Episiotomy vs. Spontaneous laceration? - page 3
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... Read More
Jan 23, '06Occupation: Labor & Delivery RN Joined: Jan '06; Posts: 5I am a L&D RN at two of the busiest hospitals in Birmingham, AL, I have also worked in SC and Atlanta, I have worked L&D since 1989. All of the MD's I have worked with do not routinely do episiotomies. The only time it is done is if a tear is inevitable. If there is one that does do routine episiotomies it is usually an older physician. If it is coming down between an episiotomy vs. a tear, I would go for the episiotomy. It is a cleaner method and much easier to repair vs. a tear. I have seen more tears end up with what we call "vaginal c-sections", that is it requires more sutures than a c-section to repair. The recovery from episiotomies are much easier for the patient because it is controlled vs traumatic. I have had both and personally if it were necessary I would go with the episiotomy. The key is that if it is done it is medically necessary to get the baby out safely for both the mom and baby. It is not done so that the physician can get back to the golf course.
Jan 23, '06Joined: Apr '02; Posts: 38,756; Likes: 16,286I have worked 3 different hospitals and in my observation what you say above, well it depends. An Epis can easily extend to a 3rd or 4th degree tear. In which case, this IS NOT the better way to go. That is one reason why many physicians and midwives are deferring from "cutting" unless they see no other way around it.
Also, a naturally-occuring 1st degree tear (the most common) is easier to repair (if repair is needed) and heals relatively fast, versus an epis, which extends more into the perineal body.
And in my experience, there WERE physicians who hastily cut epis's on everyone not delivering VERY rapidly. Never in my life, did I see SO MANY 3rd/4th degree lacerations than I did in that place where episiotomy was a routine procedure. Some are very impatient and DO cut unnecessarily. And yes, I noted it was usually the "older school" docs doing this. Thankfully, more are thinking twice now.Last edit by SmilingBluEyes on Jan 23, '06
Jan 26, '06Joined: Jan '06; Posts: 12I have to leap in here as this is a hot topic with me right now. I am a travelling OB nurse so see it all. My background is Midwifery ( NZ) I had my own practise and can tell you that there is no need for rouine epis... The use off warm cloths on the perineum, controlled breathing as the head crowns so it eases out slowly.. oil applied to the vaginal opening and head control are all ways to prevent tearing though some times its inevitable I am afraid.
Its is known a lac will repair well even left to its own devices.. though would no of course expect anything over a 2nd degree to be left to heal on its own ( with instruction on care of the area of course)
We have an MD at the Hospital I work at now who will do an epis on every single pt given a chance.. my strategy is to call him at the last moment so he does not get a chance.. though he will if he can.. before he even evaluates the perineum he will reach for the local and the scissors.. (makes me so mad)
I caught one of his babies lasr week after the hopsital had a lock down and he was locked out ( some fault with the doors and the generator), and he still managed to get a suture into the woman.. for a very tiny tiny lac.. ( i hear he is paid $100 for a surgical fee)..
Jan 26, '06Occupation: Registered Nurse Specialty: 8 year(s) of experience in med/surg/tele/neuro ; From: US ; Joined: Feb '05; Posts: 1,842; Likes: 664My third baby was delivered very rapidly. It really hurt and she was coming very fast and fast down the birth canal too (I had just gotten to the hospital) The doctor did an epi with no local. no time I guess. I could feel it but it didn't really hurt. too much pressure. I guess I needed it. She was my biggest baby at 8lbs 2oz.
My fourth child was 7lbs 14oz. No epi. broken collarbone. Slowest delivery of all my children. Perhaps he came down the birth canal fast. hard to remember. Experienced small tear. no biggie.
Jan 26, '06Occupation: L&D RN Joined: Jun '05; Posts: 323; Likes: 17Quote from FaeriewandThat's not uncommon. The pressure and stretching from the baby's head "numbs" the perineum. Well, if you've been crowning for awhile, anyway.The doctor did an epi with no local. no time I guess. I could feel it but it didn't really hurt. too much pressure.
We have a couple docs who don't always do them, but do them more than I think is necessary. We have one young, female doc who does them routinely. And she's been known to snap a cord if she doesn't get the chance to cut an epis. Not purposely, that's just the way it seems to go with her. She is just way too impatient. I was told by another RN, she managed to cut an epis on one pt after the head delivered. :imbar
Jan 26, '06Joined: Nov '05; Posts: 346; Likes: 17Quote from becca.utnsMy first 2 children are 16 and 18. My first the OB used suction so I had a 4th degree(horrible) my 2nd I had a 3rd degree refused suction, didnt' want the delivery dose of my epidural but the anesthetist wouldnt' listen to me and numbed me up too much. MY last 2 children are 5 and 9. My epidurals were just enough for pain control and I could move my legs. I had massage done to lessen the chance of an episotomy. My OB was more up to date and I knew what I wanted. I had one stitch with my last 2 children. Wow it was amazing I was up and running right away. I was more verbal about what I wanted and didn't want.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?
Jan 26, '06Occupation: Stay at home mom (for now) Joined: Jan '06; Posts: 165; Likes: 9With my first son I had an epi. after 1 hour of pushing. With my second son I tore after 45 minutes of labor and 3 pushes. Both of them hurt like heck, but I would rather have an epi than and tear. I healed much faster w/ the epi. and had less pain.