Posted by My OB said WHAT?!?.
Dec
29
Posted by My OB said WHAT?!?.
“Well, I Haven’t Seen A Woman Give Birth In 8 Years Without One”
“Well I haven’t seen a woman give birth in 8 years without one”. -Nurse Practitioner to mother who wanted it noted in her chart during her prenatal visit that she did not want an episiotomy.
There are 26 comments to this post.
candice had this to say,
Dec 29, 2009 @ 4:50 pm (Quote)
Well I gave birth to twins without one, to a 10lb baby without one AND to our newest addition at home in our bathtub and without tearing. it is totally possible, unfortunately most medical professionals don’t seem to understand that anymore.
ore.
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This comment actually surprises me. Unlike Ceseareans, Episiotomies are actually on the decline. When I was born in the late 70′s they were close to 100%. The only mothers spared them were the ones who gave birth to quickly for the doctor to grab their scalpel.
Today the episiotomy rates are much lower.
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Heather (qtberryhead) had this to say,
Dec 30, 2009 @ 12:06 am (Quote)
When I informed my OB with my first baby that I did not want an episiotomy, he told me that “99% of his patients needed one.”
Correct me if I’m wrong…but aren’t you unable to decide that an episiotomy is needed until it is too late? And aren’t most tears smaller than a normal episiotomy?
How do you know if every woman “needs” one if you automatically do them on everyone!?!
I’m confused.
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Genet Reply:
December 30th, 2009 at 7:57 am (Quote)
These practitioners are the ones who are confused. If they admitted that episiotomies are unnecessary, then they would have to admit that they have been abusing women for their entire careers. In other words, because medicine is usually based on the doctor’s habits instead of the client’s informed decisions, medical practice is very resistant to change.
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judith Reply:
December 30th, 2009 at 11:22 am (Quote)
it is unfortunate that doctors are not asked to update their knowledge after they leave school. it seems that they learn new technology and are not interested in much else. unless a hospital has a climate that encourages change and they are open minded. I see the hospital bowing down to doctors and changing what we do even when it is wrong-because they are the doctor! I cannot wait to retire!
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Andy Reply:
January 3rd, 2010 at 1:18 pm (Quote)
In the UK, they are introducing a system called revalidation, where doctors are expected to update skills on a regular basis and show evidence that their skills are current. I think there will be an element of testing involved- it will certainly be formally assessed. As you may imagine, the doctors are up in arms, but it is being introduced to avoid the situation where outdated notions and ‘we’ve always done it’ inform their practice
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Jane Reply:
December 30th, 2009 at 8:14 am (Quote)
That’s exactly what happened to me. At the 7 month visit,I said, “I’d prefer not to have an episiotomy” and he told me “Well, you’re going to need one.”
Four subsequent births,BTW, did not require one.
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Judith Reply:
December 30th, 2009 at 11:54 am (Quote)
two resources I would you all to know about, well actually three: Mothering magazine, Childbirth Connections, Lamaze, Henci Goer’s book: Obstetrical Myths versus Research Realitis: a guide to the Medical Literature. I believe a new edition is coming out this year.
I do wish there was a way we could communicate about resources outside of these postings.
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Heather (qtberryhead) Reply:
December 30th, 2009 at 12:14 pm (Quote)
Saying “I’m confused” was tongue in cheek. haha.
The thing that confuses me is the supposed logic behind statements made by these cavepeople, er, OB’s.
As many of you have pointed out, OB’s often don’t know anything else. My ex and his girlfriend are getting their bachelors in nursing and when I skimmed through their textbooks there was a miniscule chapter on “normal” labor, and that labor included the use of an episiotomy.
I think too many OB’s get into this “faster is better” mindset. Like the sooner we get the baby born, the sooner we can stop worrying about things that can go wrong. They fail to associate newborn issues with labor interventions.
There are reasons why we women undergo the things we do in labor. We get loose stools at the beginning, we crave light snacks and water to sustain us. Our thoughts turn inward while we grasp the realization of what we are doing and where we are going with this new life altering experience. We feel compelled to walk around, moan, grunt. We get the urge to push when it’s needed, and we feel burning when we need to back off. An intact perineum contracts on the babies chest in order to expell excess fluid from the lungs. These are things that women need to experience in order to birth a baby in the safest way possible. Why are people confounded by that?
Sorry to get all gooey…
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In the past, doctors were taught to do episiotomies on everyone, standard of care. they also learned to use forceps with all births,needed or not. I worked L&D at a teaching hospital in 1990, and they still taught epis and at a higher level, how to catch babies over an intact perineum. crazy, I know! I brought in articles for the residents to show them that it was out of date and cutting would do more harm. they agreed and felt they could not change practice until they were on their own.
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Jane Reply:
December 30th, 2009 at 8:16 am (Quote)
I read an article by one doctor who said that in the same position, he took to becoming “clumsy” and dropping the episiotomy scissors. Once they were on the floor, they weren’t sterile enough to perform a surgical procedure any longer,so the woman “had” to deliver without the episiotomy. Doctors and nurses were STUNNED: my goodness, these women weren’t ripping from stem to stern like old velcro! I think they thought an un-episiotomied woman would just rip right through, and you’d be stitching up her lungs, her teeth, even putting her hair back on her head.
He said that after a while of dropping the scissors or failing to properly take them from the nurse so they fell, it was understood that he was the non-slicing doctor. 
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This is the story I submitted. It took place 10 years ago with my first baby. I was only 16 (17 when I had her). I ended up doing one test push, she crowned, the dang doctor was nowhere to be found and the floor Dr. was in another birth. I was *forced* to lay there and not push for 15 minutes. The doctor came in and slid out into her ungloved hands. No tears, never any pain. My second daughter was born in 2006 and I had her under the care of a midwife in a birth center. She too was a one pusher, had a big head and came out with her hand on her face and I still didn’t tear. I am now pregnant with my 3rd DAUGHTER and we are planning a homebirth. I hear and see the craziest things with OB’s! I submitted two more stories, but I am not sure they made the cut!
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On my second delivery my OB (who I had to switch to due to insurance reasons) insisted that I have needed one even though I had my first without one and no tears. Yes my second child was slightly larger (10 ounces), but not that much bigger.
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Until I started reading this site, I always assumed tearing was something that was inevitable (and I’m 21). I can’t tell you how much of a relief it is to know now that it can be avoided, and obviously not just by getting a completely useless episiotomy.
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Jane Reply:
January 3rd, 2010 at 4:43 am (Quote)
Think about this, though: they want you to avoid tearing by CUTTING you open.
That’s like saying, “You want to avoid a broken leg, so instead we’ll smash your kneecap with this hammer.”
And no,I’ve found that I have stretchy skin and I delivered four of my five babies without tearing. The only time I had a tear was when the doctor used the episiotomy scissors.
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Kat Reply:
January 3rd, 2010 at 8:27 am (Quote)
Another thing to consider is the degree of tearing.
An episiotomy cuts through the skin and muscle, which if it happened naturally would be second-degree tearing.
If you tear just a little bit, you might only have tearing in the skin (first degree). Obviously the lesser amount of damage will heal faster and easier.
And, once your tissues are cut, they are more likely to tear further. Like when you cut a slit in a piece of cloth, it is much easier to just rip it all the way through than to rip a cloth without a slit in it. The analogy has been mentioned before but it bears repeating because it is true!
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I have been a midwife 8 and a bit years, and I have done 5 episiotomies. Each of those has been to expedite delivery because of distress. We don’t do them routinely over here, and haven’t since the eighties I think. There used to be 2 criteria for getting the scissors out: 1) first baby, and 2) previous episiotomy. There has been a lot of research done over the years that has shown that episiotomy doesn’t reduce the risk of a serious tear. It also may increase the risk of more extensive damage from the cut extending. It has also been shown that a tear will heal much better than a cut anyway, because a cut crushes and bruises the tissues, causing odema and a wound that doesn’t come together well. A tear occurs along natural break lines around the cell walls, so the wound naturally closes better. I haven’t got the refrences to hand, but I will do a search later and put it on here.
Andy
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Sign #8 that you need to change practices.
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