Silly Episiotomy Question

  1. I have a question that has been burning at me for a while. Forgive me, because I am not intensely knowledgeable regarding labor & delivery.

    I simply wanted to know whether local anesthesia is given before the doctor or midwife makes the episiotomy incision. Thanks in advance for any responses.
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  2. 16 Comments

  3. by   mommy2boys
    I'm not a nurse yet, but I had to have an episiotomy with my first son. If I remember correctly they did give me a local before cutting. That was the only time my sister got a little freaked out during my whole delivery (that and when they did episiotomy). She said the needle was HUGE!

    HTH
    ERin

    ps I didn't have an epidural, so I don't know if that matters.
  4. by   UKRNinUSA
    I got a local before mine. I had a great fear of "the big scissors" all thru pregnancy, after seeing an episiotomy as a student. But after pushing for nearly 5 hours and getting nowhere fast, those "big scissors" looked really good. On a scale of 0-10 the shot hurt about 0.5. No biggie IMO. The thought is worse than the reality
  5. by   Spidey's mom
    Usually the doc injects lidocaine but if it is an emergency, he/she cuts without.

    steph
  6. by   old rural nurse
    When I had my first baby, she came so fast the MD did two cuts to prevent me from tearing, with no lidocaine, but with all the pressure down there, I did feel something but it did not hurt
  7. by   Beary-nice
    Not a silly question at all, a very good question!

    I have seen it go both ways, with and without. In emergent situations, that is when I have seen no anesthesia.
  8. by   wincha
    Quote from TheCommuter
    I have a question that has been burning at me for a while. Forgive me, because I am not intensely knowledgeable regarding labor & delivery.

    I simply wanted to know whether local anesthesia is given before the doctor or midwife makes the episiotomy incision. Thanks in advance for any responses.
    Had an epi before all births ..way back when they used suction and i had 4th and 3rd degree epis with my first 2. years later the ob used massage, no suction, no epis. 1-2 stitches, fantastic recovery. perineal massage works well. sorry can't answer the epis question. don't think epis are necessary anymore with the right perineal massage. and my last baby was 9lbs 6 oz and I am not that big.
  9. by   SmilingBluEyes
    some use it;others not
    if there is a good epidural going, they do not use it at all. but if the epidural is not working they might.

    they use it more often for lac/epis repairs.
  10. by   rph3664
    Has anyone worked with a doctor who REFUSED to use local anesthesia for episiotomies? When I was growing up, there was a doctor in my city who not only did that, he did them even when it wasn't necessary and then sewed the women up so tight, they couldn't have sex with their husbands.

    How this guy stayed in practice defies explanation. I did hear that a lot of women liked to go to him because "he's so gorgeous." ***?
  11. by   SmilingBluEyes
    Yes, some do refuse, because locals can really swell up the very tissues they are trying to cut and make it difficult to do well. Very often, the tissues during pushing and contraction are burning intensely and the cut is not felt, if done at a very precise time during pushing. I knew many docs who did not use locals to cut, and while I hated it, I understood the rationale about tissue swelling; I saw it with my own eyes many a time, from those who did, and it was dramatic.

    Really nowadays, where I work, our docs rarely cut episiotomies anymore, preferring to let the perineums naturally stretch and if they lacerate, usually, it's only 1st degree, which is preferable to a cut epis. anyhow. And all of them will use local to do any peri repair work if the patient feels so much as a pinch during this process.
  12. by   mitchsmom
    Quote from SmilingBluEyes
    Yes, some do refuse, because locals can really swell up the very tissues they are trying to cut and make it difficult to do well. Very often, the tissues during pushing and contraction are burning intensely and the cut is not felt, if done at a very precise time during pushing. I knew many docs who did not use locals to cut, and while I hated it, I understood the rationale about tissue swelling; I saw it with my own eyes many a time, from those who did, and it was dramatic.

    Really nowadays, where I work, our docs rarely cut episiotomies anymore, preferring to let the perineums naturally stretch and if they lacerate, usually, it's only 1st degree, which is preferable to a cut epis. anyhow. And all of them will use local to do any peri repair work if the patient feels so much as a pinch during this process.
    :yeahthat:
    We don't do very many of them, I have seen maaaybe 5 since July, probably not even that many. I don't remember seeing locals injected for them. That said, I also don't remember ever seeing any kind of pain response when it was done either. I'm not saying that they didn't feel it, I didn't ask; but it did not appear that they felt it. I know at least some did not though because when all was said and done they didn't even realize that they had an epis. They are usually done right at that last minute when everything is really stretched, intense, and hurting already (I would think that the nociceptors in the skin are already at least somewhat fatigued - not that I'm some fan of getting cut in any form).
    Last edit by mitchsmom on Dec 29, '06
  13. by   q12RN
    I seen an episiotomy Friday that was done but the mom had an epidural, good thing she did cause she tore down past the episiotomy almost to her rectum.
  14. by   Marie_LPN, RN
    Pardon the bluntness of my statement, but anything involving down there and scissors, there IS no silly questions lol. :stone

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