I'm learning so much from this board, thank you! I'm going into nursing school in June and I am interested in L&D. Forgive my ignorance.
I have read so many posts in here that talk about the interventions docs do during the labor. How much control do mom's and/or dad's really have during the labor?
For example:
Can mom's refuse to have an episiotomy?
Can mom's refuse to have their perinium stretched?
Can mom's refuse to give birth in the lithotomy position in stirrups?
If a mom wants to move around, will she be able to?
Do docs actually listen to mom and/or dad?
Or, should mom's who want any control just use a midwife?
I always thought that stretching the perineum during labor was a good thing because it helps ward off tearing or the need for an episiotomy. Is stretching something that women frequently DON'T want? If so, how come?
I really thing there is too much "education" going on for laboring moms....In any other area of medicine, people are allowed to voice their choices without some well intentioned medical person thinking they are either uninformed or uneducated. There are many more rectal fistulas with tears and I have to say I prefer intact perineums and no episiotomies, but as a person who has been personally through just about every OB experience one person can have, if I say I want an episiotomy because of what I have been through and seen over two decades of nursing, it does not mean I am either uninformed or uneducated. It simply means I know what I want, and to assume otherwise is a great dis service to most patients that present to labor and delivery. We can spout statistics until we are blue in the face but rarely are research poles unbiased in some fashion. If you agree with something you can find a report to back yourself up, but out in the trenches, that is not always the case. We have a follow up clinic so we see those patients post severe tears vs episiotomies and the healthier healing is by far, the episiotomy crowd. That may have to do with hygiene and many other factors, but in my experience and despite the research quoted here, episiotomis win ( and we probably do only 15 a year in a population of 700 or so births in that time so I am not advocating them at all). If you have ever seen or ever had a rectal fistual and seen the pain and suffering involved, you just might jump back to the real world and not the statistics. I am for natural as delivery as possible and in the case of first or second degree tears which do or don't require repair, that is one thing, but the more severe, or tears "naturally" down to the rectum, are another thing.
I'm not sure we have jumped out of the "real world " at all here. I can remember seeing only one fistula and that was after an episiotomy. Of course you can have bad tears, but the presence of an epis is more likely to cause one of those 4th degree lacerations.
KRVRN, BSN, RN
1,334 Posts
I always thought that stretching the perineum during labor was a good thing because it helps ward off tearing or the need for an episiotomy. Is stretching something that women frequently DON'T want? If so, how come?