Episiotomy vs. Spontaneous laceration?

SCmomof3, RN · May 17, 2004

All of the research I have read says that episiotomies are done frequently but moms do better without having one. I have also read research that shows moms who have episiotomies have greater incidence of 3rd & 4th degree lacerations, whereas moms who do not recieve an episiotomy usually only have 1st to 2nd degree lacerations.
My question is with all of the research why are OB's continuing with such a high rate of episiotomies. Also, in your practice, do you agree with the research findings that show the risks of episiotomies outweigh the benefits?

Well I have the same question! I'm a student but I'm also a mom. I hope to work in L&D.

I had an episiotomy with my first child, who was a 5 pound 35 weeker. That episiotomy was completely unnecessary and was performed simply because the dr I went to at the time did them routinely :angryfire I was barely 20 and didn't know better. I am not kidding when I say that recovering from the episiotomy was the most horrible part of the entire experience. It hurt so much.

With my second child (5 yrs later) I was much more informed (due to the first experience) and I went for all natural birth. I had a midwife that time. No episiotomy among other things. This was the most incredible experience, and my son was FT weighing 6 pounds 9 oz (still a peanut :)). He shot out no problem and I had maybe a little scratch that needed no stitches. I was up and around within 30 minutes. I probably would have been up before that but I was too busy loving on my newborn! Everything healed up quickly "down there". Seriously, the soreness subsided with a day or two!! Kegels kegels kegels :rotfl:

I planned the third labor experience to be the same as my second, but the little stinker turned frank breech a few days before he was born:crying2:

So from my experience, I think that episiotomies are performed routinely by many doctors, especially "older" ones. This is just my opinion. :)

galenight, BSN, RN · May 17, 2004

I am not an OB nurse, but do have a personal incident. When I gave birth to my son 15 (ohmygod) years ago I had a precipitous delivery. There was no time for the doc to arrive let alone perform an episotomy. I delivered a 8#7oz healthy boy without difficulty. There was one tiny internal tear, or so I'm told, that did not require stitches. Recovery was a breeze. Four years later I went to the hospital in labor with my daughter and insisted that the doc (an old timer hell bent on having his way) not give me an episotomy. I repeated, time and again to not do it since I had given birth to a large baby without one. He reluctantly relented telling me (between and during contractions) how horribly I would tear and I would regret it. Well, she was 9# 2 oz and again, I did well. The doc looked and looked for a tear and despite looking in earnest, found nothing. Again recovery was easy. Now of course, my experience is not the same as others. But the moral of the story is that not everyone needs or wants an episotomy. I believe my recovery was much speedier without the stitches. Just my 2 cents.

fergus51 · May 17, 2004

I saw them performed more often in the US by older docs and those who felt it would protect them from liability. However, it wasn't routine. In Canada I only saw a few done and it was when there was an emergency and we needed the baby out NOW.

I would not allow a routine episiotomy if I was in labor. I would also never refuse intervention when it's needed.

SCmomof3, RN · May 17, 2004

I would not allow a routine episiotomy if I was in labor. I would also never refuse intervention when it's needed.

I think that is the key right there! WHEN IT IS NEEDED! Women need to be informed and make decisions about their birth experience while being open to things that may be necessary as situations arise. It's hard though, because of the routine-ness (is that a word?? :chuckle ) of so many things.

Birth has changed so much into a convenience factor, many times convenience for the doctor. IE scheduled inductions instead of letting nature take its course (I'm not talking about when there is reason to fear postmaturity, large baby (which usually is not the case anyway), etc.), scheduled C sections, routine procedures that should NOT be routine. Things that should be done AS NEEDED.

My friend's OB made her schedule an induction at not quite 38 1/2 weeks only because he was going on vacation. :rolleyes: That is unprofessional IMHO.

Sorry to go off on a tangent:imbar Just my humble opinion, your mileage may vary

palesarah · May 17, 2004

All of the research I have read says that episiotomies are done frequently but moms do better without having one. I have also read research that shows moms who have episiotomies have greater incidence of 3rd & 4th degree lacerations, whereas moms who do not recieve an episiotomy usually only have 1st to 2nd degree lacerations.
My question is with all of the research why are OB's continuing with such a high rate of episiotomies. Also, in your practice, do you agree with the research findings that show the risks of episiotomies outweigh the benefits?

A great book to read that addresses this issue, if you haven't already read it, is "Obstetric Myths VS Research Realities" by Henci Goer.

Not all OBs continue to practice in such a manner. There are two OB/CNM groups that catch babies at my hospital, and they both rely on evidence-based practice. So in my hospital episiotomies are generally only performed when there's no time to allow tissues to stretch, when babies need to come out NOW.

I wish it were like that everywhere. Not too long ago, an online friend on another message board wrote that she was thinking about finding a new OB midway through her pregnancy because her OB told her that "95% of primips required episiotomies" because the human baby's head is too big for the lady partsl opening :rolleyes: .

BTW, she found another OB!

Energizer Bunny · May 17, 2004

For my first birth, it was imperative that I have an episiotomy because of the way that Trey was coming out. This was also with an OB. He explained why he had to do it before he did. With both of my other deliveries, I had a CNM and tore, but my recovery time was not nearly as long and the pain was not as bad as with the episiotomy. Just my experience.

DidiRN · May 17, 2004

I wish I had had an episiotomy. I tore so bad that when I went back to my room and the epidural wore off...wow, the worse pain I have ever had in my entire life. I actually felt like someone was taking a knife and repeatedly me stabbing me down there, I kid you not. I don't have a low pain tolerance at all, but I tell you...the pain was so bad it took my breath away. I was actually writhing on the bed and all I could say was "Oh my God!" over and over again. I couldn't even cry at the time, it was excruciating. It made labor seem like nothing. I will never forget it, lying on my bed in complete agony. Six months later ended up having surgery for a fistula repair.

I'm not saying that everyone should have one of course, but in my case, I sure wish I had. I didn't refuse one at all, but I wondered if my doc didn't do it because of all the anti-episiotomy talk out there. I ended up losing alot of the joy of being with my first baby because of this experience.

Sherri

PegRNBSN · May 17, 2004

Very few routine episiotomies (can only think of one MD where I work who does them routinely) done.

My personal experience 1st baby RML (worse pain than my c-section)

2nd baby c-sectioin

3rd baby midline epis (not bad)

4th baby 2nd degree laceration (didn't even feel it)

My friend and I also helped with the delivery of a co-worker who had had two previous deliveries with 4th degree extensions of midline episiotomies. We researched prior to her delivery and convinced the MD to deliver without stirrups (this was 13 years ago) and not do an episiotomy. She delivered without any tears!!

L&D_RN_OH · May 17, 2004

I have also read research that shows moms who have episiotomies have greater incidence of 3rd & 4th degree lacerations, whereas moms who do not recieve an episiotomy usually only have 1st to 2nd degree lacerations.

All the 4th degrees I have seen, were episiotmoy extensions. I have never seen a 4th degreee laceration. Luckily, only 1 of the dos I work with does them on a regular basis, and we hardly ever see her. Our largest practice, made up of OB's and CNM's rarely do episiotomies.

becca.utns · May 17, 2004

Thanks for your opinions and experience!!! :)

I think I have a little too much time on my hands having just graduated and sittin' around waiting for my beautiful baby to arrive!

During my L&D rotation in school I never saw an epis. being done (keeping in mind I was only there 1 day a week for a semester). It is nice to hear many nurses saying episiotomies are not routine anymore where they are, thank goodness. But, of course, if baby were in anyway at risk and needed out stat I wouldn't mind an epis. Anywho...I was curious about opinions and what you all have actually seen in practice.

SmilingBluEyes · May 17, 2004

You know, I liken an episiotomy to putting a tiny tear in paper THEN putting PRESSURE ON IT---- what happens? It rips readily and fast......much more so than a paper without the little tear at the top.

I hate to see em, and fortunately, our doctors rarely do them. It DOES open up a woman to deeper tearing, studies have shown. I wish I could quote you one right now, but I can't. But to me, that is what routine episiotomy does....acts like the tiny tear in paper, making a HUGE tear MUCH more likely when tension is placed on it.

Ok off my soapbox now.