A Rant on Episiotomy - Mothering Forums
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Birth and Beyond > A Rant on Episiotomy
MegBoz's Avatar MegBoz 12:55 PM 10-27-2010
I was looking for birth videos & landed on "My Best Birth." There was a video titled "hospital birth" & I decided to watch. <sigh> Stupid, but I've read a lot about totally unnecessary** episiotomy & now I've had the chance to see one.

It was every bit as horrifying, infuriating, & nauseating as I'd anticipated-- because I watched this cut knowing full well that it was not only not necessary, not only not helpful, but completely and utterly damaging. He might as well have stuck those scissors up her nose & made a cut there, for all the benefit episiotomy provides - or cut the soft webbing on her hand between index finger & thumb.

Actually, come to think of it, if given the choice, I'd personally rather be cut at the nose or hand than have an unnecessary episiotomy. At least those cuts don't have the substantial risk of extending into something much worse (i.e. 3rd or 4th degree tear through the rectum.) & then there's that whole painful sex thing to be concerned about.

Am I way off on the nose/hand thing? It sounds wacky at first, but the more I ponder it, the more I do think a cut in either of those places would be the lesser evil.

**Yeah, I'm nearly certain it was totally unnecessary (there was NO reason to suspect the baby was in distress and needed to be born NOW - so, therefore, epis was 100% unnecessary!)

lynsage's Avatar lynsage 01:12 PM 10-27-2010
That just makes me nuts. Just this morning I was looking for info on fetal positioning for my mom because we were chatting about whether the baby was head down yet, and the web page I was looking at said the position my daughter was born in (posterior) was likely to require forceps AND an episiotomy "to ease delivery". My mom and I both flipped out when I read that to her- not only did I NOT tear at my easy, fast home birth of a baby in this position, I remarked on how GOOD it felt when she came out! No way would that have happened if someone had taken a pair of scissors to my body.

My daughter had a nuchal hand, too...I bet they would have wanted to cut me six ways from Sunday in an average hospital birth in the area I was living in back then!
mamabadger's Avatar mamabadger 12:57 AM 10-28-2010
Quote:
Originally Posted by MegBoz View Post
Am I way off on the nose/hand thing? It sounds wacky at first, but the more I ponder it, the more I do think a cut in either of those places would be the lesser evil.
It would certainly be preferable to the woman who was cut. Unfortunately, cutting the hand or nose would not fulfill the more central purpose of ritually mutilating the female body parts, so it could never catch on in the medical community.
Yes, yes, I am angry and hyperbolic.
SashaBreeze's Avatar SashaBreeze 02:04 AM 10-28-2010
I was cut with my first and am a survivor of the 4th degree tear through the rectum that resulted afterwards. I would have to say, having lived through it, that yes, yes I would have rather had my hand or nose cut. The pain and swelling is horrendous and it takes what feels like forever to recover from it, I dont even remember how long it took for me to be able to walk around like a normal human being again after that.

I hate episiotomies.

My third child had a nuchal hand, and he was also my first natural birth with a midwife. Not a single tear, not so much as a skid mark. Beautiful blissful birth.

I hate episiotomies.
Smokering's Avatar Smokering 03:10 AM 10-28-2010
Yep. I came close to tearing up when I heard Mum had been given one with my eldest sister, just as a routine thing. She wasn't too enthusiastic about it herself, but having read so much about them, I just found it horrific.

And I'm another one who gave birth to my first child with a nuchal hand (not tiny either, 8 pounds 7) with only "skid marks" to show for it and NO CUTTING. I'm so glad they do it more rarely here. I would totally kick a doctor in the face with all the force I could muster, if it came down to it.
jen&james's Avatar jen&james 07:21 PM 10-28-2010
I also had a episiotomy with my first and had a 4th degree tear thru the rectum. It took forever to heal. My baby was only 7lbs 9oz. my second birth was at home and I was afraid of tearing in the smae spot so I massaged with EPO a week or so before. My second was 9lbs 8oz and I had the tiniest tear.
Brittee's Avatar Brittee 02:54 PM 10-31-2010
I was talking about this with my mom the other day. I was explaining how I think that I am pregnant and am leaning toward a home birth. She was all, "Can a midwife do an episiotomy? You'll want her to do one if you need it."
I was all, what the heck? No!!
And then she explained that I was so BIG that she had to have an episiotomy and forceps used when I was born. My birth weight was 8lbs, 13 oz. And my mom, she's 6 feet tall. I managed to get off the phone but on the inside I was so sad for my mom. The only good thing for her is that she thinks it was necessary and saved baby me.
AutumnAir's Avatar AutumnAir 06:54 PM 10-31-2010
I'm with you!!

I was cut too with my first DD - very much as a way to ritually mutilate, humiliate and establish power over me. I was transferred in from a planned homebirth in a country where doctors are seen as near-gods and don't take kindly to having their authority questioned. It was a huge episiotomy and I suffered fecal incontinence for nearly a year afterwards as a result. (Oh, I hadn't even started pushing at the time, and was given no anesthetic at all - not a pleasant sensation to say the least )

I also tore this time around (UC birth - lovely, easy and fast) right along the scar line, though not as severely this time, thank goodness. So it even impacts your subsequent births.

I'm also not convinced that they're ever really necessary - it seems to me that they really are a tool in the general practice of ritually humiliating pregnant/birthing women and convincing them (and society) that they are incapable of birthing without such awful interventions.
TeaJunkie's Avatar TeaJunkie 07:18 PM 10-31-2010
I was at my sister's hospital labor and birth (really my nephew's birth!) in July.

To give you an idea how fast he came, she was 4cm at 2:00 and he was out at 2:35. The doctor did an episiotomy! Her 7lb 8oz boy was out in 4 pushes!!! Why on earth did the doc do an episiotomy?!

I was seething for her because it was SO unnecessary but even though she wishes it wasn't done, she was okay and at peace with it. Most likely because her DD was 9lb 11oz and tore her up pretty badly, so she felt a lot better even with the episiotomy!

I love my MWs...
ursusarctos's Avatar ursusarctos 11:31 AM 11-01-2010
Quote:
Originally Posted by mamabadger View Post
Unfortunately, cutting the hand or nose would not fulfill the more central purpose of ritually mutilating the female body parts, so it could never catch on in the medical community.
Yes, yes, I am angry and hyperbolic.
I'm with you!

My good friend had a medicated hospital birth with a (sounds like from her story) totally unnecessary episiotomy. While she was happy with her birth, I'm still seething that her midwife cut her The same midwife gave her pitocin without asking and told her not to make noise because it wouldn't help I live in a country with one of the lowest maternal and fetal mortality rates in the world that consistently ranks in the top 5 of the "most equal countries for women" and yet 50% of first time mothers still get episiotomies!

My mom had an episiotomy with me, resulting in a fourth degree tear that required 100 stiches. That made me tear up just to hear. But at least it sounds like it was necessary - apparently it was a situation when I needed to come out immediately and it wasn't happening. This was a homebirth in the 80s.
Super~Single~Mama 11:38 AM 11-01-2010
You know, I think an episiotomy would have LESSENED the degree to which I tore with my ds. I tore REALLY weirdly - in a semi-circle, so it had to be cut so he could be born anyway - and it took FOREVER to heal. Seriously, FOREVER - I was in EXCRUCIATING pain for 12 weeks after the birth, literally the ONLY time I wasn't in pain was when I first woke up in the morning and hadn't moved at all.

An episiotomy would have been neater, and the scar probably would have actually healed rather than still being gaping open at 21mo pp. I will NEVER have ANYTHING that even resembles a perineum ever again, unless I go through incredibly painful reconstructive surgery.

So, to say that they are always the devil, and always bad, is not accurate. It's just impossible to tell when it would make it better, until its too late to change anything.
MegBoz's Avatar MegBoz 10:27 AM 11-02-2010
Quote:
Originally Posted by ursusarctos View Post
I live in a country with one of the lowest maternal and fetal mortality rates in the world that consistently ranks in the top 5 of the "most equal countries for women" and yet 50% of first time mothers still get episiotomies!

Get out of here! FIFTY PERCENT of FTMs get epis? Wow! I think the nationwide rate here in the US is like 30%, so I'm shocked that it's even worse in Finland! (Of course, that's not to say US maternity care is better, but I'm just saying on this particular issue, I'm shocked that we're better.)
mamabadger's Avatar mamabadger 11:33 AM 11-02-2010
Quote:
Originally Posted by MegBoz View Post

Get out of here! FIFTY PERCENT of FTMs get epis? Wow! I think the nationwide rate here in the US is like 30%, so I'm shocked that it's even worse in Finland! (Of course, that's not to say US maternity care is better, but I'm just saying on this particular issue, I'm shocked that we're better.)
Could it be that the U.S. episiotomy rate is lower than it might be because its C-section rate is higher?
MegBoz's Avatar MegBoz 11:53 AM 11-02-2010
Quote:
Originally Posted by mamabadger View Post
Could it be that the U.S. episiotomy rate is lower than it might be because its C-section rate is higher?
Hm, interesting Q. I assumed when I read the US epis rate is "30%" than that is "30% of all vaginal births." Not much point in listing the epis rate of ALL births when over 32% of births are CS.

Here's the 1st link when I Googled, "US episiotomy rate"
Quote:
One in three mothers who delivered vaginally in the U.S. from 1995 to 2003 had episiotomies.
& from Childbirth Connection
Quote:
The episiotomy rate has been falling off for some time in the U.S. However, when Childbirth Connection carried out its national U.S. Listening to Mothers survey among women who had given birth from 2000 to 2002, 35% of mothers with a vaginal birth had experienced episiotomy.

jeminijad's Avatar jeminijad 12:28 PM 11-02-2010
I am quite surprised by that 30ish% number, honestly.

Amongst the roughly two dozen women with whom I have discussed their births, not one had an epis. This is between the Houston area, the Philadelphia area, and the northern NYS area.

It is at the very bottom of my birth concerns, because I do not perceive it to be a current threat. But it must be in at least some places!
branbran54's Avatar branbran54 03:15 PM 11-02-2010
I live ein the sticks of TN and I can't name one person who has had one. I do know that the OB/Midwife practice that I have gone to for the past 10 years does not do them. I heard someone ask my midwife about them and she said that it is part of their policy. All research showed that it was better to tear so they go with that.
mrs_mandolini's Avatar mrs_mandolini 06:12 PM 11-02-2010
I live in the central midwest and know at least 3 women who have had them in the last 5 years. I can't comment on how "necessary" they were in each case, all 3 were first time moms with epidurals.
AlexisT's Avatar AlexisT 06:36 PM 11-02-2010
I remember seeing hospital level stats for NYS. The variation from hospital to hospital was amazing. Like, from 10% to 40%. It doesn't entirely correlate to other stats, either--the high epis hospitals had high epi rates, but the converse was not true. There were very interventionist hospitals with episiotomy rates from 10-15%.
MegBoz's Avatar MegBoz 06:39 PM 11-02-2010
Quote:
Originally Posted by AlexisT View Post
I remember seeing hospital level stats for NYS. The variation from hospital to hospital was amazing. Like, from 10% to 40%. It doesn't entirely correlate to other stats, either--the high epis hospitals had high epi rates, but the converse was not true. There were very interventionist hospitals with episiotomy rates from 10-15%.
That's interesting. Yeah, it seems that, on the whole, American OBs realize that it's best NOT to do an epis - but they still think induction, purple pushing, CS for FTP, VBAC-bans, AROM & pit to speed things up are all great ideas.

I did read in one of the articles that there were big regional differences. The West was listed as higher.
MegBoz's Avatar MegBoz 06:40 PM 11-02-2010
While we're discussing it, has anyone else ever SEEN an unnecessary episiotomy on video or in person? Just wondering if you all would be as furious & haunted by it as I was.

(& yes, I know, sometimes they ARE necessary, which is why is wrote the "unnecessary" one made me furious.)
Turquesa's Avatar Turquesa 08:21 PM 11-02-2010
It's too bad that this info isn't recorded on birth certificates. Unnecessary epis are very much a public health issue, so it would be nice to pin down some raw data on how often epis in general are happening.

By the way, this pamphlet says that hospitals shouldn't do epis more than 20% of the time, and they "should be working to bring that number down." 20% seems like a lot, and why does bringing that number down have to be such an incremental process? That's not a rhetorical question. I'm curious if I'm missing something....
eclipse's Avatar eclipse 08:27 PM 11-02-2010
They did one on me for no apparent reason and I was SO pissed. Iw as actually saying "No, Don't!" and the guy did it anyway. It was so hard to recover from that birth compared to my later two, when I didn't have one - it even made things like breastfeeding harder because I was in so much pain that I had a hard time sitting up for long enough and was taking strong pain meds to help get through it. It still makes me angry when I think about it. My husband was understrict orders on my second two births to yell and grab the hand of anyone picking up scissors. Thankfully, no one tried with those births.
Marissamom's Avatar Marissamom 10:43 PM 11-02-2010
I'm going to say that there are *VERY* rare situations where it's preferable to have an episiotomy. I had a band of scar tissue from horrid, disposable tampons when I was a teenager, and it would*not* stretch DD was so stuck and would get down to that point and then I could feel her slid back up in between contractions. maybe if I had been able to use gravity I could have forced it to tear, but after about 15 pushes where we were completely stuck, and DD's heartbeat going way lower than the hospital was comfortable with, I was given the choice of c-section or episiotomy. I chose the episiotomy. maybe, in a different environment, or with a different doctor (I was stuck with the one on call) I could have torn instead. The thing I'm actually madder about then the episiotomy was that she did a crappy job stitching me up. now, I really don't think that the more routine perinial episiotomy is ever truly necessary, there are some times when the episiotomy is not the worst choice.
AuroraPolaris's Avatar AuroraPolaris 07:35 AM 11-03-2010
I`m glad this have changed through the years.
My mother gave birth to 4 girls, all of them average size. She gave birth laying straight on her back, feet in stirrups, and she was cut every time.

I have given birth 3 times, the last time twins. Every time I have written in my papers that I would not accept an episiotomy.
And I never had one! The midwife told me straight after the birth of number two that she nearly had to cut, because the babys hart rate was dangerously low the last contractions. If I didnt tell her I didn`t want one several times during labour, I guess I would have one. But she tryed her best to meet my wishes, and thankfully it turned out ok.

From what I could google midwives here try their best to avoid episiotomy these days. They only cut for the baby, if he/she really need to come out as quickly as possible.
minkajane's Avatar minkajane 01:06 AM 11-04-2010
I was watching a birth on TV the other day and right as the baby was about to come out, the doctor says all nonchalantly, "We'll just make a little room..." and snip snip snip! There was no consent, no question, just "a little room"!!!! She only pushed for like half an hour, so there was no reason for it. It was obvious the doctor does them as a matter of routine. And the fact that he was so laid-back about it even on camera makes it so clear that he sees no problem with it.

I hate watching those shows, I don't know why I do it. The abuses that you see ON CAMERA are so bad. It shows you that they're so widely accepted that they're not even considered at all. And if they're that bad on camera, what's happening when the cameras are off???
karanyavel's Avatar karanyavel 01:10 AM 11-04-2010
My ex-OB told me she performs episiotomies "as needed". She didn't cut me, but I didn't give her a chance -- I pushed the baby out in one hard shove because I was so adamant that she not cut me. As a result of the "superwoman push", I had a 3rd degree tear. I bet if I'd been able to push at my own pace, I wouldn't have had nearly as much tearing. Ugh.

She repaired my tear very poorly, too.

Luckily, this time I am using a midwife practice & freestanding birth center.

--K
Storm Bride's Avatar Storm Bride 01:16 AM 11-04-2010
I've never had one. It's the only plus I see to having had all c-sections.
ursusarctos's Avatar ursusarctos 05:37 AM 11-04-2010
Quote:
Originally Posted by MegBoz View Post

Get out of here! FIFTY PERCENT of FTMs get epis? Wow! I think the nationwide rate here in the US is like 30%, so I'm shocked that it's even worse in Finland! (Of course, that's not to say US maternity care is better, but I'm just saying on this particular issue, I'm shocked that we're better.)
Yep. At least that's what they told my friend at her birth preparation class and she told me. It scared her, too, she kept telling me how she really hoped she didn't need one and I kept trying to tell her that she probably didn't and that they couldn't cut her if she told them not to (I have the impression that they are generally respectful of your wishes if you let them know) but she didn't seem to believe me There is just no way a 50% rate is necessary. But they pass it off as if it is.

Quote:
Originally Posted by mamabadger View Post
Could it be that the U.S. episiotomy rate is lower than it might be because its C-section rate is higher?
Maybe. Last time I checked Finland's was 17%, but the hospital where my friend gave birth has one of 9%.
MegBoz's Avatar MegBoz 01:41 PM 11-04-2010
Quote:
Originally Posted by minkajane View Post
I was watching a birth on TV the other day and right as the baby was about to come out, the doctor says all nonchalantly, "We'll just make a little room..." and snip snip snip! There was no consent, no question, just "a little room"!!!!

<snip>

The abuses that you see ON CAMERA are so bad. It shows you that they're so widely accepted that they're not even considered at all. And if they're that bad on camera, what's happening when the cameras are off???

So, yeah, that little smiley lineup sums up my feelings on those mainstream birth shows as well. I totally feel the same way - if that's how they act on camera, what's it like off?

Although I suppose the doc feels that since the patient has accepted his care, then she has left it up to the doc to "manage/ guide/ direct/control/ protect" the situation as the doc sees fit.

Maternity care in America makes me insane enough as it is - so I do try to avoid the temptation to look at any of those shows for even an instant since odds are very high that it will make me crazy (well, crazier - ha!).
Smokering's Avatar Smokering 05:31 PM 11-04-2010
So... I'm having a hard time seeing how episiotomy is EVER necessary. Some of you seem to accept a low (but not zero) rate as inevitable - how come? Aren't they usually done when the baby is quite far down in the birth canal? And if it had got that far, doesn't that prove that the vagina is big enough to birth it? (Er, it... him or her, you know.) I mean, I know some mothers tear, even with good positioning - not that most of them get that chance in mainstream hospitals! - but isn't tearing considered to be a better deal, as it might be superficial, whereas epis always cut through all the tissue? I mean, tears can just be on the surface of the perineum, which would be analogous to the doc "scoring" the perineum like slashing a loaf of bread... but they don't do that, they cut all the way through, deeply into the muscle.

Can anyone enlighten me?
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