I cringe as he cuts...

  1. In general, OBs seem to be cutting less these days, but one OB relatively new to our hospital, who is otherwise likeable, cuts such horrible episiotomies that I get sick in the pit of my stomach just watching him. And not much sickens me anymore.

    He will start it as a midline, then curve off to his left and sort of make a 'J' shape. He cuts so far it seems like he's cutting into mom's buttock! The babies literally FALL OUT into his hands because the hole he makes is so big. He often can hardly get the scissors out of his hand in time to catch them!

    It takes everything I have not to tell them mom to find a different doc for her next baby. Can they see it in my face?
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  2. 10 Comments

  3. by   rn/writer
    Surely some of the other nurses share your concerns. Can you collectively speak with your nurse manager and ask her to speak to the head of the OB department? Docs don't often see what other docs are doing unless there is a reason to observe.

    Do his patients complain? Do they require more pain meds and have a more difficult recovery postpartum?

    This is an important question. I hope you will continue to look into the situation.
  4. by   33-weeker
    I suppose. I haven't heard anyone be vocal about it particularly. When I've mentioned it to other nsy nurses, they say they really haven't been to that many deliveries with him to notice. Perhaps I haven't run accross the right people. Working 12's and opposite shifts can contribute to spotty communication.

    I did complain about a doc who was stitching ER drop-ins without numbing them and that seemed to improve. I'll see what I can do.
  5. by   SmilingBluEyes
    I agree w/RN/Writer. It's a good idea to discuss concerns with your coworkers and manager.
  6. by   NurseNora
    I've only worked with one doc who did this type of episiotomy, I'm having a senior moment and can't remember the name of it. It's a combination of midline and mediolateral. It's supposed to be less painful than a mediolateral (have you seen one of them, they go thru some really thick tissue and look horrible--painful too) and less likely to extend into a 4th degree laceration than a midline.

    It's just how this guy was taught. So try teaching him other ways. Ask him about it. What is it called. Why does he do this one rather than a plain midline. What are the advantages/disadvantages of it. Ask the PP nurses about his patients. Is there a difference in the amount of pain these women have in comparison to others? See if they'll talk to him (or wake him at 3am for extra pain medication--always an effective fallback). If he's young, there's a chance he'll change. If he's older, it's less likely, but it is possible to teach old docs new tricks if you're patient and persistent.
  7. by   prmenrs
    Seems like this is a doc to doc thing to me. I would just work w/the nurse manager, OB chief of service. If you can determine via chart review that his pts need more pain meds, that might be objective data to support alternatives.

    Does every woman NEED an episiotomy? Or does he just like doing them?
  8. by   33-weeker
    He seems to do them if the mom is not pushing the baby out fast enough. I've seen multips birth too fast for him to get his scissors. Of the few I have seen him cut, most were not necessary.
  9. by   mgalloLPN
    I know this may sound stupid but I am not sure. Do all women have to have an episiotomy? I am not a nurse yet but my dream is to be an L and D nurse. Another stupid question, are bowel movements a problem with an episiotomy? It seems like it would be extremely painful. How far down does the incision go? Thanks for the help!!
  10. by   NurseNora
    No, all women DO NOT need an episiotomy. Most do very well without one. The tissue is very elastic and can stretch enough to allow the baby to pass through. Even if there is a tear, it is usually only a very small one that needs no more than a few stitches.

    After delivering a baby, with or without an episiotomy, that area is tender. Most providers offer stool softeners so that the first BM is passed more easily.

    Ideally, an episiotomy is very small, but it's not an ideal world. Infrequently, the perineum tears from the end of the episiotomy to or even all the way through to the rectum. That's the 4th degree laceration I referred to above. That's painful.
  11. by   SmilingBluEyes
    Our OBs rarely cut episiotomies, preferring to let the perineal bodies stretch and if need be, tear just a bit, in the process of giving birth. Rare is the woman who tears beyond a 2nd degree this way. I have seen plenty of episiotomies extend to 3rd and 4th degree lacs in the past, when they were done routinely. And if you think about it, it makes sense. You are creating a path for an easy tear if you cut the perineal body unnecessarily and at the wrong time.
  12. by   buddiage
    Quote from mindyg22
    I know this may sound stupid but I am not sure. Do all women have to have an episiotomy? I am not a nurse yet but my dream is to be an L and D nurse. Another stupid question, are bowel movements a problem with an episiotomy? It seems like it would be extremely painful. How far down does the incision go? Thanks for the help!!
    For personal experience-
    An episiotomy didn't help me one bit I believe. I had a 3rd degree tear, and (sorry for my bluntness) a huge vagina afterwards (pushed for nearly 4 hours, so maybe that had something to do with it).

    I don't think they are particularly helpful.

    As far as BM's, they were difficult, but I don't know if that was the episiotomy, or the fact that I just calved.

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