Posted by My OB said WHAT?!?.
Oct
8
Posted by My OB said WHAT?!?.
“…Nurse, Hand Me My Magic Wand.”
OB: “Would you rather be cut or tear?”
Mother: ‘Neither!”
OB: “Nurse, hand me my magic wand.”
There are 52 comments to this post.
Jessica had this to say,
Oct 8, 2011 @ 10:48 am (Quote)
Totally on the side of the OB. This one is funny and it’s obvious what he means.
Sure, it’s possible to not tear. But if you’re going to tear, they can’t stop it. Hence the need for a magic wand.
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BeckyJ Reply:
October 8th, 2011 at 10:52 am (Quote)
Umm no. Because if a person wouldn’t want either to happen, it’s more likely she’d opt to tear. Making the decision FOR her was completely wrong and unprofessional and to think it’s funny is wrong as well.
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Chara Reply:
October 8th, 2011 at 11:09 am (Quote)
It is unprofessional, but I can understand the OB’s frustration. Women say they want to be consulted in their care, but she is choosing not to make a choice. He should have answered her differently, but so should she. Tearing is sometimes a part of childbirth, no matter how much your perineum is supported, or how careful you are when you push. Sometimes it just happens, and he’s giving her the opportunity to make a choice. Maybe what he needs to do here is educate her a little (assuming that she’s not pushing at this moment) in a professional manner.
Let’s face it- he’s offering her the opportunity to be involved in her own care, and she is not participating realistically.
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BeckyJ Reply:
October 8th, 2011 at 11:40 am (Quote)
I just think maybe he could have said “Look, you have to make this decision in my care for you. One of the two is bound to happen.” Not just “alright I’m gonna cut you.”
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Chara Reply:
October 8th, 2011 at 11:50 am (Quote)
I keep reading this and going back and forth- do you think he’s asking for the scissors, or do you think he’s just really sarcastically telling her that she’s being unreasonable? I initially read it as a sarcastic response, not him just deciding to cut her.
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BeckyJ Reply:
October 8th, 2011 at 12:34 pm (Quote)
When I was cut with my 1st, my OB used a scalpel. That might be the “magic wand”
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Krista Reply:
October 8th, 2011 at 12:44 pm (Quote)
I read it more as a, “Well, then I sprinkle this fairy dust on your perineum and cast a spell with my magic wand and you’ll magically do neither!” Pretty sure the doctor was making a joke.
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Jessica Reply:
October 8th, 2011 at 2:05 pm (Quote)
What decision did he make for her? It doesn’t say this was during pushing, or that he then performed an episiotomy. The reasonable assumption is that this was during a normal visit when making plans for what the mom wanted. Otherwise it would SAY he did one, like most of the posts do.
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juliewashere88 Reply:
October 9th, 2011 at 8:48 pm (Quote)
Ha! No, this is funny. Yes, tearing can sometimes be prevented, but it’s more likely to happen than not. Sometimes, you just have to pick which you want.
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Kristy Reply:
October 9th, 2011 at 9:12 pm (Quote)
“it’s more likely to happen than not”
No… really it isn’t. When a birth is allowed to happen without directed pushing and other ‘forced’ time tables and interventions you very often get the ‘just a skid mark’ ending. And the pink link makes it clear that mama had already stated she wanted as natural a birth as possible… so she *had* picked what she wanted unless episiotomies are suddenly ‘natural’.
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Jade Reply:
October 9th, 2011 at 10:14 pm (Quote)
Between my grandma with 4 kids, all 4 of those girls have got children (10 children) and of those children 3 have children (5 children) So that would be 8 mothers with 19 children in total, there is 1 c/s and for the other 18 children, NONE of us have had either an episiotomy or torn (inluding a vaginally born 12 lb baby)
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Jessica had this to say,
Oct 8, 2011 @ 10:58 am (Quote)
Becky, how did the OB make the decision for her?
You have to realize that no matter how much you don’t WANT to tear, it can happen. Be willing to accept that if you don’t want an episiotomy. And lighten up, this one IS humorous.
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Mama Wrench Reply:
October 8th, 2011 at 11:20 am (Quote)
The lack of consent is not implied consent. It’s impossible for a doctor to be able to know which women will tear and which won’t — he’s simply assuming that the woman will end up with a separated perineum, one way or another. It’s like a schoolyard bully giving the skinny kid the choice of getting punched in the face or punched in the gut — without mentioning just walking away as another option. Then when the skinny kid says “neither,” the bully takes that as meaning “You just make up my mind for me” and goes straight for the nose.
Yes, some women will tear. An episiotomy often LEADS to a tear. And unless he has a crystal ball and a book of spells to go with that “magic wand” he has no way of knowing if she would even tear at all.
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Jessica Reply:
October 8th, 2011 at 2:06 pm (Quote)
“The lack of consent is not implied consent.”
And again, how did he make any decision? Where does it say he did “cut” her?
This is a joke about the fact that if she’s not willing to consider potential outcomes and plan for them, she might as well wish the baby out. You need to plan for what can happen, not expect it to magically go the way you want.
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Seriously? The doctor is about to slash her perineum against her explicit instruction and you’re on the side of the OB? (The “magic wand” the nurse is to hand him is the surgical shears, yes?)
—
Apart from that… the fact is that no doctor should ever be asking this question. An episiotomy increases the risk of severe tearing, and is itself a second-degree cut. If done to purportedly “prevent tearing” (as opposed to speeding up the birth when the baby is crashing), the procedure is worse than useless, because it’s likely to cause either the same or worse outcome compared to a tear. It is unethical to perform episiotomy for this purpose, even if the mother consents to it (which she clearly didn’t in this case), because doctors are not supposed to be performing procedures which predictably cause worse outcomes.
Blecch.
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Kay Reply:
October 8th, 2011 at 11:31 am (Quote)
I thought he was just implying that it would be unlikely for her to do neither by asking for his “magic wand”. Maybe I’m just optimistic, but I don’t think he was actually asking for an instrument to give her an episiotomy with.
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jaed Reply:
October 8th, 2011 at 12:09 pm (Quote)
Hmm, maybe so. I can see that you could read it either way.
Although the natural tear rate is what, maybe 30% for second degree or more? So it doesn’t seem likely that the OB was actually claiming it would take “magic wand” to prevent any perineal injury.
Hard to say.
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At first by “magic wand” I thought the doctor meant the scalpel to cut her (as in – making the choice for her), but then I realized what was meant and also found it kind of funny. This is an OB that explicitly asked the patient what she would prefer – something that a lot of OBs featured on this site don’t do. The problem is that the patient gave an answer that’s not really in the OB’s hands. What’s he/she supposed to do to make her not tear?? At most he/she could try to slow down the crowning to give mom time to stretch, but even that’s no guarantee.
OP, I’m sorry that you found this offensive in your situation and I don’t mean to make light of your feelings.
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Ways to reduce tearing: upright birthing positions, not telling her when to push, no episiotomy to start off a worse tear. There are a few things he could be trying.
I’ve had 2 vaginal births, babies were 9lbs and 7lbs10, not so much as a skid mark. Of course that was because I danced around a unicorn to the beautiful glow of twinkle lights. Silly OB, you meant unicorn, not magic wand.
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Hahaha ok that’s funny. I totally would have laughed… and then chosen to tear. And hey, c’mon at least the ob asked her preference. He didn’t just slice her wothout even asking for consent. It’s not his fault that she chose ‘neither’. That isn’t always an option.
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If this was done in the moment of crowning and the doctor saw a tear starting, then the doctor’s only fault is that s/he didn’t say “You’re starting to tear.” If the doctor sees the tear starting then the doctor knows “neither” is no longer an option and would need a magic wand to undo the tear.
But that’s presuming the doctor said this with an actual tear starting to form before his or her very eyes. If the doctor is indicating by this that EVERY woman tears unless the baby is apparated out by magic, that’s different.
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Alyson Miers had this to say,
Oct 8, 2011 @ 11:55 am (Quote)
Okay, perhaps the doc could’ve worded the question differently. Perhaps, “Would you prefer to be cut or allow for a natural tear?” would have been better?
Still, I can see where the doc is coming from. There’s no way to guarantee a tear-free birth.
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Aron Reply:
October 9th, 2011 at 7:45 am (Quote)
I think the best way he could have worded it would have been: “how do you feel about episiotomies?” Nice and open-ended, not either-or, can be asked at any stage during pregnancy or labor and leaves room for the mom to simply say “I don’t want one.”
Anyone who says tearing and cutting are the only two options or that nothing can be done to reduce the risk of tearing is incompetent as a care provider. (I know you already know that.) Several actions by the care provider can directly reduce the risk and several other actions by him/her can directly increase the risk.
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No…
One of the two is NOT bound to happen. They are two out of three possibilities, and maybe the mom would prefer to focus on prevention (not that there are any guarantees, but there are things you can do to make tearing less likely, and not using the scissors in the first place can rule a cut right out!)
Why not ask “alright, if it comes down to it, and I think you’re going to tear, would you rather I preemptively cut you, or would you rather just wait to find out if you do indeed tear and how the tear will go?”
Yes, the mom does need to tell her doctor yes/no on the scissors question. But this doctor is treating the mom like an idiot for not assuming that either one of the two IS going to happen. Not OK. Also, something we should remember: this isn’t the whole conversation, just one line from it. I’d bet the mom did answer the question, right before/after indicating that she would rather not do EITHER.
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My midwife (CNM) asked me this exact question at a third trimester visit. And I gave the exact same response.
Forunately, my midwife responded with, “I hope so too, and we will do everything we can to make sure that happens.” I also followed up with the fact that I definitely did NOT want an episiotomy, which she was fine with.
I did end up with a tear, but that was because DD decided to come so fast. Head and shoulders came out together in one push. That would do a hard number on anybody’s perineum!
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I agree we need the pink link. I want to take this as the ob saying, well yeah, no one wants to tear OR be cut, but I can’t magically make that happen. Obviously mom was offended by this, and I can see why she would say neither. You can of course choose not to be cut, but you can only do so much to prevent tearing. I did not read “magic wand” to be knife, scissors or other instruments of mass distruction! OBs do need to know which moms would prefer if the situation occurs and hopefully educate their patients. He returned sarcasm/flippancy with the same, as I see it.
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This is mine, it was almost 5 years ago with my first son. The guy was not my OB, he was the one on call since I went into labor on a Sunday. I had only met him once before, and didn’t like him then. I was expecting my OB, so I was thrown off when he walked in the room.
The question was asked during transition, before pushing, and he was most definitely being a condescending smartass, since he had all his “tools” right there on a tray and held his hand out to the nurse, who was empty handed.
Like I said, this was my first child and I was not the battle-hardened mama bear I am today. I had already said I wanted the birth to be as natural as possible so when he asked, I was confused. And I was dead serious, I wanted neither. I also didn’t want to be lying there flat on my back, but I was young and he was intimidating.
I went ahead and got the episiotomy out of fear, since he implied that my son was about to rip me from asshole to belly button. I did have trouble getting him out but that was because the epidural (that I also hadn’t wanted but allowed for the absolute worst reason ever and I am ashamed to admit – because the nurse had called in the anesthesiologist from home in the middle of the night without my knowledge and I felt bad FOR HIM) took away any sensation of my body telling me to push.
That was the hardest birth and worst recovery of the three I’ve had. My second was born naturally and easily two years later with my regular OB, who never even mentioned an episiotomy. Number three followed two years after that with a midwife, the biggest of all three of my boys and born quickly! No cutting, no tearing… no magic.
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Jane Reply:
October 8th, 2011 at 6:53 pm (Quote)
I’m so sorry that everyone at your birth seemed to be in it for themselves.
Don’t be ashamed to talk about how they badgered and bullied you. You did nothing wrong. It’s not until medical “professionals” act this badly that it even enters our minds that such things are possible.
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jaed Reply:
October 8th, 2011 at 9:31 pm (Quote)
that I also hadn’t wanted but allowed for the absolute worst reason ever and I am ashamed to admit
It sounds like they took advantage of your natural consideration and courtesy to bully you into doing something that made life easier for them and harder for you. That’s absolutely nothing for you to be ashamed of – the people you should have been able to trust instead used your good qualities against you. They’re the ones that ought to feel shame.
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first time mommy had this to say,
Oct 8, 2011 @ 9:48 pm (Quote)
You’re magic wand? What are you Harry Potter? And if she hands you it will you disappear?!
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first time mommy Reply:
October 8th, 2011 at 9:48 pm (Quote)
argh YOUR magic wand. It’s late =P
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I never consented to an episiotomy. He cut me anyways. That was in March. I never healed properly and I’m too afraid they will have to re-cut and re-stitch me again to make it better…
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jenni Reply:
October 13th, 2011 at 6:02 am (Quote)
I was TOLD i tore naturally with my daughter… but in hindsight, between the pain, difficult recovery, and the rather straight nature of the tear… and the SOB who delivered, my husband and i strongly suspect i was given an unwanted episiotomy.
the good news is… when #2 was born, i had a much lesser tear, and when that Dr put me back together things seem to have lined up correclty again, and it feels TONS better. recovery much quicked and with much less pain! thank you #2 and awesome Dr!
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Well, that one’s funny! Women have to choose either the episiotomy (not a good idea) or let their bodies tear naturally.
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Kati Reply:
October 8th, 2011 at 11:17 am Kati(Quote)
Really? Because I didn’t tear with either of mine, and they were 9 and 10 lbs. Laboring/birthing in water is a big help.
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Mama Wrench Reply:
October 8th, 2011 at 11:30 am Mama Wrench(Quote)
Women don’t CHOOSE to tear or to be cut. Tearing is a possibility that it’s possible to prevent with proper support and pushing positions and procedures. Cutting is something done TO women that guarantees an injured perineum (while tearing is frequently merely superficial).
Not to mention — I don’t know about anyone else, but when *I’m* busy pushing, I don’t have time or mental wherewithal to reply with anything other than one-word answers to anything. Asking a mom who’s in the process of evacuating her baby such a dumb question is pretty unfair.
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Jessica Reply:
October 8th, 2011 at 2:03 pm Jessica(Quote)
This one doesn’t say when it was asked. Why do you assume it was during pushing? This is the type of question that would be asked during prior visits, to prepare for the birth.
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Mama Wrench Reply:
October 8th, 2011 at 4:17 pm Mama Wrench(Quote)
Except that: 1, there is no way to know whether the OB attending the birth is the same one the woman has been seeing; 2, there’s no way for the doctor to know whether she was going to tear at ANY point during labor, whether it be during pushing or not; 3, following transition MOST women with natural labor are simply too focused on giving birth to hold a conversation on the risks and benefits of tearing versus cutting; 4, there’s no way to know whether the doctor agreed with the mother for 90% of her pregnancy, only to change his tune during labor; and 5, the woman reserves the right at ANY point in labor to decline ANY medical procedure that’s not necessary to save her or her child’s life.
It doesn’t matter when the question was asked. I assume that it was asked during pushing because that seems the most likely context. It could have been at the 30-week prenatal for all that matters.
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K Reply:
October 8th, 2011 at 6:33 pm K(Quote)
No, it is _not_ possible to prevent tears. Anyone who says they can guarantee you an intact perineum is lying or trying to sell you something. I hear the doc on this one. It is exactly what would go through my head, although I’d like to think I have a better filter between my brain and mouth. Ask me at 4am after 36 hours awake, though, and I’m not sure! Um… although now that I think about it, I
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K Reply:
October 8th, 2011 at 6:35 pm K(Quote)
…would not ever offer to cut instead of allow a tear, since I would rather not have a patient with a 3rd or 4th degree laceration.
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Danielle Reply:
October 8th, 2011 at 6:48 pm Danielle(Quote)
It’s possible to prevent *some* tears, not all. I don’t think anyone’s suggesting that all tears can be prevented, just that it’s *possible* through various means. Which he wasn’t willing to do. With him it was one or the other.
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Mama Wrench Reply:
October 9th, 2011 at 7:11 pm Mama Wrench(Quote)
Exactly.
It’s pretty obvious that lithotomy purple-pushing can lead to tears. It stands to reason that avoiding this “standard” pushing procedure would reduce the risk of tearing. You can’t guarantee an intact perineum, but you can guarantee an injured one when your belief is that the only options are to be cut or to tear.
Perineum stretches during pregnancy, pushing in physiologically-appropriate positions, non-directed pushing… all reduce the risk of tearing. Episiotomies, however, do not.
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