What would you have done? Episiotomy

AspiringNurseMW · Jun 3, 2015

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.

You have to be my twin. I feel the SAME about practicing as a CNM, to help impact the birth culture at large, imo, women who are seeking homebirth are already way ahead of the curve.

It took me a long time to watch the video, I would keep pausing it because I would alternate between sick and angry and almost in tears.

queenanneslace, ADN, MSN, APRN, CNM · Jun 3, 2015

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?

Unfortunately - I've witnessed physicians doing things to their patients that they explicitly do not consent to, not get consent at all, and not explain what they are doing - as well as things that don't conform to our hospital's policies.

I wish I could say I spoke directly to the physician and said "Excuse me, could we please discuss this?" Then I wish I could say that I got my charge nurse involved. That an incident report was written up - we only went a little way up the chain of communication - the physician the error in his/her ways - and we're all a happy patient-centered-care OB unit.

Most of the time [please, this is the internet - so judge me at will!] I watch in silent horror. Sometimes the physician doing this is the chief of OB - so activating the chain of communication seems pretty ridiculous - if the buck stops with them.

I've acknowledged that I work on a unit that does this. That operates this way. I watched the video and I can say that I've never witnessed the extent of verbal and physical abuse that was evident in that video - but it's apparent that that's a hospital where that type of behavior is tolerated. And probably has been tolerated for a long time.

What's my responsibility? That's a good question - there are days that I personally feel that I cannot continue to work in an environment that treats women so atrociously. There are days when I wonder if my own personal ethics can allow me to work there any longer.

I've asked other nurses why they do not activate the chain of communication when they see these horrible policy violations and dangerous practices from physicians. They will say they're afraid of retribution. And I can identify with that fear. The culture is filled with so much animosity already between nurses and physicians - calling the MDs on their s*** could make it worse. It's totally dysfunctional.

Back to the video - I've NEVER witnessed a physician where I work treating a patient that way - so it made me grateful that my OB unit is not *that bad.* But a physician was speaking to a patient the way the physician did in this video, I would have called my charge nurse into the room - it was abuse - even before he got the scissors out.

Technically - we as nurses are supposed to be empowered to speak up when we have concerns - and administration is constantly reminding us of this. But I rarely see it done - and never with the worst offenders. And there are real slippery, dodgy ways of getting 'consent' - not consent by my definition - so patients say yes to things and I don't feel that the doc is really providing all the information needed for true informed consent - this really is a gray area - lots of gray areas.

Luckily - women who live in my area have lots of choices for places to give birth - and I they are making those choices to give birth elsewhere. Unfortunately, it will be dollar signs (or lack thereof) that will change the hospital culture and practices. And maybe some retirement of some folks who have been doing things like this for 40 years.

tweety1023 · Jun 3, 2015

Ours docs only do them when the women are crowning and its apparent they will have a significant tear. Or when they are crowning and baby is in trouble and the lack of stretching is really slowing down delivery of the head. So the women are distracted and really are not paying attention to what people are saying...so really no consent is being obtained. The doc usually says something along the line of "okay so I'm just going to help you out and give you a little incision here to help the head come out" while the woman is in the middle of a push -_- they don't wait until the woman says anything they just snip snip right away.

I have to say that our patients never complain about it but I can't help but feel like most of them don't even know or noticed that it happened at all.

biggolp · Jun 3, 2015

We also (I love to brag about this) have a very low c/section rate. :)

I assume that it is NOT a coincidence that in a place where doctors do minimal interventions and listen to laboring patients, there is also a low c-sec rate

Red Kryptonite · Jun 3, 2015

Ours docs only do them when the women are crowning and its apparent they will have a significant tear. Or when they are crowning and baby is in trouble and the lack of stretching is really slowing down delivery of the head.

MF...I can feel my blood pressure rising just reading this. The research is clear that natural tears heal better and more quickly than episiotomies. 4th degree tears are almost always episiotomy extensions. Slow delivery is not necessarily detrimental, in fact, not even usually.

I have to say that our patients never complain about it but I can't help but feel like most of them don't even know or noticed that it happened at all.

Trust me, they notice the next day! Patients don't complain because women in this country are socially conditioned to accept any abuse as the price of birth. Most women didn't complain about twilight sleep and restraints, either.

Elvish, BSN, DNP, RN, NP · Jun 3, 2015

I assume that it is NOT a coincidence that in a place where doctors do minimal interventions and listen to laboring patients, there is also a low c-sec rate

Yes! It also helps that our L&D unit has a ton of nurses who are very supportive of natural birth, who won't push things on patients, and who do their best to keep the docs out of the room if all is well.

tweety1023 · Jun 3, 2015

MF...I can feel my blood pressure rising just reading this. The research is clear that natural tears heal better and more quickly than episiotomies. 4th degree tears are almost always episiotomy extensions. Slow delivery is not necessarily detrimental, in fact, not even usually.
Trust me, they notice the next day! Patients don't complain because women in this country are socially conditioned to accept any abuse as the price of birth. Most women didn't complain about twilight sleep and restraints, either.

Look I'm not saying that they are doing an appropriate intervention, and I NEVER said that I agreed with it. I am just stating what happens when my docs do an epis. Are you kidding? We hate it when they do it. Also, it's not like they go around giving episiotomys. I am simply explaining what happens when they do give them. I only see one done maybe once every 6 months? Not even

I work on an LDRP floor. Our women that do get them do not notice a difference between an epis and a natural tear (I'm talking first or second degree. 4th degrees are a different story) when it comes to pain. They are all sore and most report a 1-3/10 pain and refuse additional pain medication if offered. And generally our women have no problem taking pain meds when needed. A lot of times we will do checks on postpartum day 1 or 2 and ask them how their pain is and to look at their episiotomy and 9 times out of ten they say "oh wow I didn't know that i had one." And shame on the doctor and nurse that does not make this known to the patient. I've also never seen an epis extension the entire time that I have worked here.

Red Kryptonite · Jun 3, 2015

Look I'm not saying that they are doing an appropriate intervention, and I NEVER said that I agreed with it. I am just stating what happens when my docs do an epis. Are you kidding? We hate it when they do it. Also, it's not like they go around giving episiotomys. I am simply explaining what happens when they do give them. I only see one done maybe once every 6 months? Not even

I'm glad to hear of the rarity.

My anger was not meant for you, it's for the doctors that should know better and the hospitals that allow them to practice in ways that have been known to be outdated for 20 years. Sorry if you felt that blast....it was more generally directed, but of course I quoted your post. So I'm sorry if you felt attacked, that wasn't my intent.

And that is part of the reason I know working in L & D is probably a bad idea for me, unless I can find out where Elvish works. :)

ComeTogether, LPN · Jun 4, 2015

I watched my sister get one and there was no consent given, but if the doc had waited even two seconds she would have torn from eyeballs to .... well, you know.

AspiringNurseMW · Jun 4, 2015

I watched my sister get one and there was no consent given, but if the doc had waited even two seconds she would have torn from eyeballs to .... well, you know.

Just curious, how do you know her tearing would have been that bad? Generally tears that occur naturally heal better and faster than an episiotomy.

queenanneslace, ADN, MSN, APRN, CNM · Jun 4, 2015

http://jama.jamanetwork.com/data/Journals/JAMA/4974/JCR50003.pdf

ACOG Recommends Restricted Use of Episiotomies - ACOG

There are really a couple of different issues being discussed here, right?

- Evidence-based indications for episiotomies.

- Obtaining consent to cut a woman's genitals.

If a woman 'doesn't mind' that she got an episiotomy, and she feels that she ultimately benefitted from it, does that absolve the provider of the the obligation to get consent to do it?

musingmom · Jun 4, 2015

The woman in the video served the MD in a lawsuit today, alleging assault and battery, according to the Improving Birth website that initially posted the video. The lawsuit comes after a fundraising and nationwide search for an attorney that would take the case.

http://improvingbirth.org/2015/06/preview-woman-charges-ob-with-assault-battery-for-forced-episiotomy/