What would you have done? Episiotomy

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Starting my program in the fall, so this is not a HW question.

I only just now got around to watching this video even though I've heard about it for months now.

Video makes me sick, maybe its because I'd never seen and episiotomy and the lies everyone is telling her to try and get her to consent.

As a nurse, if your patient is very clearly NOT consenting to a procedure or really not wanting one and the doctor so blatantly went ahead and did it/tried to do it , what would you do? How would you have acted as the nurse in this situation?

What is the extend of your responsibility in a case like this? Furthermore, how common is it, or for OBs to perform one without even notifying the mom, or do most women just begrudgingly consent?

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Specializes in ICU Stepdown.

Most women I've known to give birth were given episiotomies without their consent 😤

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.

I'm not an L&D nurse but if your patient says no, that means NO! That baby would've come out even if he didn't cut her. Would she tore? Maybe, but he didn't need to do an episiotomy maybe she would've tore less than that huge episiotomy she got. I would've reported him to the medical board if he did that to me.

Oh if I was that patient's nurse I would've told the doctor, look she is saying no! No means no. If you cut her that is assault. The fact that, that nurse went along with it is scary as well. If I had to I would've went & got my charge nurse. That is just, really sickening.

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Specializes in Nurse Leader specializing in Labor & Delivery.

I'm not going to watch the video right now because I'm at work, so I can't comment on the specifics of it. But it REALLY bothers me that in any other situation, doing something to a patient against their will and express wishes would be grounds for malpractice. But in OB it just seems to be par for the course. I do think we're moving away from that paternalistic attitude in general (the OBs I work with now, who are mostly younger docs who have been in practice for 10 years or less, would never dream of doing that), but I did see it a lot from a few private practice docs I worked with as a new nurse.

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Specializes in hospice.

I'd get stabbed in the hand by his scissors. Not even kidding.

I determined a long time ago that I can never work OB. I'd do murder in my heart every day over the despicable things done to laboring mothers.

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Specializes in Nurse Leader specializing in Labor & Delivery.

Okay, home and watched it. Actually, only watched the first 3 minutes. Horrible, couldn't watch any more. Yuck yuck yuck.

Kryptonite, not all places and not all OBs are like that. Some actually do practice evidence based obstetrics and allow the woman the autonomy to refuse anything she doesn't want, and actually treats the woman and her partner as part of th team.

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Specializes in hospice.
Okay, home and watched it. Actually, only watched the first 3 minutes. Horrible, couldn't watch any more. Yuck yuck yuck.

Kryptonite, not all places and not all OBs are like that. Some actually do practice evidence based obstetrics and allow the woman the autonomy to refuse anything she doesn't want, and actually treats the woman and her partner as part of th team.

If you know of any in the Phoenix area I'd be grateful for the info. Or how to find out which hospitals those are. I can see myself becoming a CNM, because I'd love to be part of changing birth culture in this country, but I'd have to be a L&D nurse first. As much as I love my home births and think that should be an option, in this country most births take place in hospital, so really impacting birth culture needs to happen there. And frankly, my first home birth was a crisis reaction and running away. If I could have been safe and supported and found EBP and respectful care in a hospital, I wouldn't have chosen home birth.

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Specializes in Nurse Leader specializing in Labor & Delivery.

Sadly, I do not. I had a homebirth with my second (in Minneapolis) and would have with my third child as well, but in AZ there just were not any good, safe options for homebirth providers. AZ is not a very homebirth- or FSBC-birth friendly state. :( It wasn't until I moved to Colorado that I saw in practice that there are OBs that actually allow women to labor without intervention.

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Specializes in PACU.
If I could have been safe and supported and found EBP and respectful care in a hospital, I wouldn't have chosen home birth.

I've never been given birth, but the one thing that makes me keep putting pregnancy off (and off and off), besides nursing school, is partially due to my fear of excessive interventions in hospitals and having a traumatizing birth and hospital staff going against my wishes or consent. I will most likely try as I might for home birth as a result unless things change. I just think there is too much intervening going on in hospitals and the best way for me to avoid that is simply not going to a hospital and finding an alternative. What is the culture at most birth centers? As you can tell, childbirth is not at the forefront of my mind so I haven't exactly done my due research on the other options besides home birth.

The fact that I would most likely have to depend on my husband to speak up for me in a difficult labor situation is also unnerving considering he probably wouldn't know his head from his you-know-what in that situation. I have talked to him about my wishes and surprisingly he said he would be ok with me literally giving birth in the backseat of a car as long as the baby was healthy.

My friends and family have had horrible labors when doctors excessively intervene and I am really not trying to let that happen to me, too. I hope by the time I'm ready to take the plunge the culture changes but for now who knows? It's a scary thought about how some (not all--there are awesome OBs out there that don't do this) women are treated during labor.

Ok, that seriously felt so much better to get out. I bet it seems super trivial to many but loss of control in such a vulnerable state is absolutely terrifying to me.

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Specializes in Community, OB, Nursery.

I can count on one hand the number of epis-es I've seen in the last almost-10 years in perinatal nursing. They were almost all done emergently, like to make space for shoulder dystocia maneuvers. In the situation described by OP, a lot of us at my place would say very loudly to the patient and stare right the doc while saying it, "Now, you did say no epis, right?" If they did the epis anyway, that's an incident report. But like I said, epises are so rare I haven't really had to think about that particular situation.

There really are great docs out there that do listen to their patients. None of the ones I work with now would do it without the pt's consent. We also (I love to brag about this) have a very low c/section rate. :)

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
I've never been given birth, but the one thing that makes me keep putting pregnancy off (and off and off), besides nursing school, is partially due to my fear of excessive interventions in hospitals and having a traumatizing birth and hospital staff going against my wishes or consent. I will most likely try as I might for home birth as a result unless things change. I just think there is too much intervening going on in hospitals and the best way for me to avoid that is simply not going to a hospital and finding an alternative. What is the culture at most birth centers? As you can tell, childbirth is not at the forefront of my mind so I haven't exactly done my due research on the other options besides home birth.

The fact that I would most likely have to depend on my husband to speak up for me in a difficult labor situation is also unnerving considering he probably wouldn't know his head from his you-know-what in that situation. I have talked to him about my wishes and surprisingly he said he would be ok with me literally giving birth in the backseat of a car as long as the baby was healthy.

My friends and family have had horrible labors when doctors excessively intervene and I am really not trying to let that happen to me, too. I hope by the time I'm ready to take the plunge the culture changes but for now who knows? It's a scary thought about how some (not all--there are awesome OBs out there that don't do this) women are treated during labor.

Ok, that seriously felt so much better to get out. I bet it seems super trivial to many but loss of control in such a vulnerable state is absolutely terrifying to me.

Don't let other people's birthing horror stories scare you into not having a baby. I LOVED my birth & my OB! I had a complicated pregnancy too. He really worked with me & didn't do anything I didn't want including not having an episiotomy. I couldn't have asked for a better OB or birth. :)

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Specializes in PACU.
Don't let other people's birthing horror stories scare you into not having a baby. I LOVED my birth & my OB! I had a complicated pregnancy too. He really worked with me & didn't do anything I didn't want including not having an episiotomy. I couldn't have asked for a better OB or birth. :)

Haha, thank you. It's not the #1 reason I won't have a baby yet, but it definitely a contributing factor. My SO's aunt is an L/D nurse and has said over and over she would advocate for me to the death if it's truly what I wanted so I know those awesome nurses and doctors are out there.

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