Episiotomy......

[Mind_your_head]

My niece recently delivered her first child. I was 'horrified' to hear that they didn't do an episiotomy. They just let her tear. That is the "new normal" I'm told.

I'm horrified. It doesn't make sense (to me).

It seems like a calculated cut would be 'better' than a random 'tear'. The last time I gave birth was 15 years ago. I know things have changed, BUT.....

TIA for your opinions/thoughts.

M_Y_H

[Neoma]

1. Uhm, just.

OW, that sounds like it'd hurt.

[CaliforniaPeggy]

2. That's strange...

Was she delivered by a midwife? Not that they are a problem, but perhaps they felt she wouldn't tear.

I have not heard about this "new normal." There is no question that a straight cut is easier to fix than a random tear.

But if the birth is handled carefully, sometimes the episiotomy can be avoided.

I'd like to hear more about the birth's details. Her position in the bed, how quickly the child came, like that...

:wtf:

[Mind_your_head]

10. The baby was delivered at a (nameless) ' Center for Women's Health' in Atlanta

it's unofficial nickname is the "baby factory".

I'm sure that their IS expertise in a place that has "seen it all", but still I'm horrified at the concept of the 'baby factory' AND the lack of an episiotomoy being done (cost cutting??? = no 'cutting')

Women often/usually bear the load of unfair practices.

[BlueGADawg]

13. I bet that it starts with North-

and we switched doctors and hospitals for that very reason (the baby factory) when my wife had our first. She wanted to try natural and you would have thought that we were some kind of aliens. They only want to induce you when it's at the doctors convenience for you to give birth. We ended up at Piedmont and had the best experience possible with both of our kids.

[Mind_your_head]

15. You are correct in your assumption. eom

[pnwmom]

3. The policy changed more than 20 years ago, in my area.

I needed one with my first, because it was an emergency forceps delivery (the heart rate slowed). But not with the second or third. And I just ended up with an easily repaired natural tear with one of them.

The research showed that the calculated cuts actually resulted in bigger and harder-to-repair tears than if you allowed the perineum to stretch naturally. That's why they don't do episiotomies as much anymore.

[annabanana]

4. I had an episiotomy. .

and I seem to remember that, what with everything else going on at the time.. it wouldn't have made much difference either way.

[TNDemo]

5. I had a fourth degree episiotomy

and a tear would have been preferable to heal (if it did not extend as far as the 4th). I had a section later and that was like a day at the beach. This just makes me hurt all over again talking about it.

[enlightenment]

12. I tore.

47 stitches (inside and out) . . . I would have infinitely preferred a cut.

[TNDemo]

17. I guess it is depending on how big it is.

I have no idea how many stitches I had but my husband said they were sure doing a lot of sewing. The episiotomy ripped open a couple of weeks later. I kept calling and telling the doctor I felt like everything was falling out and he told me I needed to exercise more. I went back at six weeks and it turns out it had all ripped open, my rectum was open into my vagina (TMI, I know) and he cauterized the whole thing (no anesthesia) and I about became unglued. I was really furious thinking about it later because I had to drive my baby across town after this and I was in some severe pain. Then he did the cauterization every two weeks for several months trying to get all the skin to heal together. He left me a mess. I should have just had surgery or something. Actually I should have gone to another doctor but I didn't know better at the time. But the section was fabbo - no peeing and pooping out the incision and no labor.

[trotsky]

18. Wow, what a terrible experience.

Sorry you had to go through that.

[Fire_Medic_Dave]

27. You officially are tougher than anyone I know and I know some bad, bad men.

I did have an open needle biopsy of my humerus without any medication. That sucked pretty bad. The nurse assisting the doctor almost got sick. When I sat up he was sitting there white as a ghost, I thought he was going to pass out. None of that compares in any way to what you went through. I'm very sorry for your experience, you have my utmost admiration.

David

[Thirtieschild]

6. Neither tore nor had an episiotomy with my third

I did the week's grocery shopping when she was three days old. (She's now 46.) Huge, huge difference.

[netania99]

7. I was told that a tear heals better and faster

than a cut. I guess raggedy meshes together faster than straight? Anyway, I went with the tear and I was fine. This was 15 years ago.

[trotsky]

16. My wife and I used the midwife services at our hospital, and they said the same thing.

Fortunately my wife didn't tear, but the reasoning made sense.

[Barack_America]

24. Yes, tears are now thought to heal better and faster, but can be more difficult to stitch...

Which may be why some doctors still favor them.

[BrklynLiberal]

8. I was under the impression that episiotomies were only done when it

became obvious that there might be a tear.
I have heard there are techniques to aid the stretching so as to avoid the tear.
http://pregnancychildbirth.suite101.com/article.cfm/episiotomy

I have had only C-section, so cannot speak from experience. But I know that I did not have to sit on an inner tube for weeks.

[Kali]

9. midwife/homebirths here

tried to stretch/go slow - tore (not that I noticed) and healed fine

[HuckleB]

11. Here are some good links on why it's not used as much -- and probably shouldn't be used as much.

An episiotomy was once a routine part of childbirth — but the procedure isn't always necessary. Here's what you need to know about episiotomy risks, benefits and recovery.
http://mayoclinic.com/health/episiotomy/HO00064

Obstetric Myths Versus Research Realities
Chapter 14: Episiotomy
http://www.efn.org/~djz/birth/obmyth/epis.html

Outcomes of Routine Episiotomy
http://jama.ama-assn.org/cgi/content/short/293/17/2141

[customerserviceguy]

14. I just remember thirty one years ago

when my first son was born, my ex didn't get an episiotomy, and it took a very long time for the doc to sew things back up. She would have went for an episiotomy on the second and third child, but it wasn't necessary.

It's certainly something that a woman and her doctor need to discuss in depth, rather than wait for the moment to decide definitively.

[Warpy]

19. The tears are generally superficial and heal quickly

They're also a normal part of the birth process. They're slightly worsened by the lithotomy position, that position of a mother on her back with her feet up in the air, convenient for the doc but not for the mom or her baby.

What was barbaric was slicing her open and then stitching her together tightly on the theory that the husband wanted a really tight vagina. To hell with her enjoyment or even comfort.

I'm delighted to see the episiotomy go away. It caused a lot more problems than it ever solved.

[Why Syzygy]

20. You may be right.

But, most women in Ethiopia don't have that choice.

Just thought this might be a good place to post this moving story of what childbirth is like when there is no hospital.

http://www.pbs.org/wgbh/nova/beautiful/

[Warpy]

21. Fistulas happen most frequently in mothers who haven't matured

sufficiently to be able to bear children safely. Statistically, the safest years for childbirth are 18-26, although the 18 can be stretched downward to 16 in some women who mature and reach their final height and weight earlier.

Unfortunately, women are still girl children when they are married off in much of the world and cycstocele and rectocele are all too common. When they occur, the child/woman is largely banished from her home, the smell being too overpowering for the husband's family to tolerate.

Episiotomy prevents neither. It's done mainly to avoid vaginal tearing and because of the male prejudice that a vagina that has stretched temporarily in childbirth is never going to be much fun for a husband. It is overused and mostly unnecessary.

There is good news, Oprah Winfrey has done shows on the problem in Africa, especially, and response was good. If you are interested in contributing to the care of these women, there are links at http://www.directrelief.org/OurFocus/MCH/ObstetricFistula.aspx

[Why Syzygy]

22. Thanks.

I just assumed the fistulas were related to lack of episiotomy. The story above reminded me of the Nova show. Thanks for the link too.
I was very impressed with the doctor who runs the clinic there. I wonder who will carry on after she is gone.

[Barack_America]

23. It is the new normal.

Studies have shown that an episiotomy doesn't necessarily prevent tears and, in many cases, leads to deeper and more serious tears than natural tears.

This discusses the current guidelines for use of an episiotomy.
http://www.medscape.com/viewarticle/529251

[moc]

25. Actually, an episiotomy increases your risk for higher degree tears.

Perineal massage during labor can reduce tearing, but generally tearing is less risky than episiotomy.

[Mamacrat]

26. Read that during my pregnancy.

I ended up being induced early (diabetes, high blood pressure), which led to an emergency C-section. However, I'd read that the tearing would heal better, so I had planned to go that route. I can remember how it was worded, but something like it was a more natural "pattern" (can't think of the word), so it would heal better and possibly cause less problems later. Either one sounds horrible, though. I think I read all of this in a book on the Bradley method, although we did not have anyone in our area that follows that method. I think they said using Epsom salts on the area prior to delivery for a period of time would help prepare it to stretch.

All that said, I do not remember the pain from my C-section anymore. I guess that's how we are prepared to have more children if we want!

[csibona]

30. c-sections don't sound like much fun either

[Nikia]

28. I delivered an almost nine pound baby without one

I had some second degree tearing. An episiotomy is a surgical second degree tear. The tearing that I had to that degree though was a smaller area than a usual episiotomy though. My doctor didn't have any trouble stitching the tear even though it wasn't calculated.

[Horse with no Name]

29. Many times the practitioner will massage the perineum and help it to stretch

It is effective in most cases instead of the routine episiotomy.
That being said--I had routine episiotomies with both of my kids and everything went fine--didn't have any problems.