How necessary are episiotomies?

  1. My mother said the worst thing about my brother's and my delivery was the episiotomy. After taking a class in women's reproductive health, I understand that episitomies are performed more often than is necessay so that the babies can be born faster for the doctor's ease.

    How often are episiotomies really necessary and how often does your unit perform them?
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    About WhatToDo

    Joined: Nov '04; Posts: 83
    Senior Project Coordinator, Baylor College of Medicine

    25 Comments

  3. by   SmilingBluEyes
    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.
  4. by   palesarah
    ditto Deb! No routine episiotomies at my hospital.
  5. by   BETSRN
    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.
  6. by   BRANDY LPN
    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.
  7. by   Fun2, RN, BSN
    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.
  8. by   ayndim
    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.
  9. by   hypnotic_nurse
    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.
  10. by   SmilingBluEyes
    Quote from hypnotic_nurse
    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.
  11. by   Montessori Mommy
    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
  12. by   BittyBabyGrower
    Not unless they have too. I had 2 epis and a 4th degree + with my daughter...she was hung up by the cord.
  13. by   MarySunshine
    Eek. Gotta run go make sure I took my birth control pill today!
  14. by   lifeLONGstudent
    Quote from BittyBabyGrower
    Not unless they have too. I had 2 epis and a 4th degree + with my daughter...she was hung up by the cord.
    OMG - you should get a medal (and WEAR it everyday)....


    this might be a stupid question, but why is an episiotomy a bad thing? (I never had one.....I had a section with my only child - that was after I got to push for about 3.5 hour ... pit started Friday night and section was Sunday).

    Isn't it better (and easier to repair) if you have a cut verses a tear? Please explain.

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