Nov 172012
 

“I’d rather repair a straight line than a hamburger blowout.”  - OB to mother who stated that she would prefer to avoid an episiotomy.

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 November 17, 2012  episiotomy, OB  Add comments

  29 Responses to ““I’d Rather Repair A Straight Line Than A Hamburger Blowout.””

  1. Well then I guess you are not the right OB for me since evidence confirms that a natural tear it is better for the mother and I don’t give a sh!t what is better for you! BTW if you are getting hamburger blow outs on a regular basis you are doing somethig wrong. You might want to look up the negative outcomes associated with the mom purple pushing on her back. Like I said you are doing it wrong. I’ll take my records now. No need to add any editorial comments to my records. I’ll take them as is, thank you.

  2. “So it’s all about you, then? That’s not what I read in the patient’s bill of rights. Shall I ask the hospital administration what THEY prefer?”

    (But yeah, I’d have to leave this practice after the doctor flat-out stated s/he would overrule my preferences based on hers/his.)

  3. Whoa, doctor, you’re talking way above my head! What, exactly, are the layman’s terms for “hamburger blowout”?

  4. So you’re going to let me birth in water and/or in whatever position I choose and push on my time table? That’s a relief.

  5. To professionals reading this site: Statements like this are a root cause of the small but increasing tendency for American women to cross state lines in search of a midwife or do without a birth attendant altogether.

    Have you ever considered attempting to prevent “hamburger blowouts” by some method other than cutting “straight lines” or any “lines” at all?

    • You’re totally right! It’s statements like this, unnecessary interventions, and OBs/nurses attitudes that are the reason that many of us home birthers base our decisions on.

  6. If you’d actually repair the straight line correctly or not cut it so long. My vagina has never healed from my episiotomy making sex completely unenjoyable for me. My husband and I are both furious and the hospital unapologetic since I “consented” (she told me she was going to make a “slight” cut in the middle of a contraction so the babys shoulders didn’t get stuck. As I was in the middle of a contraction I barely heard her )

  7. I always try to imagine my patients perineum as my own. And I DO everything I can to prevent tearing because I would want my nurse to do everything to prevent me from tearing. This has included “forgetting” to put scissors on certain doctors delivery tables bc they cut for no reason in my opinion. (I have reported this doc MANY times and i know other nurses have too but for some reason no one listens to us!). I am APPALLED this doctor actually used the term “hamburger meat.” Maybe it’s time to stop practicing!
    With that being said, sometimes it is just not possible to deliver without a tear or episiotomy. And if I HAD to chose what happens to MY perineum I would choose an episiotomy. It’s a much cleaner repair and I’ve noted that the tears don’t seem as bad as people who rip on their own. I’m hoping that in addition to support from my midwife I will be able to control my pushing enough to gently ease the baby out so I can avoid any kind of cut or tear. But I guess we will see how it goes!

    • Have you looked into prenatal perineal massage? I did it for my last three births, and it was amazing how different the experience was. No ring of fire, no tearing. And that’s with two of those babies being born over one contraction (or one push, even.)

      The William & Martha Sears directions are here:
      http://www.childbirth.org/articles/massage.html

      You start a few weeks before your due date, and my personal experience was that it was very difficult until I’d been doing it about ten days — and then one day, the tissues just fanned out under my fingers, and it was as if my body had been “taught” how to open up to let the baby out. Very cool how the body works. :-)

      • I also suggest that you look into this! My husband helped me by massaging my perineum about a month out from my due date a few times a week and it made a huge difference! With my first birth, the delivery part was awful and with my second and third, it was so much more comfortable!

        I also think the position of the mother has a lot to do with the delivery. I was on my hands and knees with my third and while it still took quite a bit of work, my body seemed to be in a spot that allowed her to slide out a lot easier.

    • While I respect your right to make your own decisions, I really feel the need to warn you that there is a lot more to a perineal injury than what you see in the delivery room. Natural tears, despite how hard they are to stitch and what they look like, heal much easier with less long-lasting complication. My first birth came with an episiotomy that tore completely through to my anus. The scar tissue was tough to deal with. My sister’s episiotomy didn’t even tear through, but sex was too painful for her for a long time, and she tore along the incision site at her second birth. As for the natural tears that I have had, there is not even a mark where they were, even the one that tore a bit into my urethra.

  8. *****SERIOUSLY****
    My best piece of advice for not tearing is to use slow and controlled pushing at the very end to allow the perineum to stretch as much as it possibly can. This can be very difficult, especially if you do not have an epidural. I highly recommend learning meditation and visualization to help you as much as possible with this. Your perineum will thank you! This is more important than anything your doc or midwife can do to assist in preventing tears!!!

    • Yup. This is what my OB did with me. She massaged me like crazy while I was pushing, and had me push very slowly when he was coming out. No tearing. I also pushed when I felt like it, as the coaching was annoying me and also difficult as I can’t hold my breath that long. Haha.

    • Hmmm… The time that I actually tore was when I delivered my son slowly. I took a long time and went through quite a few contractions.

      With my second and third kids, I did perineal massage and had no pain associated with the actual delivery. My recovery was also so much better. I had very minimal swelling.

    • If only my body had given me that choice! My second shot out, and I tore forward and backward.

      Just about the only benefit I can see to cutting an episiotomy is that women with one tend to tear, when they do, toward the perineum, whereas women without one may either tear toward the perineum or forward toward the labia. My perineum healed very well, but my labia took forever to heal, then fused, and I ended up needing extra surgery before it was all finally done with. Not something I’d want to repeat.

      • Just to play devil’s advocate here, my doctor stated that he needed to cut an episiotomy because I was tearing up toward my urethra. The episiotomy tore completely through to my anus. I think that it would have been far more helpful to stop forcing me to push to the count of 10 on my back. My second birth was absolutely uncoached, with a baby a whole pound bigger. I only had a first degree tear from a nuchal hand.

  9. I guess my other comment got lost in moderation land. My ob didn’t repair my episiotomy properly, causing a loss in enjoyable intercourse that has never healed and since my birth plan didnt specifically state no cuts the hospital is completely unapologetic

    • They may be completely unapologetic, but if your OB didn’t ask you before making the cut (mine didn’t ask then didn’t record the cut in my medical records), then you might have some recourse. Not that legal recourse is in any way able to make up for what was done to you. It is more for the next mom than it is for you.

  10. My biggest problem with episiotomy is, how can you be certain that someone is going to tear before it happens? I’ve had some pretty difficult deliveries, and I’ve never torn even the slightest bit. And even if you were sure a woman was going to tear, how can you be sure it wouldn’t be just a tiny one? Once you cut, it’s done, you can’t take it back. How can you ever be sure you haven’t just created a problem worse than the one you were trying to prevent?

    • Right. There’s no way to tell a tear is imminent, even with big babies and difficult births. My 2nd baby (1st vbac) was 10lbs 2oz, 14 1/4″ head, shoulder dystocia requiring my midwife to reach her hand up and do some internal manipulations to free his shoulder..NO tears. 3rd baby.. 11lbs, 15″ head (and it didn’t mold, so all 15 inches were coming out) and a nuchal arm, midwife again reached in and assisted his arm out. Again.. no tears. And if I had been with a typical OB for either of those, they probably would have felt inclined to cut a nice big episiotomy before even attempting to reach their hand in! 2 enormous babies, no tearing even when a midwife’s hand going IN at the same time as they are coming OUT, and no tears..

  11. Funny, the time I was made to push flat on my back because I was “induced” (with Cervidil) and had an episiotomy, I had a 2nd-3rd degree tear. The two following births where I was allowed to labor and deliver in the most comfortable position for me (kneeling/squatting in a birth tub), I didn’t tear at all. Imagine that.

  12. I should add, my first was my smallest by over a pound.

  13. episiotomy’s are rarely done where i live, but saying that, if they were done i agree with the above poster, you dont know if they will tear before hand, and if they do tear it may not even need repair. with my last child, only vaginal so far, he was almost 8lb (not huge but a decent size for a 39 weeker) and had a 36.5 cm head and his arm up elbow first, i had the smallest tear, and while it was a bugger trying to pee around for a couple weeks it did not need any stitches, if i had a doctor who liked to do epis then i would have ended up with stitches for no reason! honestly if doctors would read up on why epis were introduced then they would see that they are no longer necessary in the majority of births, even forceps (which if the baby is high may require an epis) are rarely used these days in favour of vetouse! hey? whats that? no im not a OB, just someone who has actually studied birth and all it entails

  14. First of all, just EW! Hamburger blowout? Seriously? That’s unnecessary!

    Second of all, I don’t really care what you’d prefer, doctor! This is my body and I do not give you universal permission to slice it open! If a true need arises, we can discuss it then. And by discuss, I mean talk it over and then allow me to make my own decision!

  15. I would guess that if a man had even a slight tear in his penis he would be seen by the head of plastic surgery and every effort would be made to be sure he had normal function…but for a woman it is just a cast of slapping a hamburger back together?

  16. So what you’re saying is this: you are not a very competent OB. You should be trained and able to repair all kinds of lines, not just straight. What happens if your perfect episiotomy tears further in a jagged line? You’d rather not repair that?

    In my opinion, the only time episiotomies are warranted is if the baby is truly distressed and must come out NOW. Or maybe if the mother says she wants one, as long as she knows all the risks.

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