accompany vacuum - the vacuum doesn't increase the circumference of the 'presenting part' - in other words, there is absolutely no need to make 'extra space'. (Although, yeah, can be needed with forceps, but I believe forceps are relatively rare in the US these days anyway.)

Most hospitals won't "let" mom push more than like 2 hours anyway before moving to CS, so I'd find out what the policy is there.

Yes, if the doc needed to reach in to make adjustments in the case of SD, it can be necessary.

& I believe tearing is always preferable to epis. Period. Epis just leads to even WORSE tears than without epis. Like the cloth analogy as someone already posted.

As others have said, almost no OBs do them "Routinely" anymore - i.e. with every single solitary birth. It's just not that way anymore. HOWEVER - the rate nationwide, I believe is 20% & evidence-based is nearly like 5%! So I'd ask the docs rate of epis - then I'd ask under what circumstances he does them. If he says anything other than "baby in distress" I'd worry. I.e. if he says, "If I see a mama about to tear upward, I'll do one to prevent that." Then I'd worry - that's not evidence based either.

But, again, if you hear "only if medically necessary b/c baby is in distress" and "5% rate" then try to relax & trust that these really are good HCPs.
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#32 of 54 Old 09-17-2010, 03:30 PM
 
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Re: your q about tearing worse with subsequent births...I tore quite a lot with my first- I needed stitches in half a dozen locations (although none of the tears individually were really big). Anyway, I didn't tear at all with either of my others.
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#33 of 54 Old 09-17-2010, 05:56 PM - Thread Starter
 
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Originally Posted by MegBoz View Post
You sound really uncomfortable & anxious with this hospital.
Actually, this is the one hospital within 45-60 miles that I am comfortable with. It's the going it alone and nobody "in charge" besides the OB is what scares me. (For the record, I like my OB as well.) I may have a nice, easy birth, or, I might have so many other situations where I need to make decisions and am unable to make decisions (think emergency c-section when they have to put me under). Even if my wishes are made very known beforehand, there's no guarantee that they will be carried out, unless someone I can trust, if not myself, is there to "supervise" the OB.

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I'm not a trusting person & I wasn't comfortable with the idea of a hospital birth so I totally & completely understand this anxiety, but try to do the best you can to make your birth experience a positive one - and I think at this point the most important thing to do, after getting a labor support person, is to work towards greatly reducing this anxiety somehow.
The best I've got, is if I can't find anyone until the very last minute, I "might" be able to talk my soon-to-be ExHusband into sticking around in case something happens. Out of all the people in my life, besides my Mother, and she is unable to be there, he'd be the one I'd trust most on this situation, on what I'd want for myself, what I'd want for the baby, etc, plus, the divorce is still not final, so technically I'm his legal Wife and he's the baby's legal Father (not biological). But I don't know if I could talk him into it, even at the last minute- we've got a weird married-but-not married friendship and he would be very uncomfortable being there in that situation.

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Re: your q about tearing worse with subsequent births...I tore quite a lot with my first- I needed stitches in half a dozen locations (although none of the tears individually were really big). Anyway, I didn't tear at all with either of my others.
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Okay, good to know.

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#34 of 54 Old 09-17-2010, 08:25 PM
 
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My first was born in a military hospital and I was scared to death about what would happen. I was active duty at the time and the attitude of a lot of doctors was "you do what we tell you since your active duty".. I told the nurse I had that I didn't want to be cut at all, Id rather tear and she told me "Oh we only do that by request and if he tries anything Ill body slam him.." The doctor (he was an intern so not really an ob) laughed and told me he would take the scissors and knives out of the room if it would make me more comfortable." They were an amusing pair, made birth interesting. Of course he would have made a great OB, he also asked if I wanted a mirror to see the birth or if I wanted to catch the baby. I said no to both since first I didn't want anything distracting me and second I started shaking REALLY bad right before birth and didn't think Id be able to hold anything. To bad he wanted to work with kids instead and was trying to go the Ped route.

I tore pretty bad with my first (40 stitches, but the midwife commented he was acting like he was doing plastic surgery I guess he made the stitches really small), with my second I had around 20.. in a different spot. I guess I tear really easily.

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#35 of 54 Old 09-18-2010, 10:44 AM
 
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Originally Posted by Galatea View Post
One OB I saw said if he didn't do an episiotomy, my labia would rip off. !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

We dumped him that day.
Have you submitted that to MyOBSaidWhat.com ?

Leigh, mama to Rostislav homeborn Aug 9 2007, and Oksana homeborn Feb 24 2011.
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#36 of 54 Old 09-18-2010, 10:48 AM
 
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Originally Posted by kittywitty View Post
Really? I pushed 3 hours with my first with a swollen cervix that left a lip and doc had both hands in pulling it back while I pushed. No episiotomy and no tear-just a slight "skid mark". Forceps or vacuum I can see, but not always and I don't see why it'd be necessary for hands/arms in the canal.
Our vaginas are all different.

TMI ALERT: A girlfriend of mine tells me her boyfriend has no trouble getting both of his (huge) hands into her without taking any time to stretch her. Yet my husband finds it a very tight fit for 2 or 3 fingers.

So, I can't imagine a doctor having both hands in me without having to either take hours to stretch me, or having to cut me.

Leigh, mama to Rostislav homeborn Aug 9 2007, and Oksana homeborn Feb 24 2011.
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#37 of 54 Old 09-18-2010, 05:59 PM
 
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Ob said he was going to do an epi for a vacuum extraction, I said no way (it was the only time I stood up for myself in that labour), he didn't do it but he treated me like crap after I said no. He literally went from kinda ok to jerk.
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#38 of 54 Old 09-18-2010, 06:26 PM
 
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I didn't want one with my first. I was young (18), but I'd done my research and knew that the vast majority of episiotomies either weren't necessary, or they caused more damage than they were intended to prevent. My own mother had an episiotomy that had torn through to her anus. That's something I wanted to avoid. I told my OB as much, and he seemed very agreeable. Of course, he'd seemed very agreeable to pretty much every natural childbirth idea I'd presented... all the way up until he talked me into an unnecessary induction. The interventions cascaded from there.

In the end, he informed me that he was about to perform an episiotomy. I told him "No!" very firmly. I reminded him again that I desired not to have an episiotomy. He proceeded to perform the cut anyway, while telling me that if he didn't, then I was going to tear. Unfortunately, once my daughter's head was out, they realized her cord was wrapped around her neck and she was blue. So they had to quickly pull her out, which caused my episiotomy to transform into a 4th degree tear. The OB (who had insisted on the episiotomy presumably to save time, since surgical cuts are easier to repair than tears) had actually created a situation in which my injuries were so severe that he had to spend HOURS stitching me back up.

I will say that I suffered from back labor, and I'm fairly sure that my daughter was presenting face up, instead of down... So it could be that the OB was right, and I was about to tear. But as you seem to be aware of: while not fun, a natural tear is almost always preferable to a man-made cut... especially since that cut could very well end up tearing anyway.

I want to add that while I suffered from that 4th degree tear the first time, I delivered an 8lb 8oz baby (1lb 4 oz bigger than my first) all naturally the second time-- and didn't suffer from a single tear, skid mark, or ANYTHING. I kept asking them to check. LOL. It was funny because the OB I'd seen, prior to switching to that midwife team, had told me that in no uncertain terms I would tear again, and it would be worse. He had me in tears because he said that if I insisted on a vaginal delivery, then I would likely become severely incontinent for the rest of my life. Clearly he was an ass... as well as WRONG. If you've had once incidence of tearing, you still have every chance in the world of having a tear-free delivery. Honestly, I credit birthing position to the dramatic difference in condition of my vagina/ vulva after my births. My first was in a hospital where I was hooked up to an epidural and was lying in a hospital bed with my legs up in the air. My second was at the edge of a real bed, on my hands and knees, with a pushing stage that *I* was completely in control of.

I say stick to your guns. Tell your doctor and the rest of the staff ahead of time that under NO circumstances do you want an episiotomy to be performed. Not counting, of course, the event of it being necessary to save your child's life. Good luck to you. I hope your birth goes as you wish, and that your birthing team is able to respect your desires.

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#39 of 54 Old 09-18-2010, 09:28 PM
 
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Where in NY are you? I know a couple of people who will do births upstate for free. PM me if you're nearby.

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13yo ds   10yo dd  8yo ds and 6yo ds and 1yo ds  
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#40 of 54 Old 09-18-2010, 09:34 PM - Thread Starter
 
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Where in NY are you? I know a couple of people who will do births upstate for free. PM me if you're nearby.
I'm in Lower Westchester, just North of the Bronx (the hospital I will be delivering in is in Greenwich, CT).

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#41 of 54 Old 09-18-2010, 09:55 PM
 
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Baby #1: Delivered lying on my side, dr cut an episiotomy, I had 4th degree tears and hours of stitching up. Overheard between the *two* doctors working on me, one my OB and the other a plastic surgeon: "Do you think this bit goes here?"

Baby #2, 8 years later. I had those fears of the scar tissue not stretching. Had a midwife, but delivered in hospital, induced, under OB care due to hypertension and possible pre-eclampsia.

Delivered squatting. No cuts, no interventions other than the induction. Baby was out in 3 pushes. Needed 3 tiny stitches - 3 separate, tiny, 1-stitch tears.

Here's the fun part. When I was trying to get up into a squat, the nurse on duty kept yelling at me to lie down, "for the sake of the baby". Hubby, love 'im, yelled at the nurse to let me get up and squat. Nurse, resident, other nurses, all imploring me to lie down, I'm refusing. Finally OB comes in and says it's okay, I'm allowed to squat, as long as I consent and acknowledge that I'm putting myself at greater risk of tearing.

Yeah, whatever.

So a few weeks later my midwife showed me the birth report the OB had written up. "Patient delivered in a squat position. Patient was warned of the increased risk of tearing. Patient did tear and required several stitches."

ARGHHHHHH.... Talk about missing the point...

Anyway, that's my experience, despite my fears my first cut and tear and scar tissue did NOT create greater problems in the second birth. I was planning a waterbirth -- in part to help the scar tissue stay soft. If you can at all manage to labour at home in water and only go to the hospital at the last minute... or even just miss the chance entirely -- it would give a chance to stretch a bit before the actual delivery. But even if you can't, just yell and boss them around, be in charge of YOUR birth, squat and refuse interventions you don't want unless they are really necessary, and an episiotomy is NOT.

I like the "I DO NOT CONSENT" phrasing idea. Perfect. I'd also go so far as to research some of the more recent studies on episiotomies that do indeed show that they are not only unnecessary but make tears WORSE. Make sure you have the journal publication information. Print out what you can. If your ob or the resident nutjob on hand tries to push one on you, hand them the documentation and ask them why they aren't keeping up with current research and knowledge related to their supposed profession. ;p

Heather, mom to Caileigh 12/06 and aspie ADHD prodigy David 05/98 :intact lact
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#42 of 54 Old 09-18-2010, 10:20 PM
 
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"Patient delivered in a squat position. Patient was warned of the increased risk of tearing. Patient did tear and required several stitches."
I guess you "learned your lesson" then.

Sometimes I think the women who just let pregnancy 'happen' ruin it for the rest of us who actually want to be aware and part of the process. I can't imagine not having at least a basic knowledge of something that is going to take up years of my life!!

This Mommy and Military Daddy are loving their son.
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#43 of 54 Old 09-18-2010, 10:40 PM
 
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Yes, that will learn you!

A woman can refuse any intervention to her body that she wants.

In the hospital, you are on the medical doctors' (surgeons') "turf", so to say, so they are in charge and may not listen to you.

An episiotomy, while not done as much as it used to be, is still considered the standard of care in obstetrics and a doctor can justify doing an episiotomy for any birth.
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#44 of 54 Old 09-18-2010, 11:01 PM - Thread Starter
 
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If you can at all manage to labour at home in water and only go to the hospital at the last minute... or even just miss the chance entirely
The thought has crossed my mind, but around here, if, God forbid, I ended up going to the hospital AFTER the baby was born, I'd be on the 12 o'clock news. I'm also concerned because I'm at greater risk of a complicated delivery, and it would be a completely unassisted homebirth. Not sure I like those odds.

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#45 of 54 Old 09-19-2010, 08:56 AM
 
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I just wanted to mention that IME, these are becoming less and less common. Every OB I interviewed w/my last pregnancy stated that they "did not do routine epis." And I have never heard a peep of one, in either live birth I've had.

I think you are more likely to be fighting a section than an episiotomy!
Just wanted to add that this was my experience. My OB never brought it up at all. She just kept massaging the area, which felt sort of unpleasant. I did tear though, second degree.
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#46 of 54 Old 09-19-2010, 01:53 PM
 
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There's gonna be so much to remember while I'm giving birth- I'm gonna be constantly telling them not to circumcise the baby and constantly telling them to keep the baby with me for all procedures and constantly telling them no bottles and pacifiers and constantly telling them to screen my visitors (the baby's father was abusive and threatened to take the baby) and now it occured to me that I will also be constantly telling them not to cut me (in any way!) unless it's a life or death situation. I'm worried that I will be unable to keep up with denying their demands, and I'm also aware of the fact that, even if they mean well, and even if they really do try to do everything my way, it's alot for the doctor and the nurses, etc. to remember.

Not exactly on topic here, but wanted to try to ease your mind about the bolded part above. Circumcision is an elective procedure that requires your consent prior to the surgery - there should be no fight to protect your baby from this!

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#47 of 54 Old 09-19-2010, 03:10 PM
 
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Jessica, haven't you heard about baby Mario who was circed against his parents' wishes in a Miami hospital last month? The parents said again and again they didn't want him circumcised. He was in the NICU. They went home for one hour to get a change of clothes, and during that time he was circed.

Leigh, mama to Rostislav homeborn Aug 9 2007, and Oksana homeborn Feb 24 2011.
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#48 of 54 Old 09-19-2010, 03:25 PM - Thread Starter
 
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Not exactly on topic here, but wanted to try to ease your mind about the bolded part above. Circumcision is an elective procedure that requires your consent prior to the surgery - there should be no fight to protect your baby from this!
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Jessica, haven't you heard about baby Mario who was circed against his parents' wishes in a Miami hospital last month? The parents said again and again they didn't want him circumcised. He was in the NICU. They went home for one hour to get a change of clothes, and during that time he was circed.
Yeah, that's part of my concern- it happens, and I do know people who have had close calls, as in baby taken and prepped, only to have the nurse notice there was no consent signed, literally seconds before the baby was to be cut. I don't want my main concern giving birth to be to keep everyone's genitals safe, I want to concentrating on bonding on my new baby!

I pray for the day Family Court recognizes that CHILDREN have rights, parents only have PRIVILEGES.  Only then, will I know my child is safe.
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#49 of 54 Old 09-19-2010, 03:30 PM
 
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My friend in Seattle had his son cut against his wishes too. If I were him I would have made a big noise about it.

Leigh, mama to Rostislav homeborn Aug 9 2007, and Oksana homeborn Feb 24 2011.
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#50 of 54 Old 09-20-2010, 09:54 AM
 
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One OB I saw said if he didn't do an episiotomy, my labia would rip off. !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

We dumped him that day.
WOW.

Mama to Ahnna-Bella (Dec 05) dust.gif, Harrison (Oct 08) kid.gif, and Kellan Wilder (Jan '12) baby.gif

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#51 of 54 Old 09-20-2010, 01:37 PM
 
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Jessica, haven't you heard about baby Mario who was circed against his parents' wishes in a Miami hospital last month?
Sure, things like this happen, but I would agree with Jessica that it really isn't a big concern. Besides, AAP doesn't recommend routine circ (sure, they don't explicitly recommend against it, but they don't recommend it either.) It's not so unusual to decline.

Besides, if your baby is always in your sight, you don't have to worry about it. If you're really concerned & maybe baby is in NICU, you can always put a sign on the bassinet or talk to the nurses & make sure they all know.

I agree with others about episiotomy - if a doc wants to do one, he'll find an excuse to do one. Even if you decline, sometimes they do it anyway. It would be difficult to find a lawyer to take the case to court even though it IS medical battery and IT IS A CRIME.

But I think circ without consent is much, much more rare & not something I'd really worry about much.
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#52 of 54 Old 09-20-2010, 01:58 PM
 
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Yeah, that's part of my concern- it happens, and I do know people who have had close calls, as in baby taken and prepped, only to have the nurse notice there was no consent signed, literally seconds before the baby was to be cut. I don't want my main concern giving birth to be to keep everyone's genitals safe, I want to concentrating on bonding on my new baby!
If you are seriously, seriously concerned about this sort of unauthorized cutting being done to you or to the baby, I would really consider going elsewhere to give birth. You are right, this should not be an issue you have to deal with during birth or postpartum. "Don't cut me, don't cut my baby" is not that hard to understand. If you must give birth at this place, I would advise you to contact the patient representative before you give birth, talk to them about your desire and fears ahead of time, deliver this in writing, make sure it's in your charts, have signs posted in large print in your room and on the door spelling out your wishes. I was kidding before, but now I am serious - write "I do not consent to an episiotomy" in sharpie on your thigh for the birth, and have the baby outfitted in onesies that say something to the effect of, "Don't even think about circing me." Talk with your OB though about practice protocols - maybe you are worrying needlessly?

Doula, WOHM, wife to a super-fun papa, mama to the Monkey ('07), and his little brother, the Sea Monkey ('09).
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#53 of 54 Old 09-20-2010, 02:35 PM
 
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I have heard again and again about things being done to babies against parents' wishes. Whether it is circ, vaxes, giving formula or sugar water or pacifiers.

I've also heard again and again about doctors doing unwanted things to mothers during a birth. Sometimes without them even knowing (ie putting something in the IV). Sometimes too fast for them to say no. Sometimes even while they are saying no.

I don't think the fear of unwanted episiotomy is unfounded. That is why I am planning my second homebirth.

Leigh, mama to Rostislav homeborn Aug 9 2007, and Oksana homeborn Feb 24 2011.
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#54 of 54 Old 09-20-2010, 03:40 PM
 
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Originally Posted by Lady Lilya View Post
I have heard again and again about things being done to babies against parents' wishes. Whether it is circ, vaxes, giving formula or sugar water or pacifiers.
I do personally think the fears of unwanted vaxes & pacifiers are warranted. First of all, both are so common & routine - MORE common & routine than circ.

Second of all, it's thought of as "dangerous" to NOT vax! but I do believe most medical professionals are aware there is no "danger" in not circing! (Again, AAP doesn't recommend it as routine.)

& HCPs do things to a birthing mama without (or even in spite of a lack of) her consent because of habit (remember, most mama's never question anything a doc says anyway!) or because they legitimately believe they know best and it's "necessary." Again, with circ, there's no issue of 'blanket consent' which gives an HCP more legal freedom to do things to a birthing mama- it's an optional thing, it's not viewed as dangerous to forgo & even it's not covered by all insurance some places.

I still say the fear of unwanted circ isn't that warranted - and no where near as much as the fear of unwanted epis or other procedures in labor (I agree - that fear is warranted.)

But, again, all this being said, I still think it's worth going on the hospital tour, chatting with the nurses, finding out what common rates are for things like epis, nursery-stays, etc. If only 50-60% of all boy babies are circed in the hospital anyway, I'd be a LOT less nervous about unwanted circ than at a place where 99% of the boys are. That's not to say I still wouldn't put it in the birth plan & remind the OB & the nurses, but I wouldn't let it stress me. Again - I wouldn't let it stress me - just like every time I get on the highway, I'm not stressed about an accident.

As I wrote before, it seems to me this OP is very stressed & anxious about this hospital birth - and all the responders only seem to be affirming that she has legitimate reason to be terrified & expect constant battles. In that regard, this thread is kinda making me sad.

Again, I believe I already wrote it - but while it's true that only the whole American maternity care is an "atrocity" - there are plenty of great hospitals & HCPs out there. It's absolutely ridiculous to paint them all with the same brush! Just as it's ridiculous to say, "You pick a hospital birth, you take the hospital ride." . Yeah, whatever. Just like every Homebirth midwife is caring, & consistently provides woman-centered, evidence-based, competent, & patient care. Right? There are no great hospital births & no horrible HB MWs?
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