How necessary are episiotomies?

SmilingBluEyes · Jan 20, 2005

Where I work, episiotomies ARE NOT routine and ONLY performed in the face of serious fetal distress or signs the baby won't come out w/o help-----usually only to save a worse tear. The docs would rather see a minor tear than just cut an epis. I like, as a nurse, to let a baby "labor down" if there is epidural, or let a mom "grunt" and use open-glottis pushing techniques to bring baby down gradually and reduce tearing. Some midwives I know, like to use heat packs and oil massage of the perineum to help it along.....I am reading now though, less manipulation of the perineal body, the better.

palesarah · Jan 21, 2005

ditto Deb! No routine episiotomies at my hospital.

BETSRN · Jan 21, 2005

No routine epis's at my place, either. It's all in the technique. In fact, most episiotomies are unnecessary and the work of a practitioner in a hurry.

Always ask about your practitioner's episiotomy rate. If it is anything more than infrequent, RUN the other way.

BRANDY LPN · Jan 21, 2005

Where I used to work it depended more on the doc, there is one doc who ROUTINELY cuts one, it used to drive me insane, I tried to wait as long as I possibley could before calling her to a delivery I have seen her cut when you could see the baby's ears!! I swear I would not let that woman do a PAP on me for fear she would cut an epis.

Fun2, BSN, RN · Jan 21, 2005

I had to have one for my first child as it was an "emergency forceps delivery", but with my second child, I did not need one.

Both of these deliveries were at the same hospital.

ayndim · Jan 21, 2005

I didn't have one with any of my kids. I had a superficial tear (skin only) requiring 4 stitches with # 1 and no tears with #2 or 3. Then again I had a MW. I think they are unnecessary in most cases. Fetal distress is about the only indication I know of. While some women do have severe tears with one I did some research in my stats class and most of the time the severe tears are do to an episiotomy extended. Not saying a severe tear cannot happen w/o one just that it is rarer.

BTW, the docs who practice with the MW's where I go do not do episiotomies for forceps or vacuum.

hypnotic_nurse · Jan 21, 2005

With my first child, I had an evil MD who thought it was a good thing to cut and then stitch up tightly (to please the husband, he said). Very painful, for at least a year following.

After that horrible experience, with my second child, I told the (different and much better MD) that I would change doctors if he insisted on doing epis. Even though I tore that time (15 stitches), the pain was less, it healed quicker, and I didn't have any lingering pain.

SmilingBluEyes · Jan 21, 2005

With my first child, I had an evil MD who thought it was a good thing to cut and then stitch up tightly (to please the husband, he said). Very painful, for at least a year following.
After that horrible experience, with my second child, I told the (different and much better MD) that I would change doctors if he insisted on doing epis. Even though I tore that time (15 stitches), the pain was less, it healed quicker, and I didn't have any lingering pain.

wow that first doctor must reallllly hate women. What a jerk.

Montessori Mommy · Jan 21, 2005

I'm still just a pre-nursing student, so I can't help you with the statistics you asked for. I just wanted to share a great story....

Almost six years ago when we were expecting out first baby, my husband & I took Bradley classes. We had a very well researched birthplan that we wrote together. At 39 weeks, I had to be induced with toximia. I was devastated that things weren't going to be as we imagined them. (Luckily, while Bradley encourages births with as little intervention as possible, they also prepared us for any possibility.) The wonderful nurse in L&D did everything she she could to stick to our birthplan even thought most of it had to be abandon for the induction. This nurse applied warm compresses - for almost an hour - until I was ready to push. I didn't tear at all.

(Our second daughter was born three years later, and came so quickly that there was no time for compresses or an epis. I tore a bit, but it wasn't painful.)

That wonderful, patient nurse is one of the reasons I've decided to go into nursing....

Beth

BittyBabyGrower, MSN, RN · Jan 21, 2005

Not unless they have too. I had 2 epis and a 4th degree + with my daughter...she was hung up by the cord.

MarySunshine · Jan 21, 2005

Eek. Gotta run go make sure I took my birth control pill today!