Can you say no to an episiotomy? - Mothering Forums

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Old 09-16-2010, 02:45 PM - Thread Starter
 
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I woke up thinking about episiotomies. I don't want one at all! I have a good doctor and I'm delivering in one of the best hospitals in the area, and, by some miracle, both take my insurance, so I don't want to go switch things around, if I do find out my OB likes giving episiotomies.

When I had my son 15 years ago, I had to be induced, and then when things finally started happening, things happened so fast, that the OB never had a chance to do one (don't know if he would have). I tore with my first son. Hurt like the dickens, but I prefered that to being cut. I'd rather tear with this baby, also, than be cut.

Is there EVER any legitimate reason for needing an episiotomy? What "arguments" might I be given by the doctor if I absolutely refuse? Can the doctor force me to have one (unless, of course, the baby's life is in danger if I don't)? What do I need to do in order to avoid an episiotomy?

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.

(I will be delivering without a labor coach or any kind of advocate for me, so there's a very good chance that I will literally be going it alone from being dropped off at the hospital to being given a ride home when all is said and done. The more I think about it, the more uncomfortable I feel about it.)

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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Old 09-16-2010, 03:02 PM
 
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You could try to find a doula-in-training. They're usually on the cheap (or free) side.

You can refuse an episiotomy but I've heard stories of doctors who really didn't care, one even cutting one for the placenta when he missed the birth! BUT when you're in labor and having a baby you should not have to fight for what you want.

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Old 09-16-2010, 03:08 PM
 
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You can refuse anything but that doesn't mean they will listen.

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Old 09-16-2010, 03:17 PM
 
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The on call OB was going to cut one on me and I started yelling my head off at him that I'd rather tear (I was yelling in general, but that pissed me off). So I tore instead. My MIL was shocked I was yelling at the OB lol!

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Old 09-16-2010, 03:25 PM
 
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I don't think they usually even announce it, much less get your permission. Or they might just mutter something like "let me help this along" while they're doing it.

You can say no, absolutely, but they don't necessarily listen.

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.

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Old 09-16-2010, 03:28 PM
 
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Yes, you can refuse. If they ignore your refusal you may be able to take legal action.

I had an episiotomy with my vba2c. My OB doesn't do them much (she's pretty hands off in general), but I had been pushing for 2 hours and she was sitting *right there* on my perineum for a good 7 or 8 pushes and not budging. I was just losing steam from the 2 hours of pushing. Anyway, my OB said that she would recommend an epi at that point and i said yes, got cut and 2 pushes later (one for head, one for shoulders) she was out. I did tear and had to get 2 stitches in my rectum, but surprisingly it seemed to heal really well. I never had much pain from it.
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Old 09-16-2010, 03:31 PM
 
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Yes, you can refuse. If they ignore your refusal you may be able to take legal action.
The problem with that is episiotomy lawsuits are said to be some of the hardest medical suits to win and many lawyers won't take the case because of that.

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Old 09-16-2010, 03:34 PM
 
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I absolutely denied one. I had to reiterated it a lot and they actually numbed me to do one against my consent or desire and my mom caught them and made them stop. I highly recommend someone there to hold your ground.

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Old 09-16-2010, 03:37 PM
 
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The problem with episiotomies is that you can actually tear worse once you have one, think of a piece of cloth - it's hard to rip, but if you make a slight cut in it, you can tear the whole thing. That being said, I do think there are times for them, absolutely. Mine was not one of them, I had only been pushing for 10 minutes and she was crowning. She was out 5 minutes later.

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Old 09-16-2010, 03:58 PM
 
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There are reasons an episiotomy might become necessary, but they all involve sticking something else up there, an arm(the OB's), or tools(forceps/vacuum) But thats about it.

I would really suggest you get a doula.

Have you spoken with your OB about this? Ask him about episiotomies. If he feels like most women need one, or that you will probably need one, consider switching providers.

I had an OB that told me that most moms need an episiotomy(along with a ton of other BS that I just wasn't interested in having as a part of my birth), so I switched to a MW that I felt comfortable with. (And, BTW, I was 33 weeks when I switched) I've even heard stories about women switching at 42 weeks. What I mean is, its never too late

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Old 09-16-2010, 04:27 PM
 
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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.

DS1 2004 ~ DS2 2005 ~ DD1 2008 ~ DS3 2010 ~ DD2 born at 31 weeks Oct. 2014
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Old 09-16-2010, 04:28 PM
 
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In refusing things you should make sure you phrase it as "I do not consent to ____" because from everything I have read that is the onlylanguage that gives you legal power over them and that will actually be heeded. So if you are strongly against having them do an episiotomy, I would tell them "I do not consent to an episiotomy", As long as you say "I DO NOT CONSENT" they can't do anything without fear of legal reprucussion...if you use any other language though they could thoretically go ahead and do it anyway without risk to themselves. Make sure you use the "I do not consent" for the other things you are not wanting as well, like telling them not to take the baby from you and all that.
Also, like a PP, it may be helpful to you to find a doula in training to be with you.
Good luck!
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Old 09-16-2010, 04:28 PM
 
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I agree with the advice to get a doula, or bring a close female friend or relative to come help you be an advocate and watch for scissors in hands at the end. You can also bring a sign to post in the room, write it in Sharpie on your thigh (jk), tell the nurse and whoever is attending you that you don't want one and will cow-kick anybody who gets near your bottom with scissors if it isn't an emergency (like the baby is crashing and needs to be born right away), whatever you think you need to do to get that point across.

I think they are seldom necessary unless there is a concern that baby will suffer imminent harm (persistent low heart rate would be the best indicator that babe isn't tolerating pushing and needs to be born quickly). I have even seen a vacuum extraction that did not require an episiotomy. Standard of care is NOT to do one just because or just to speed things up in the absence of an emergency. Talk about it with your doc before the birth - ask if your OB and the other OBs he/she shares call with do them as a matter of routine.

Also, you can always play the "patient advocate" card on your nurse. Part of her job is to be YOUR advocate, and if you tell her when you come in that this is very important to you, have her read your birth plan, and say, "I am asking you to be my advocate in this matter," she is supposed to step up to the plate and help make sure that your decisions are honored.

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Old 09-16-2010, 06:03 PM
 
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I have even seen a vacuum extraction that did not require an episiotomy.
I had an attempted vacuum extraction, not sure if they do it before or after the baby starts to come out, but I didn't get one. I did have a c-section though : (

I did feel a lot of intense sharp pain when she started using it.

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Old 09-16-2010, 06:13 PM
 
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You can definitely refuse. As others said they may or may not listen.

As for the reasons for one I had a forceps delivery without an episiotomy so it's not absolutely necessary.

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Old 09-16-2010, 07:00 PM
 
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There are reasons an episiotomy might become necessary, but they all involve sticking something else up there, an arm(the OB's), or tools(forceps/vacuum) But thats about it.
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.

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Old 09-16-2010, 07:10 PM
 
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According to Ina May a breech baby presenting testicles first is a reason for episiotomy. Although I do doubt that any doctor who does them routinely would even attempt a vaginal breech birth.

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Old 09-16-2010, 07:14 PM - Thread Starter
 
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You could try to find a doula-in-training. They're usually on the cheap (or free) side.
I'm looking into it, no luck yet. Only free would be "affordable".

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The problem with episiotomies is that you can actually tear worse once you have one.
Can you tear worse, in the same place as before, if you had a previous tear from a previous delivery, that was previously fixed? That's also a concern of mine (though I'd still rather tear than be cut).

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Have you spoken with your OB about this? Ask him about episiotomies. If he feels like most women need one, or that you will probably need one, consider switching providers.
No, actually. I feel kinda dumb, but the thought only occurred to me this morning. It never came up (15 years ago) when I had my first son and quite honestly, I've had so much bigger things on my mind. I plan on asking her asap.

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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Old 09-16-2010, 07:18 PM
 
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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!

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Old 09-16-2010, 07:24 PM
 
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Old 09-16-2010, 07:26 PM
 
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in my experience, its been the same. less and less routine.

The hospital I delivered my first two at does not do them at all unless medically necessary. I ended up tearing with both... but both times WAY less than I would have been with an epi. My doctor said that was a huge reason why... they actually perform less stitches if they leave a womans body to do what it has to to get the baby out.

As for tearing worse if you have already torn before... i dont know if its a risk but it certainly did not happen for me! I tore worse first time than I did second time... even though it was in the same spot (because obviously that was the weakest place to begin with, since it tore the first time too)

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Old 09-16-2010, 08:25 PM - Thread Starter
 
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I think you are more likely to be fighting a section than an episiotomy!
I've thought about that, too, but it's not like you can be surprised to suddenly find yourself in the middle of a c-section, know what I mean? I've been hearing horror stories about women who did not want an epi, only to have the doctor begin cutting before they had a chance to stop them.

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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Old 09-16-2010, 10:11 PM
 
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I brought this up at the prenatal appt where we went over my birth plan. I thought I'd have to fight not to get one b/c from the boards here it seems like doctors are episiotomy happy. My doctor looked at me like I'd grown another head and said they hardly ever do them anymore. I screamed I'd rather tear during pushing at some point and the doctor laughed and said she doesn't even remember the last time she cut one.

So basically my advice is bring it up at a prenatal appt and stop worrying until then since you might be surprised.

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Old 09-16-2010, 10:17 PM
 
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I SO hope you can find somebody to support you,
If you have not done so already, have you thought about writing up a birth plan? Obviously there's still no guarantee-but that way you can go over what things you are and are NOT ok with, point-by-point, with your doc beforehand.
We did with our ob, she kept a copy, we printed several and had one in our hospital suitcase, one at home, one in the car, one in my purse and one in DH's work bag!! First thing we did at check-in was get it to the nursing staff and saw it was put in my chart. It can't hurt.

good luck!!
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Old 09-16-2010, 11:22 PM
 
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As for the reasons for one I had a forceps delivery without an episiotomy so it's not absolutely necessary.
Same here!

I was terrified of the idea of an episiotomy. When I asked my OB under what circumstances she would do one, she looked down at me and said, in no uncertain terms: "I trained with midwives in New York. I only do an episiotomy in the rare case that it's medically necessary."

When we got to the need for forceps (after 5 hours of pushing, with an OB, in a hospital birthing center), my first question was "are you going to do an episiotomy?!?" And she smiled and said "oh no. You might tear a little." I did end up with a pretty good size tear (my son had enormous head & shoulders at birth).

To address your 2nd time around tearing question, my daughter was born in the same hospital birthing center with the same OB, no forceps (whew!), and I did tear but it was much much smaller.


On the other hand, a friend of mine gave birth with midwives in a freestanding birthing center. She pushed for 7 hours before they did an episiotomy, and then her son popped right out. Turned out his head was turned at a wonky angle.

So. . .check with your OB! Tell her your fears and discuss what she may deem "medically necessary."
You'll do great, good luck!
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Old 09-17-2010, 01:19 AM
 
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in my experience (2 episiotomies, 1 very epi happy doc) I had time to refuse both times, though she still argued her way into cutting me - both times. - the time i fought more, was a lot smaller cut.. i could have said absolutely not but the scare tactics were too much for me she said.. 'you're going to tear in every direction and i won't be able to fix it" - as DS was crowning and of course it felt like i was going to tear in every direction ..after when she was stitching me up she basically thanked me for letting her cut and making her job easier..

To prevent cutting without you noticing - i would ask for a mirror when you start to push, then you'll see what is going on.. and tell the nurse - in my experiences the nurse was with me the entire time i was pushing and the doctor doesn't come in until the baby is nearly crowning the nurse would have told me what was going on had i told her i REALLY didn't want one..

My midwife said i am more likely to tear on my scar tissue from my previous epi's .. she also says epi's are only necessary in rare 'baby needs to come out NOW' situations..

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Old 09-17-2010, 01:55 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!
I think this is definitely true, however...

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in my experience (2 episiotomies, 1 very epi happy doc) I had time to refuse both times, though she still argued her way into cutting me - both times. - the time i fought more, was a lot smaller cut.. i could have said absolutely not but the scare tactics were too much for me she said.. 'you're going to tear in every direction and i won't be able to fix it" - as DS was crowning and of course it felt like i was going to tear in every direction ..after when she was stitching me up she basically thanked me for letting her cut and making her job easier..

...she also says epi's are only necessary in rare 'baby needs to come out NOW' situations..
If a doc likes to do epis, he's going to find a reason to do an epi most of the time. he's going to say things that are designed to make you say "do it." You have to be prepared for that. Crowning feels crazy, and you may start tearing, and heart decels are common during pushing, and while none of this is usually emergent an epi pushing doc will make it seem to be.

Stay upright when you give birth, if you don't give him the access he can't cut. It's better for you anyway.

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Old 09-17-2010, 02:41 AM
 
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If a doc likes to do epis, he's going to find a reason to do an epi most of the time. he's going to say things that are designed to make you say "do it."
This is the bottom line. Episiotomies are seldom truly necessary, so in the end, you are likely to get one if your doctor likes to do them, and less likely to get one if your doctor avoids them.
I have seen women argue, yell, and even try to kick the scissors out of the doctor's hand. Sometimes they were successful.
I also coached a woman whose #1 birth plan item was avoiding an episiotomy; she said she would much rather tear. When her OB prepared to cut her, I told him she had wanted to avoid an epis. at all costs. He said, "Well, she's getting one anyway," and cut her. Later on, he called me out into the corridor and told me off for mentioning it to him. This is an OB who prides himself on his low episiotomy rate - but still likes to be the one who decides. In cases like that, there is not much a doula can do.
I agree with Banana: push upright, so he will not be able to get at you.
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Old 09-17-2010, 06:49 AM
 
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The obgyn in CA told me that all first time moms require an epi. I disagreed, ended up with his midwife on call who didnt do them.
A birth plan is good, but I do think you need to bring someone to the birth. Low cost doula, friend, mom. Be firm and yell. I wish I had a doula with ds, I was forced on my back by a nurse so pushing upright is out of question. You need someone who tells the birth attendant we do not consent to bla and we will sue you.
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Old 09-17-2010, 10:21 AM
 
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I had one with DS1 and wasn't even told until after it happened.
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