Posted by My OB said WHAT?!?.
Jul
8
Posted by My OB said WHAT?!?.
“…I Find That Pretty Much All My 1st Time Mothers Require An Episiotomy.”
“Well, we’ll see. I find that pretty much all of my first time mothers require an episiotomy.” – OB to mother prenatally, who stated she did not want an episiotomy.
There are 34 comments to this post.
Well, then I guess you are doing it wrong!
[Reply]
Jane Reply:
July 8th, 2011 at 6:37 am (Quote)
That’s what I keep finding pathetic: these doctors have such a blind spot that they don’t realize their own actions are the reason the moms “require” all these interventions.
My own idiot doctor, when I said I didn’t want an episiotomy, said, “Well, you’re gonna have one,” and I was enough of an idiot that I stayed in the practice. I was only 7 months pregnant, not crowning. But I imagine that after hearing 90% of their moms saying “I don’t want an episiotomy” the doctors feel the emotional need to justify the fact that they’re cutting the genitals of so many women who don’t want it done.
[Reply]
Dreamy Reply:
July 8th, 2011 at 7:04 am (Quote)
Sadly, it’s probably nowhere near 90% (either because most moms haven’t even heard of one, have been told by their own mothers that it’s “better than a tear,” or because they think theirs will have been necessary if it is done)… But even if it’s 10%, it’s definitely enough to make those doctors defensive.
Hey– I get it. There’s plenty of things in life and in medicine that are counterintuitive*. But episiotomy to prevent tearing (or even to do any good at all, in most cases) just ain’t one of them.
*You know, like how my ADHD brain is actually HELPED by stimulants.
[Reply]
Jena Reply:
July 8th, 2011 at 1:43 pm (Quote)
When I was in 6th or 7th grade and we were doing the sex ed unit, the teacher told us that episiotomies were necessary to prevent tearing, which was much worse. I think that’s when I decided that I wasn’t having kids; sounded like the craziest thing ever to me. And then I met my hubby and it seemed crazy not to have kids. And I did my reading and found that episiotomies are considered old school by many doctors, and when I told my doctor I didn’t want one, she agreed that they’re pretty unnecessary except in rare circumstances.
[Reply]
:headdesk:
How long is it gonna take for EVIDENCE BASED care to make it into every day prenatal and birth care?
Seriously, put down the scissors and back away from my genitalia. NOW.
[Reply]
Aron Reply:
July 8th, 2011 at 8:30 am (Quote)
It will happen when care providers are actually held accountable for NOT practicing evidence-based care….so, basically, never.
Sorry, but I got up on the cynical side of the bed this morning.
[Reply]
Kat Reply:
July 8th, 2011 at 8:50 am (Quote)
Just to encourage you:
I attended an informational/hospital tour hosted by my care provider’s office (CNMs).
The room was PACKED. Several of the dads went and stood in the doorway or next room to make seats available to the pregnant mothers, my own husband included.
The midwives and their backup physician spoke about the shockingly high induction and c-section rates in our area, and the dismal lack of evidence-based care in the US in general. There were heads nodding all over the room, and several occasions of spontaneous applause (especially when they mentioned their plans to open a free-standing birth center in the next 2-3 years).
There ARE women out there demanding evidence-based care. We’re trying to raise our girls to demand it too. There are care providers out there who get it, and who are trying to effect change.
It may be a ways off, but I think change is possible. I get cynical sometimes too, but it’s probably good so I don’t make people puke with my repulsively cheery optimism. 
[Reply]
Sheva Reply:
July 8th, 2011 at 10:37 am (Quote)
Yes – education is the key. My girls are 8 and 3, but they know more about birth than most kids here (ultra religious community). People (my mother included) think I’m nuts, but I don’t care. My girls already know that even a doctor can’t touch them without their permission, and they know all about birth and how natural it is.
[Reply]
Aron Reply:
July 8th, 2011 at 12:14 pm (Quote)
Thanks, that’s really cool to hear – especially that the CNMs and doctors seemed to be collaborating to enact changes. That’s really the population my cynicism is aimed at. Sometimes it just seems like nothing will ever change in the medical profession itself to require care providers to practice according to the best standards of evidence available. I wish, for instance, that OBs had to attend monthly review sessions where random cases were pulled from records of births they attended that month and they were made to account for each deviation from evidence-based care. (“We notice that all but 2 of your vaginal births included episiotomies. Care to explain?”) I know it’s not realistic, but if care providers knew at every birth there was a real chance they would have to explain the facts of that birth to their peers and had the real chance of facing some sort of unpleasant consequence as a result, we might start to see more changes. Law suit threats don’t really accomplish anything in terms of bringing standards in line with evidence – they just make people practice more CYA techniques.
Anyway, no more ranting from me. It’s the start of the weekend and the end of a good but tiring week. And your news about that sort of meeting is fantastic! We need more of that. Thanks!
[Reply]
This doctor must attract a really unique set of women if “pretty much all” his first time mothers require episiotomies. Because that is certainly not backed up in any research, literature, or experience I’ve had.
[Reply]
Can someone please tell me what is so preferable about an episiotomy versus a tear? I had 2nd degree tears for both of my births, AND a vestibular tear for my first, and it wasn’t a big deal. The midwives stitched me up just fine, no problems. I understand that “a cut is easier to repair than a tear”, but re-tearing for cuts is a problem, and really, tears are not that hard to stitch.
Soooo… why do we need episiotomies so much, doctor? Are you just incompetent at repairs?
[Reply]
Sheva Reply:
July 8th, 2011 at 10:38 am (Quote)
Yep, that’s it – I’ve heard that tears are harder, apparently. Any midwives or docs reading this care to comment on which is harder?
[Reply]
alice Reply:
July 8th, 2011 at 3:31 pm (Quote)
It is generally easier to identify all the ‘parts’ with an episiotomy- much more obvious where the apex of the tear is and how the skin edges align.
Saying that, it is just as ‘easy’ as a tear, I think, you just have to use a bit more judgement. I find it very satisfying when I make a good repair. I think its just laziness to use the excuse thats is easier (quicker) to repair.
I have seen many a slow crowning a ahead, particularly with a primip that took a looooong time and as the head advavces, the perineum continues to stretch and stretch and stretch….with some, I think, its never going to stretch enough- it gonna tear! But no after the birth I find that no, its completely intact.
I think episiotomies for primips come mostly from inpatience- it can take a loooong time for that perineum to distend, and the belief that it will never stretch enough.
If the babies OK and mum is in a position that facilitates normal birth, theres no reason for an epis.
[Reply]
Obstetrics: you’re doing it wrong.
I had a 2nd degree tear with my first baby. Healed beautifully. I didn’t tear at all with my second, but had another second degree tear with my third. Again, healed beautifully. I’d much rather tear naturally than get cut.
[Reply]
I’ve only had one child and the way my OB did my episiotomy was to say “Now, we are going to have to do another intervention you didn’t want, an episiotomy.” I swear to God she starting cutting as she said “episiotomy.” THEN I wanted the epidural.
[Reply]
Jespren had this to say,
Jul 8, 2011 @ 8:28 pm (Quote)
My dad (yeah I have an open, trusting relationship with my dad) was trying to convince me to get an episiotomy with my 1st birth, thinking that it would prevent a worse tear. So I took a piece of fabric, handed it over and asked him to rip it. Now my dad’s a big guy, but he couldn’t tear that intact cloth. Then I took a pair of scissors and cut it, gave it back and asked him to tear it, and of course with little effort it tore easily. He looked at it, looked at me and said ‘i see’ and didn’t talk about epis anymore! I think all women should do that with any husband/dad/doctor who claims an epi will help prevent those bad tears (since obviously the OBs are ignoring 20 years of research that shows 3rd and 4th degree tears are *more* likely with an episiotomy!)
[Reply]
Brittany J had this to say,
Jul 11, 2011 @ 6:42 pm (Quote)
My 8lb 1oz VBAC (first vaginal birth) FACE PRESENTATION bsby sure didn’t require one! I didn’t even tear!
[Reply]
This was after I explained I didn’t want an episiotomy because my mother’s idiot-fill-in-doctor performed one on her that left with her with an anal fistula and required repair surgery when I was 7 months old. When I said I didn’t want one I meant it!
[Reply]
Add Your Comment.
yep, but us women with more than one… well you can drive a freight train straight out of there!
[Reply]
Lisa Reply:
July 8th, 2011 at 8:51 am Lisa(Quote)
Actually, even with first-time mothers, if you allow them to labor down, push upright, and not scream “ONETWOTHREFOURFIVESIXSEVENEIGHTNINETENPUSHHHH!!!!” at them, more than likely they’ll deliver without major tearing.
[Reply]