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When I gave birth in 1999, I didn't have a birthplan. I never said I didn't want an episiotomy that I can remember, even though I really did not want one and that was a big issue for me. I must have forgotten by the time I was pushing though. The doctor didn't do one, and I did tear a little up in my vaginal area, but not in my perineum. My sister had routine episiotomies in the 80s with her one OB, but by the time she was giving birth in the early 90s, no more episiotomies. I've just been kind of assuming, I guess, that they aren't routine anymore, but it occurred to me that that is a bad assumption to make. I plan to make sure of this with my doctor, but I was curious what others thought.
 

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At the hospital I'm going to they say that episiotomies are not routine...but from everything else they say you'd still better make sure everyone knows you don't want one, and it really depends on what doctor/midwives you get. Some are very scissor happy, and others are not.<br><br>
I think a birthplan would always be a good idea, and episiotomy wishes definitely need to be expressed within it, reguardless of your carer's apparant attitude towards it before hand...
 

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here in AZ they do not seem to be "routine" but I would definitely say that some OBs seem to be more scissor happy than others. I would definitely raise the issue beforehand in a birth-plan session with the doctor, and maybe even have somebody such as a doula on hand to advocate for you. Birth plans seem to be ignored sometimes...I would rather have a person onhand to advocate for me than a birth plan.<br><br>
During my first labor and delivery, our birth plan specified that we did not want the cord cut until after it had stopped pulsing, but the doc cut it immediately....and then when my husband said something, a few seconds too late (he was busy greeting our newborn seconds earlier!) the doctor did a genuine "oops" and apology...birth plans are on paper, and are easy to forget about in the moment. it wasn't really the doc's fault...I really believe that. Somebody should have been watching over his shoulder for me..that would have done the trick.
 

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It really is a matter of the individual practitioner. When the first OB I had out here's partner commented "He's not going to like this, he usually does episiotomies" (concerning my insistence on not getting one), I immediately found a different practice with a provider who only does them when absolutely necessary in emergency and will do compresses/massage and allow some tearing rather than get scalpel happy. I really don't like the idea of someone slicing me down there, kwim?
 

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Seems to me like most all of my friends that have had the conventional, hospital, medicated, medical-model birth, have had an epis. Maybe it's just the area.<br><br>
However, with midwives, the rate is SUPER LOW. I did not have one with either birth, and i had two almost 9 lb. babies. I was talking to my CNM the other day and she told me a story about a woman that had an epis with a 5 lb. baby! She said it was due to an overzealous resident "showing off" for his med student. Really sad.<br><br>
I asked the homebirth mw that will birth #3 if she carried a suture kit (just in case) and she was sort of stunned--she said she has NEVER had a tear in over 100 births.<br><br>
I firmly believe that if you are allowed to labor peacefully and at your own pace, with the use of oil and hot compresses, and listen to your body, an epis is not necessary. No matter what any doc says.<br><br>
One more story (sorry to ramble). My best friend is a labor "delivery" nurse. She says that docs routinely cut women in order to "speed things up" and many times without even asking the women.<br><br>
Good luck, keep that bottom INTACT!!
 

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With my OB in 2000, they were routine. My husband said he remembered that she had a 70% episiotomy rate! (Don't ask me what I was doing there...) I had a 6 lb, 3 oz baby. My husband still talks about how since he didn't pop right out, she grabbed the scissors (or whatever) and he said "are you sure that's necessary" and she gave him a go to hell look and said "i think i know what i'm doing".<br><br>
Heh, I learned a lot about doctors from that birth.
 

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In my experience they are not anymore. Esp. if you have it on your birth plan. I think it depends more on the doctor than the hospital. The doctor who delivered dd (who was not even my regular ob) did massage and warm towels and had me push slowly and remarked that I was probably not going to tear. Then dd's h/b crashed into the 60's and stayed there for several minutes, and that plan went out the window. He made a cut and she came out with the next push. I consider my cut an emergency c-section down in my nether regions. It was not the desired outcome for the doctor or me.<br><br>
Darshani
 

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Sadly, I think they are routine in my neck of the woods--despite the fact I'm in the pretty crunchy Twin Cities (Minneapolis/St. Paul) area.<br><br>
All the 8 mamas in my LLL playgroup were surgury patients while birthing--a few c-secs, and the rest got episiotomies--with female OBs, at the 'best' hospitals (i.e., the least interventive and least old-fashioned), at the worst hosptial, or w/ a male OB.<br><br>
In my opinion, unless you get a response like<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">I asked the homebirth mw that will birth #3 if she carried a suture kit (just in case) and she was sort of stunned--she said she has NEVER had a tear in over 100 births.</td>
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-yogamamaof2+1<br><br>
you have a high chance of getting cut. LOOK OUT if you get the "I only do an episiotomy if neccessary." What consitutes neccesity, in my opinion, is the presence of the doc near his blunt-tipped Mayo scissors when your baby is coming out of your vagina. If you birth in the car or in the elevator on your way to the Maternity Ward, I guess an episotomy isn't going to be neccesary for you.<br><br>
LOOK out. I had a pretty forward-thinking OB, who was very cool during my 1st pg and 'delivered' my dd in such a way that I got to grab around her trunk and pull her out of my body. STILL, I got a nice episiotomy, for no rearson other than that is that doc's style.<br><br>
THINK about it--these docs/cnms have a style when they attend births. They will do their thing, often in spite of whatever the lowly patient's birth plan says.<br><br>
Episiotomies go hand in hand with managed labors--it is the doc/cnm's way of managing the end of your second stage of labor, just like Pit and pain meds are popular ways of managing the first stage of labor.<br><br>
Whoever is in between your legs with access to Mayo scissors will determine your perineum's fate when your baby's head is crowning.<br><br>
Episiotomy has not gone the way of knocking women out for vaginal deliveries. It's still quite prevelent, and it is a real danger to all women birthing in hosptials.
 

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Amy~ I noticed that you are somewhere in NV...I am too...it really depends on your ob. My 1st doc had a 90% episiotomy rate. She told me 9/10 moms need one!!!! I basically left her practice and chose a lay midwife to birth at home. I had complications and had to be transported to the hosp. The doc at the hospital was amazing!!! Despite the loss of our daughter he still respected my husband and I's wishes to not have an episiotomy. She was delivered with the assistance of a vaccum and I still was not cut <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/orngbiggrin.gif" style="border:0px solid;" title="orange big grin"> I tore like heck....and he sewed me up with care and compassion. Episiotomy's are only medically needed if you might tear forwards and not backwards and if you would tear completely with no skin left...Tears heal easier than surgical cuts. An episiotomy is equivelant to a 2nd to 3rd degree tear anyway....so check with your doctor and stay clear of anyone who has an episiotomy rate higher than 24%...
 

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in my part of the world, they are still very, very common with first-time moms. I'm not sure about the difference between MDs and CNMs - I would assume it would be lower with CNMs.
 

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<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;"><i>Originally posted by tinyshoes</i><br><b>Sadly, I think they are routine in my neck of the woods--despite the fact I'm in the pretty crunchy Twin Cities (Minneapolis/St. Paul) area.<br><br>
All the 8 mamas in my LLL playgroup were surgury patients while birthing--a few c-secs, and the rest got episiotomies--with female OBs, at the 'best' hospitals (i.e., the least interventive and least old-fashioned), at the worst hosptial, or w/ a male OB.</b></td>
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I am also from the Twin Cities. I had my son w/ the nurse-midwives at HCMC. Episiotimies were definately not routine w/ them. Although I knew I was not interested in having one, they encouraged me early on to start perineal massage, and let me know they rarely performed episiotimies, and only did so if absolutely necessarry.<br>
They also have an extremly low rate of C-section deliveries which was encouraging.<br>
I know they also do not perform u/s's which I found surprising. I had actually asked for an u/s to discover gender, and they said no. They said they only did them w/ high-risk pg's.<br>
Anyways, I did my perineal massages, and delivered a nearly 9 lb baby boy (underwater) w/ no tearing at all!<br>
I am seeing a different group of midwives this pg, and will deliver at Woodwinds Hospital, and they also seem pretty against routine episiotimies (thank goodness!).<br>
I do think birthing in the water made a big difference though, as well as the massage! I will be doing the same w/ this baby as well.
 

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I did not have one, and dd was born with the help of a vaccuum extractor, with a midwife attending and an OB at the last minute to do the vaccuum.<br><br>
Dh did hear the OB say, with something like regret in his voice, "Boy, I'd love to do a C-section here..." - rather than the vaccuum, I guess. I did not hear this. I was freaked out enough as it was, by the vaccuum business, so thank goodness!<br><br>
I did have a couple of stitches for tears that did not bother me at all.
 

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My understanding is that they are still routine in the average hospital. I suggest that you do all of the following:<br><br>
Put it in your birth plan<br><br>
Discuss it with your doctor in advance<br><br>
Have a doula or other advocate at the birth -- someone who will not be preoccupied with the baby or with coaching you -- someone who can watch over the doctor's shoulder<br><br>
When you get to the pushing stage, say, "Doctor _______," and make sure he makes eye contact with you, then say, "No episiotomy, okay?" and make sure he acknowledges you.
 

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Don't just put it in your birth plan, write it on your belly! That way the doctor can't say "Uh, I never saw that!"<br><br>
I hear the national average for first-time mothers is 90%, and that hospitals that boast lower-than-average c/s rates often have high epis rates. Either way, you are likely to be cut.<br><br>
People still say it improves sex (for men, I assume) and that it prevents uterine prolapse and urinary incontinence, which are commonly caused by c/s.<br><br>
I read about a woman who got an epis after her baby was born. She was in a teaching hospital and the baby was born before the resident could make the cut, but he said he had to do it anyway or his supervisor would be furious.<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"><br><br>
Some people also say without an epis the baby's head will be crushed against a tight pelvic floor, which I think is a bunch of bs. People really have this idea that birth is so traumatic and painful for babies, but I bet it's not.<br><br>
But I bet if you have a doctor who says "I'll only do one if it's medically necessary" she or he will find a "medical" reason to do one on you. I'd find a doc or midwife who never does them at all.
 

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<div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;"><i>Originally posted by Greaseball</i><br><b>he said he had to do it anyway or his supervisor would be furious</b></td>
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What an IDIOT! Didn't the woman object???
 

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Actually, she didn't object until several years later, when she realized it's not her job to make things easier for the doctors. If anything, doctors are our EMPLOYEES and if they don't perform to our specifications, we can fire them!<br><br>
So many people don't realize they were wronged until years after the event. And in many of the childbirth reform books I've read, women are quoted as saying "I'll do anything to make things easier for the doctors and nurses!"
 

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Discussion Starter · #18 ·
<div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;"><i>Originally posted by Greaseball</i><br><b><br><br>
I read about a woman who got an epis after her baby was born. She was in a teaching hospital and the baby was born before the resident could make the cut, but he said he had to do it anyway or his supervisor would be furious.<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"></b></td>
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That is absolutely sickening!<br><br>
I asked this question of a local doula last night, and she told me the episiotomy rate is way down, but it's still something like 34% throughout the country. It sounds like it's higher for first time moms, however. I'm pretty darn lucky I didn't have one the first time around.
 

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I'm lucky too, since I had a posterior baby/forceps delivery. I managed to deliver with an intact perineum anyway.<br><br>
I wrote on my birth plan "I would rather rip in half than have an episiotomy."
 

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<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;"><i>Originally posted by yogamamaof2+1</i><br><b>One more story (sorry to ramble). My best friend is a labor "delivery" nurse. She says that docs routinely cut women in order to "speed things up" and many times without even asking the women.</b></td>
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Another L&D nurse checking in here. I would say "yes" & "yes" to your friend's comments - they do seem to be more common with some practitioners, esp. those that are in a hurry (many) and most never ask. Then we have the old farts who still do them on everyone b/c "they might tear". <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/rolleyes.gif" style="border:0px solid;" title="rolleyes">: Whatever.<br><br>
I think the most important thing is to make clear ahead of time that you would rather tear than be cut, find a practitioner that is comfortable with that, and find a practitioner with a low epis. & tear rate. Midwives are often the only ones that fill this bill.<br><br>
I once heard a resident tell a woman (dead serious) that she tore b/c she didn't have an epidural. She told her "when you have an epidural we can have a slow controlled delivery of the head, but since you were unmedicated that wasn't an option." <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/jaw.gif" style="border:0px solid;" title="dropjaw"> Yeah, didn't have anything to do with the fact that everyone was screaming "push, push" (not me! promise!) while the baby was crowning.
 
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