Episiotomy

Marie_LPN, RN, LPN, RN · Jul 6, 2005

The pt. might have discussed this with the doc ahead of time.

BETSRN · Jul 6, 2005

I was wondering how others felt about the issue. I'm an lpn student, graduating this aug, currently in my ob rotation. I assisted in a lady partsl delivery today, and as soon as the head crowned, the Dr's did an epiosiotomy. I felt like they didn't even wait to see if it was necessary. Are dr's too quick to do this procedure nowadays? I feel like it's way too commonly done. I do a lot of reading up on the whole birthing process b/c I want to become a CNM.

Most often, an epis is unnecessary. Sounds like a doc who is quick to cut and one that women should stay away from!! We have 10 OB's (and 5CNM's) and not ONE of them routinely cuts anything. Docs who are properly trained (and are patient) will support the perineum as the head emerges.

rastanursern, MSN · Jul 7, 2005

Most often, an epis is unnecessary. Sounds like a doc who is quick to cut and one that women should stay away from!! We have 10 OB's (and 5CNM's) and not ONE of them routinely cuts anything. Docs who are properly trained (and are patient) will support the perineum as the head emerges.

I agree with you on that.

rastanursern, MSN · Jul 7, 2005

The pt. might have discussed this with the doc ahead of time.

It wasn't discussed w/the pt. As a matter of fact, the dr didn't even warn the pt before she injected the local. The population at this particular hospital is mostly hispanic, and it seems like most of these dr's don't seem to care. Doing most of my clinical rotations there was a real eye opener.

Dayray, RN · Jul 7, 2005

There is reasurch that supports apeas and resurch that condems it. so the most logical thing is to call it a tie and not cut them because 50/50 isent a good argument to do something to a persons body.(not sure that makes sense lol).

The only reasons for them that are really valid are to speed delivery when heart tones are down or to limit the tear.

As for limiting the tear I think this gets abused becuse is is subjective and releys on the judgment of the doctor. When there is old scar tissue I can see that cutting it might be a good idea but I find it hard to belive that the docotor can predict that a tear is going to be extensive in the absence of scar tissue.

Most apeasiotomyies are for doctors convince or out of habbit. I recently had bad situation with an old OB to whome the FOB said "we really dont want an apeasiotmy" the OB then said "oh I don't think thats going to happen" and then cut the apease. I did talk to the OB about it outside the room but he is old and cannot see beyond the ways of the past.

allnurses Guide · Jul 7, 2005

Our docs do not do episiotomies unless they are warranted. Maybe there was a reason he did one. Since you are new, maybe you didn't see the reason.

I guess I err on the side of the doc since ours are good about it. Getting the baby out safely is the point and sometimes, like the delivery I had the other day, the baby's head is just too big and the pelvic outlet too small.

Sometimes it is necessary - regardless, a tear or a cut - they need to be repaired and they hurt while healing.

steph

L&Dnurse2Be · Jul 7, 2005

With my first baby, my water broke 6 weeks early. I did not have the pleasure of my own OB delivering me. It was one of his much older partners. My baby only weighed in at 6.9 but I still had an episiotomy. It hurt like the dickens. :crying2: I always describe it by mentioning the scene from "A Nightmare on Elm Street 2" where Freddy's fingers become needles and he sticks them all into that one girl at the same time. Nothing worse than traveling to the NICU every couple of hours and sitting in the hard rocking chairs they provide after an episiotomy. My next 2 babies were both C-sections so I did not get a chance to know if I would ever need another episiotomy. Sometimes I feel the older more seasoned docs are stuck in the past as was mentioned earlier.

live4today, RN · Jul 7, 2005

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Most apeasiotomyies are for doctors convince or out of habbit. I recently had bad situation with an old OB to whome the FOB said "we really dont want an apeasiotmy" the OB then said "oh I don't think thats going to happen" and then cut the apease. I did talk to the OB about it outside the room but he is old and cannot see beyond the ways of the past.

Having had my babies in the 1970's, I can attest for the fact that docs routinely did episiotomies on the moms whether they needed them or not, just like they rushed too quickly to perform C-sections then, but don't be so hard on the docs of the past because they learned to be docs THEN and NOT now, and went with how they were trained.

Today's docs have learned a whole new way of medicine and performing procedures. They have the modern technology to assist them in the calls they make for many surgical procedures, and medical treatments. The modern day docs have been raised in modern day times, learned during these times, therefore they've learned to weigh each case separately and not make every patients care "routine".

I had an episiotomy with each child (three total). I didn't want one, but if doc said this is the way it's done, then that is the way it was done. My babies were eight pounders, so I probably would have needed the epi anyway.:chuckle

Dayray, RN · Jul 7, 2005

Having had my babies in the 1970's, I can attest for the fact that docs routinely did episiotomies on the moms whether they needed them or not, just like they rushed too quickly to perform C-sections then, but don't be so hard on the docs of the past because they learned to be docs THEN and NOT now, and went with how they were trained.
Today's docs have learned a whole new way of medicine and performing procedures. They have the modern technology to assist them in the calls they make for many surgical procedures, and medical treatments. The modern day docs have been raised in modern day times, learned during these times, therefore they've learned to weigh each case separately and not make every patients care "routine".
I had an episiotomy with each child (three total). I didn't want one, but if doc said this is the way it's done, then that is the way it was done. My babies were eight pounders, so I probably would have needed the epi anyway.:chuckle

This is very true. I actually quit like the old doctor I mentioned and I know he did what he felt was right. I don't happen to agree with the way he does things but I don't think he is mean or uncarring. He trys to take care of the pateint the way he thinks he should. It's the newer docs that cut apeas that I see as doing it for convince sake. They have seen the research coming out and were'nt trained to do routine apeas yet they sometimes do it to save their time.

That being said. The best thing is for patients to disscuss this with their doctor early on and find out what they think about it. Then decide weather or not they agree with or can except the doctors approach to care.

mstigerlily · Jul 7, 2005

Our hospital seems to do them very frequently as well, which is too bad. I had a 5 lb baby where they gave me an episiotomy without asking. I had a 7 lb baby where I had a small tear (no epis) and a 9 lb baby (no tear, no epis) and of course since the 9 lb was my third baby that probably helped! But that nurse really took the time to do perineal massage and I think it was really, really helpful.

I can tell you that when I got that episiotomy I had numbness in the area for MONTHS and stress incontinence for months as well. Not something you want when you are 23 years old. In later pregnancies and births this didn't happen and I know it was the episiotomy. IMO they are never a good idea.

Melissa

I was wondering how others felt about the issue. I'm an lpn student, graduating this aug, currently in my ob rotation. I assisted in a lady partsl delivery today, and as soon as the head crowned, the Dr's did an epiosiotomy. I felt like they didn't even wait to see if it was necessary. Are dr's too quick to do this procedure nowadays? I feel like it's way too commonly done. I do a lot of reading up on the whole birthing process b/c I want to become a CNM.

JULZ · Jul 7, 2005

okay, I'm not a nurse as of yet but here is a subject that I know a little something about. While I was having my second son (my first was c-sect), the doc just let me tear and let me tell you that was the worst experience of my life. I tore so bad she stitched me for an hour, I couldn't sit for a week without pain---would have much rather an episiotomy!!! Worst birth experience of all 3 of my children!!! Just my input!