Nov 13

“Honey, You’re Gonna Tear, But I’ll Stitch You Up Real Good.”

“Honey, you’re gonna tear, but I’ll stitch you up real good.” – OB to mother at a prenatal, when the mother asked about the benefits, if any of prenatal perineal massage.

48 people dislike these words.

There are 33 comments to this post.

v had this to say, Nov 13, 2012 @ 3:17 pm (Quote)

Ummm….

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Your Name had this to say, Nov 13, 2012 @ 3:33 pm (Quote)

Wow! Are you psychic? Ok…I’m thinking of a number between 1-100.

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pittsburgh mama had this to say, Nov 13, 2012 @ 3:36 pm (Quote)

Well, OK, OB, but I have to say I’m now questioning your listening skills, as you actually didn’t even begin to answer my question.

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Jane had this to say, Nov 13, 2012 @ 3:44 pm (Quote)

“So you’ve never heard of it?”

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Kasondra Reply:
November 14th, 2012 at 6:19 am Kasondra(Quote)

That’s what I heard.

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Proginoskes had this to say, Nov 13, 2012 @ 4:41 pm (Quote)

That sounds reallllllyyyy creepy to me.
“Honey” “real good” …ick.
It’s entirely possible that it’s just me, however.

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Jessica Reply:
November 13th, 2012 at 5:10 pm Jessica(Quote)

It isn’t just you. It gave me the heebie-jeebies.

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Mama Wrench Reply:
November 13th, 2012 at 5:33 pm Mama Wrench(Quote)

I’m from the South, so it struck me as pretty culturally normal — we call everybody “honey” and “real good” (though it grates on my sensibilities) is common.

Just shows, English isn’t the same everywhere…

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Proginoskes Reply:
November 15th, 2012 at 5:01 am Proginoskes(Quote)

I’m a Southerner too! Hi!
Everybody really does talk like that around here, but for some reason when I read it in my head, it sounded leering instead of comforting or conversational.

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kelsea Reply:
November 13th, 2012 at 5:39 pm kelsea(Quote)

Seems like a southern thing. Not ick worthy, but definitely irritating. Usually, that kind of thing is followed up with “bless your heart.”

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Nikki Reply:
November 13th, 2012 at 9:19 pm Nikki(Quote)

Yes, sounds like a Southern response, but one of those condescending type of statements that are intended to “politely patronize”…gag.

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Sheva had this to say, Nov 13, 2012 @ 8:15 pm (Quote)

You know this for sure… how?
Are you planning to cause the ‘tear’?
This sounds suspiciously like a particularly enthusiastic husband-stitcher.

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Kristin had this to say, Nov 13, 2012 @ 8:45 pm (Quote)

You answered a question that I didn’t ask.
Could you answer the question I DID ask please?

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Nikki had this to say, Nov 13, 2012 @ 9:22 pm (Quote)

This just further reinforces what I tell my clients: OBs are SURGEONS. As a general rule, they don’t care if you are cut or if you tear, because they love to suture. Midwives, on the other hand, will usually do everything they can to prevent tearing because they didn’t get into birth to sew people up! (Generalizing here, I know there are fab OBs out there and medwives, too.)

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Goldilocks Reply:
November 14th, 2012 at 2:25 pm Goldilocks(Quote)

Really? Yes OB’s are surgeons, doesn’t mean they are knife/suture wielding mad wo/men. It simply means if you tear (which can happen no matter who you birth with) they have the skill to repair the tear. I don’t think most midwives would have the skill to repair a very deep tear.

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Jane Reply:
November 14th, 2012 at 3:01 pm Jane(Quote)

I have heard of midwives transporting moms to hospitals to suture 4th degree tears. I’m not sure about 3rd degree, but I also haven’t seen studies on how often women get 3rd degree tears during midwife-attended births. I do know one midwife who said she wasn’t a good stitcher because she didn’t have enough practice.

I do believe, however, that because OBs feel more confident about repairs, that they feel a tear or an episiotomy is not a big deal. Especially the OBs who were taught every woman *needed* an episiotomy or else she’d have serious uncontrolled tearing, those doctors probably don’t even see a need to take measures to reduce tears. To those old-school doctors’ logic, episiotomies *are* a tear-reduction strategy. And if a specific outcome is not a big deal to the medical practitioner, it makes sense that the practitioner wouldn’t have spent his or her time looking for ways to minimize that particular outcome.

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Goldilocks Reply:
November 15th, 2012 at 5:24 am Goldilocks(Quote)

An episiotomie is a tear reduction technique. How exactly would a midwife repair a tear? They don’t typically have much in the way of pain relief. Are they sitting there stitching on women who can feel it? An OB might forget a women doesn’t have pain relief and start a repair by mistake, but to plan to perform a repair when you know there is no pain relief seems kind of cruel. A midwife would almost have to transport for a 3rd, once you start sewing muscles there are a lot of surgical tools needed, you need a surgeon.

What about reports of midwives misdiagnosing tears? Women being told a 3rd or 4th degree tear didn’t need stitching only to have issues later.

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Sheva Reply:
November 15th, 2012 at 5:38 am Sheva(Quote)

An episiotomy is not a tear-reduction technique. It is simply a doctor-controlled tear. How is cutting someone reducing a tear? Don’t think about what it says in the books, just use your logic.
Episiotomies carry the risk of *increasing* the length of the tear. Tears usually stay in the layer of skin, and many do not need repairing. Episiotomies by definition are already deeper and include more layers and will certainly require stitching.
Midwives carry lidocaine and are trained to repair tears. They do not have training in deeper, more extensive repairs, because they are trained to prevent tearing and encourage stretching, using massage and better birthing positions. Since doctors are well trained in repair, they see no need to prevent them, and so are not trained in the art of birth, just the science of it.
What made you lose your respect for midwives?
You sound as bitter about them as some of us are of doctors.

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Goldilocks Reply:
November 15th, 2012 at 12:38 pm Goldilocks(Quote)

I become bitter about midwives after reading story after story were it seems the midwives/doulas only role is not make the OB’s job harder. Who on earth would want to work with or cooperate with someone whose professional stance is you are a heartless knife welding lunatic and their job is to protect their client from you?

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Aron Reply:
November 16th, 2012 at 6:09 am Aron(Quote)

Neither concept is remotely true. I’m sorry you haven’t actually experienced the relationship between the average midwife and OB (which usually is a professional one, even if they operate differently). I have yet to meet even one midwife who views OBs as “knife-wielding lunatics”. It seems your view is based on hearsay and not actual experience. Also, you seem to be of the opinion that midwives are somehow untrained, unprepared and ill-equipped to do their jobs. This is also a fallacy. They go through many years of training, many have graduate or higher degrees, and are regulated in all 50 states (not to mention being the expected care-providers in most every other country of the globe). They carry all necessary equipment (including lidocaine, intramuscular pitocin for placentas and hemorrhage, oxygen, and much more). All available scientific medical research repeatedly demonstrates the safety and efficacy of midwifery care.
Lastly, when it comes to episiotomies, not a single medical organization endorses them as useful. Not one. Every single piece of research repeatedly demonstrates they cause more harm than good and should only be used in ~1% of cases. They are responsible for more than 70% of third and fourth degree tears, and automatically count as at least a second degree tear because they extend into the muscles of the perineum. Thus they are falling out of favor with obstetricians, but the practice is slow to disappear entirely because it is fast and easy (for the care provider). Providing appropriate perineal support takes effort and patience, thus some care providers (both OB and midwife) are reluctant to follow through with the more appropriate practices recommended by their certifying boards. It is what it is. But, happily, it is changing.

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Aron Reply:
November 16th, 2012 at 6:09 am Aron(Quote)

Neither concept is remotely true. I’m sorry you haven’t actually experienced the relationship between the average midwife and OB (which usually is a professional one, even if they operate differently). I have yet to meet even one midwife who views OBs as “knife-wielding lunatics”. It seems your view is based on hearsay and not actual experience. Also, you seem to be of the opinion that midwives are somehow untrained, unprepared and ill-equipped to do their jobs. This is also a fallacy. They go through many years of training, are regulated in all 50 states (not to mention being the expected care-providers in most every other country of the globe). They carry all necessary equipment (including lidocaine, intramuscular pitocin for placentas and hemorrhage, oxygen, and much more). All available scientific medical research repeatedly demonstrates the safety and efficacy of midwifery care.
Lastly, when it comes to episiotomies, not a single medical organization endorses them as useful. Not one. Every single piece of research repeatedly demonstrates they cause more harm than good and should only be used in ~1% of cases. They are responsible for more than 70% of third and fourth degree tears, and automatically count as at least a second degree tear because they extend into the muscles of the perineum. Thus they are falling out of favor with obstetricians, but the practice is slow to disappear entirely because it is fast and easy (for the care provider). Providing appropriate perineal support takes effort and patience, thus some care providers (both OB and midwife) are reluctant to follow through with the more appropriate practices recommended by their certifying boards. It is what it is. But, happily, it is changing.

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Aron Reply:
November 16th, 2012 at 6:12 am Aron(Quote)

Neither concept is remotely true.

I’m sorry you haven’t actually experienced the relationship between the average midwife and OB (which usually is a professional one, even if they operate differently). I have yet to meet even one midwife who views OBs as “knife-wielding lunatics”.

It seems your view is based on hearsay and not actual experience. Also, you seem to be of the opinion that midwives are somehow untrained, unprepared and ill-equipped to do their jobs. This is also a fallacy. They go through many years of training, are regulated in all 50 states (not to mention being the expected care-providers in most every other country of the globe). They carry all necessary equipment (including lidocaine, intramuscular pitocin for placentas and hemorrhage, oxygen, and much more). All available scientific medical research repeatedly demonstrates the safety and efficacy of midwifery care.

Lastly, when it comes to episiotomies, not a single medical organization endorses them as useful. Not one. Every single piece of research repeatedly demonstrates they cause more harm than good and should only be used in ~1% of cases. They are responsible for more than 70% of third and fourth degree tears, and automatically count as at least a second degree tear because they extend into the muscles of the perineum. Thus they are falling out of favor with obstetricians, but the practice is slow to disappear entirely because it is fast and easy (for the care provider). Providing appropriate perineal support takes effort and patience, thus some care providers (both OB and midwife) are reluctant to follow through with the more appropriate practices recommended by their certifying boards. It is what it is. But, happily, it is changing.

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Aron Reply:
November 16th, 2012 at 6:15 am Aron(Quote)

Goldilocks, I’m sorry you haven’t actually experienced the relationship between the average midwife and OB (which usually is a professional one, even if they operate differently). I have yet to meet even one midwife who views OBs as “knife-wielding lunatics”, though I do occasionally meet OBs who view midwives as “herb-waving lunatics.” It seems your view (like theirs) is based on hearsay and not actual experience or education.
Also, you seem to be of the opinion that midwives are somehow untrained, unprepared and ill-equipped to do their jobs. This is also a fallacy. They go through many years of training, are closely regulated in all 50 states (not to mention being the expected care-providers in most every other country of the globe). They carry all necessary equipment (including lidocaine, intramuscular pitocin for placentas and hemorrhage, oxygen, and much more). Many have advanced degrees in midwifery, nursing or both. All available scientific medical research repeatedly demonstrates the safety and efficacy of midwifery care.

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Aron Reply:
November 16th, 2012 at 6:16 am Aron(Quote)

(Sorry, Sheva, this post is in response to Goldilocks, but the website refuses to post my comment, so I’m trying it this way.)

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Tee Reply:
November 16th, 2012 at 8:28 pm Tee(Quote)

As a general rule, midwives carry lidocaine.

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Jenny Islander had this to say, Nov 13, 2012 @ 10:22 pm (Quote)

Look, dippydo, I didn’t ask whether you could replace my frickin’ front end. I asked whether you could tighten up the thing that tends to shimmy BEFORE ANYTHING ACTUALLY BREAKS. Capiche?

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Trisha had this to say, Nov 14, 2012 @ 6:38 am (Quote)

So this WAS my doctor and this is my story:

This was my first pregnancy and I literally just picked a doctor out of an internet search who had good reviews and in my area (Nashville/Franklin to be exact).

I’ll be the first to admit that I had no maternal instinct going into this pregnancy but I started doing research and the doctor I had just wasn’t making me comfortable. The more I looked into methods such as purple pushing, perineum massage and other things, the more resistant he got. I asked about a birth plan and he said that we could just talk about it here and that there was no reason for anything formal or written down. (should have been my first red flag!)

I was a fairly easy first pregnancy for him and my appts were about 5 minutes each time. No joke. So, having had a sister who had two 10 lb babies, a mom who had an two 11 lbs, a 9lb, a 10lb and a 12lb, tearing was a real concern to me. I’m much smaller than everyone else in my family (brothers are 6’3″, 6’6″, 6’2″, sister is 6″ without shoes, Dad is 6″ and since my sister tore, I was really afraid of tearing too. I asked him what he thought about perineum massage that I kid you not, this is what he said!

I was stunned, and pretty much speechless. I wasn’t sure if he was kidding, which I think, made it worse! I could hardly believe that someone would be so calloused to something very real to me and of which I was being so vulnerable and open. I explained about the large history of babies in my family that is what he said!

Well, if that had only been the first time he had bad bedside manners, it would have been enough to make me run for the hills…But oh, but it wasn’t!

He was scheduled to be out of the town the exact week of my due date for 10 days and failed to tell me! At all! So at my 30 week appt. he talked about being out of town the last week of July and he said, “well I’m due August 6th.” and he said, “Don’t worry, you’ll be fine.”

What kind of response is that?! Seriously! I asked who is a back up doctor or what did he do in that situation and he said “it’s your first, you won’t be early.”

So, after that, I was obviously looking around and after “the tear” comment, I was out of there as fast as I could waddle.

I found an amazing group of midwives at Vanderbilt who, my first appointment was 1 hour long…I mean they talked to me about everything, with all my concerns, helped me write a birth plan and when I mentioned tearing, THEY pulled out a sheet about the benefits of perineum massage. They were a God-sent and I made the switch at 32 weeks!

Which was just in the nick of time since Tyler made his appearance July 29th, the week that crappy doctor was out of town! Ha!

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Lisa in Texas Reply:
November 14th, 2012 at 8:39 am Lisa in Texas(Quote)

I’m so glad you ran from him! That’s the kind of situation where I would want to write him a letter telling him exactly why I left and how wonderful the experience was with the midwives. Oh, and since you found him from an internet search, make sure you go back to those websites and give him negative reviews.

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Ms. Jack Reply:
November 14th, 2012 at 5:45 pm Ms. Jack(Quote)

Did you manage to avoid an episiotomy or tear?

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genniemom had this to say, Nov 14, 2012 @ 7:35 am (Quote)

This is basically the exact opposite of what my midwife said to me. I was very concerned about tearing with my second birth because of the fourth degree tearing I had with my first. She was so reassuring, and spent a lot of time telling me all about how the way I was forced to birth with my first probably caused the tearing, and that no special consideration would likely be needed to prevent tearing the second time. But she didn’t dismiss my interest in preventive measures, either. I had one tiny tear from a nuchal hand, but I knew to expect it because she diagnosed the nuchal hand via palpation early in my labor. I was amazed that someone could have that skill! I’m just learning to palpate, and it’s a victory when I can find the head!

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pittsburgh mama Reply:
November 14th, 2012 at 3:46 pm pittsburgh mama(Quote)

I had a small tear (and very long labor) from a nuchal hand too, but we were completely unaware of it until he was born. I am amazed that your midwife could do that! How cool.