Posted by My OB said WHAT?!?.
Sep
26
Posted by My OB said WHAT?!?.
“You Have A Second Degree Tear Right Where An Episiotomy Would Have Been.”
“You have a second degree tear right where an episiotomy would have been.” – Midwife to mother who had written in her birth plan that she did not consent to routine episiotomy.
There are 31 comments to this post.
An episiotomy is a second degree laceration, right? Or is it a third degree laceration?
So either the mom was exactly the same for having torn (with the easier healing time) or she was better off (easier healing and less damage and no tearing behind the episiotomy.)
The midwife probably wanted to stick it to the mom that she “failed” or that her wishes were stupid, but frankly, the midwife just made herself look petty, as if an intact perinium isn’t one of her goals or is in fact a bad thing.
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Sara Reply:
September 26th, 2011 at 5:14 am (Quote)
I think it’s third degree.
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Jane Reply:
September 26th, 2011 at 5:16 am (Quote)
So then the midwife was saying, “See? You did what you wanted and you got hurt LESS than I would have hurt you! Aren’t you sorry you did that?”
Tell me when reality stood over on its head, because I’d like the world to start making sense again.
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I guess this one must be about tone/context, because I was told the same thing about tearing where an episiotomy would have been cut, if I’d had one, and didn’t even think to get riled up about it. It definitely wasn’t said with the implication that I would have been better off letting my care provider cut me, though, or that I somehow deserved it as punishment for refusing to be cut or any such nonsense (it was a homebirth, and episiotomy was never brought up at all during labor).
As far as degrees of laceration, most episiotomies are 2nd degree. 3rd degree extends all the way to the anus, so you’d have to tear after being cut (which isn’t uncommon) or they would have to do a bigger cut than usual to end up with that.
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Details Reply:
September 26th, 2011 at 6:09 am (Quote)
No that is 4th degree that extends into the anus.
I agree this one is going to be all about the tone which is probably “I told you so” since it is here. Personally I think it is great. If she had gotten an episiotomy she might have torn all the way into her anus and that would be bad!
If a doctor said, “You tore, but it was only about as far as an episiotomy and should be no problem to repair.” that would be much more positive than what I am imagining happened with the above quote.
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Amanda Reply:
September 26th, 2011 at 6:45 am (Quote)
See, I would get riled up because I was told at the birth of my first that I ‘tore’ but when my very experienced midwife (with my second) sat down to check my perineum after birth, she could tell, it was far too straight to have been a tear. I was so pissed off…not only that I had been cut but that I had been lied to!!
I was young, and said I didn’t want to be cut. My husband was paying more attention to me than to the staff, and I didn’t have a doula. So they cut me, and then lied about it.
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jenni Reply:
September 26th, 2011 at 7:57 am (Quote)
my husband suspects the same thing with my first birth, the Dr was very impatient, and didn’t tell me a thing until i yelled OUCH when they were giving me the local for it. the scar tissue was suspiciously straght too. and the healing time was aweful.
with our second, a different OB said i tore right along the old scar tissue, but it took considerably less recovery time, hurt considerably less, and felt considerably different.
but my husband was focused on me and not on the Dr, so unless i find a MW who can tell from the scar tissue, or a nurse willing to spill the details, then i will probably never know.
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Tenielle Reid had this to say,
Sep 26, 2011 @ 6:35 am (Quote)
I had a second degree tear with my daughter – it actually hurt less and healed faster than the graze my son gave me.
Lisa – I had no idea that’s how it was “rated”! I tore through MUSCLE? *wince* No wonder it took them ages to stitch it!
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I sort of hate that my first reaction was:
“Give me a mirror. Those ‘torn’ edge better not be surgically straight.”
But there it is.
Otherwise: seriously? Can’t you just tell the woman that she did GREAT! That, if she had gotten an episiotomy, it would have been at least as bad as this tear, and this one will heal better, so she made the right choice.
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Ya know, something funny my OB said at my first birth after she cut me and was sewing me up she looked at my husband and said with a wink “D’ya want me to throw an extra stitch in there, dad?” It COULD be seen as offensive, but at the time, given my ignorance to the procedures, it was kind of funny.
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jaed Reply:
September 26th, 2011 at 8:33 am (Quote)
The “husband stitch” has a long and ugly history. The OB was suggesting she might deliberately distort the shape of the vaginal opening in order to make it tighter, make sex painful, and suggesting that your husband might be the kind who’d get his jollies from that. I’d have been more than offended, personally. I hope she was just joking around and didn’t actually do anything like that to you!
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BeckyJ Reply:
September 26th, 2011 at 9:17 am (Quote)
She was joking. She knows how my hubby likes to joke around, (which he’d been doing my entire labor) and wanted to throw something out there too. He was a great coach and I didn’t make a fuss about much and she made sure to tell us how great of a job we both did together. She’s probably the only OB that I respect, other than that comment, which was meant as a joke anyhow.
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nicola sunnyboo had this to say,
Sep 26, 2011 @ 7:37 am (Quote)
a 2nd d-t heals better then an episiotomy because the jagged edges act like a zip and heal better, if u get what i mean. And iv had both episiotomy and 2dt.
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Rach had this to say,
Sep 26, 2011 @ 9:32 am (Quote)
Episiotomy is equivalent of 2nd, and in my opinion a 2nd heals much better. Epis are more likely to extend to a 3rd (skin, muscle and anal sphincter) or 4th (all that and anal mucosa too).
They also cause other problems too as I found out yesterday… woman having her 2nd baby whilst pushing the baby would not advance as a thick band of scar tissue from her poorly sutured epis was holding the baby in! So much so that I was considering performing one (which would have been my 2nd in 5 years!)
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This one is mine. I was a VBAC mother (previous c-section for breech baby) delivering in a hospital with a CNM practice that has a good reputation for successful VBACs. I had a fairly positive birth experience and, thankfully, very few complaints. Most of that, however, was due to my AWESOME L&D nurse, not the midwife.
When I arrived at the hospital, I found that the on-call CNM was the one midwife that I had not met with during my pregnancy. She was also the midwife in the practice with the reputation for being the most medicalized (according to others in her practice and women who have delivered with this practice).
After I checked in, the midwife sat with me to quickly review my birth plan (in between my 1 minute apart contractions 
. She was supportive about all of it except the episiotomy clause (I can’t quote it accurately d/t contractions-impacted memory, but it was something like: Are you sure you prefer to tear? Those can be dangerous.) I stated again that I did not consent, and she agreed. She then followed this agreement up with, “And I just want to let you know that if at any point you decide you can’t do this, we’ll prep you for surgery. Just say the word.” I told her that I was confident we would not be doing that.
Mostly, she left me alone, and 4 hours after arriving, I pushed my 8lb. 9oz son out with no pain medications and no interventions. While I cuddled him, she set up the light to begin her stitches and said the above. As many women have commented already, a statement like this is all about tone. Hers was dripping with “I told you so.” And (TMI) yes, I did check, and I’m pretty sure that was a real tear. Thank goodness!
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BeckyJ Reply:
September 26th, 2011 at 11:15 am (Quote)
You see, I think I have alot more respect for direct entry midwives because I hear alot less bad things about them rather than CNM’s. I’m sorry you got HER, being as she was so rude about your wishes. I’m glad you got a VBAC too. That is so awesome!
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Lora Reply:
September 26th, 2011 at 11:38 am (Quote)
I agree with you, BeckyJ, and this is why we are planning a homebirth if we have another child.
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BeckyJ Reply:
September 26th, 2011 at 12:07 pm (Quote)
I’m having an unassisted birth in November. I really wanted a midwife present, but no means of paying one. I will be arranging for schooling for direct entry midwifery after he’s born and when I go into practice, I’ll make payment arrangements with my clients so people are left with more options for homebirth instead of feeling like they either have to hospital birth or go unassisted. I really want to make a difference in the world of birthing women and babies, and I feel this is the best way to do it.
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Rebecca Reply:
September 26th, 2011 at 3:16 pm (Quote)
I haven’t had any experience with midwives but some thoughts and these aren’t directed toward you but to some things that have been going through my mind about comments here.
First, hospital midwives aren’t often not sought out (frantically searched for LOL) by their patients, so they may have the same experiences as OBs with a large, large number of uninformed patients.
Second, they’re stuck in the same medicalized environment as the labor and delivery nurses we’ve talked about before, and also stuck with hospital protocols they may not agree with.
Third, in most cases, we’re only going to hear about the bad experiences. People who haven’t had bad experiences aren’t likely to search out blogs like this one- even our Thoughtful Thursdays are mostly from people who are having a good experience after a bad one in an earlier pregnancy.
Don’t get me wrong, the things we see are still bad- no matter who says them, but it becomes very easy to demonize a whole group of people based on what type of training they have rather than treating them like individuals, the same thing we’re asking prenatal and L&D to stop doing to us.
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Aron Reply:
September 27th, 2011 at 3:17 am (Quote)
Agree. Every word. In a few months I’ll be graduating nursing school and starting into a nurse-midwifery program. As a doula and firm homebirth advocate, if you’d asked me a few years ago what route I wanted to take to become a midwife I wouldn’t have hesitated for one second in telling you I would only do direct-entry, no nursing for me! But when it came time to actually start, I realized that I (in my own circumstances) would gain the most and be prepared to offer clients the most if I went the nurse-midwifery route. It’s scary sometimes because it can be very medicalized, but I have been tremendously encouraged by the wonderful nurse-midwives I have met who will be my instructors soon. Their hearts are midwive’s hearts – they love women and they love supporting them toward normal, non-interventive births in as many settings as possible. I hope one day to be able to offer my services in home births, along with many other nurse-midwives who find themselves limited in that option and who are fighting for the chance to do the same. There are definitely some out there who do not share the same mindset of respect for human dignity and autonomy that we have, but I am coming to realize they are in the minority. Hopefully, as I work toward becoming an out-of-hospital care provider I can, meanwhile, provide women IN the hospital with the respectful and compassionate care they deserve while working to preserve the normalcy of their births (alongside many other nurse midwives working to do the same).
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I really don’t understand where doctors and medwives get this idea that a routine episiotomy is going to be a better option for the mom. Tears aren’t exactly a straight line but they’re not a zigzag either and can be repaired. Not to mention an episiotomy is a standard 2nd degree cut and a tear can be much smaller. So leave the bits alone!
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Jenny Islander had this to say,
Sep 27, 2011 @ 8:56 am (Quote)
“Oh, that’s such a relief! Imagine how much worse it would’ve been with a surgical wound already there to accelerate the process! Now let’s talk about perineal support during labor to help prevent this kind of issue for your future clients.”
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1) That sounds suspiciously coincidental. It seems like “tear” should be in quotes, as in “imposed”.
2) If I truly did just happen to tear in exactly the same place and to the same degree as an episiotomy would have been, fine. It’s much better than it would have been had you violated my informed refusal and cut me first.
Really hoping the second is the case, but considering the nature of this site, I’m guessing it’s not. Bad enough for the medwife to violate her client’s wishes, far worse to lie about it in this way.
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