What would you have done? Episiotomy

[AspiringNurseMW]

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?

[missnurse89]

I do think that certain medical interventions are appropriate WHEN needed. But this is coercion! This poor girl! Yes. Babies heads are big. But women are designed to birth babies. I think the problem lies with forcing labor in the first place. What's wrong with allowing a mom with no risks to do what her body was meant to do? Interventions are appropriate when needed, but they shouldn't be the standard of practice for all deliveries. I do appreciate the idea of assisted home births for low risk pregnancies. Actually, the research on home births vs hospital births are quite interesting if you ever find a chance to review it. Interventions perfomed when not necessary can cause more unnecessary interventions. And don't even get me started on how these interventions affect breastfeeding! Whew! Caught myself...good lol

[cayenne06, MSN, CNM]

But the bigger issue is the complete dismissal of this woman's right to bodily autonomy- it doesn't matter if her baby is crashing on the perineum and an epis could save the kid's life. If mom refuses, you educate, explain, maybe even plead to her. But you never,ever get to touch or manipulate someone's body- ESPECIALLY their genitals!- against someone's wishes. Ever.

[ShontaFutureBSN]

I am appalled. The doctor was rude and over bearing. Her mother should have also backed off and allowed her to make that decision. I was given an episiotomy when I gave birth to my daughter 8 1/2 years ago. However, I consented to it after my OBGYN allowed me to attempt to deliver my daughter without it, to no avail. I did my research before hand and knew this would be a possibility because I am only 5'3", 115lbs and my daughter was 6lbs 5oz, 21" long. I kind of figured that I would need assistance because of my tiny frame and I healed fine. However, I do not in any way agree with the way the mother was left with no choice in a matter that affects her directly. This is sad actually........smh

Shonta - Future BSN

[mamagui]

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?

^^^^THIS^^^^

[AspiringNurseMW]

I really really hope her case causes at the very least some conversations with women who aren't aware. There is just so much wrong with our obstetrical care in the US, it makes my brain hurt. And of course we out spend every other country, but yet our stats are among the worst in developed countries.

[phuretrotr]

And of course we out spend every other country, but yet our stats are among the worst in developed countries.

I always have to wonder though, if numbers are worse in developed counties, because developed countries are more likely to have a system to collect data on outcomes, thus putting forward more negative outcomes.

The same is true with other things, such as STI's. One country may have a higher incidence of STI's but is that because more people in that country report/treat the STI rather than the other country who doesn't because the cost to treat/report is more than they can afford. Or is it really because developed countries have higher incidences of STI's.

I'd like to think it's a little bit of both, however I also think the numbers would be a little bit more equal if both used the same system to collect and report.

[klone, MSN, RN]

I always have to wonder though, if numbers are worse in developed counties, because developed countries are more likely to have a system to collect data on outcomes, thus putting forward more negative outcomes.

But when you compare the stats in the US to, I think, every single European country, we come in dead last. The infrastructure for data collection in Europe should be equivalent to ours.

[queenanneslace, ADN, MSN, APRN, CNM]

Influence of definition based versus pragmatic birth registration on international comparisons of perinatal and infant mortality: population based retrospective study | The BMJ

"In summary, we observed large international differences in the reported proportion of live births under 500 g and under 1000 g birth weight and in neonatal deaths in these birthweight categories. International comparisons based on crude fetal, neonatal, and infant mortality rates yielded results that differed from comparisons that excluded extremely low birthweight and early gestation births, especially those at the borderline of viability. Variations in the registration of births at the borderline of viability and related problems compromise the validity of international rankings of industrialised countries by perinatal and infant mortality."

It is not really accurate to state that the US is 'dead last' due to the issue with variations in neonatal mortality reporting guidelines/practices in other developed countries.

[LibraSunCNM, BSN, MSN, CNM]

I had the privilege of sitting in on a lecture by Eugene DeClercq, a famed professor of public health who specializes in U.S. maternal/child morbidity and mortality. I unfortunately don't have the specific studies in front of me, but his overall take-home message was that even when you adjust for differences in how other industrialized nations report their mortality rates, the U.S. is still in fact last.

[Elvish, BSN, DNP, RN, NP]

It is not really accurate to state that the US is 'dead last' due to the issue with variations in neonatal mortality reporting guidelines/practices in other developed countries.

Perinatal statistics include other indicators besides neonatal mortality, which other members have already addressed. Maternal mortality, preterm delivery, and pregnancy complications are also addressed. If neonatal mortality were truly a one-off, we'd be doing better on all the others...and we aren't.

That said, there is a great deal of research on extreme prematurity care that comes out of Scandinavia. My Finnish friend the surgeon corroborates this; they routinely resuscitate around 23 weeks. I'm not convinced that neonatal mortality differences are so easily explained away.

[Graduation2016]

At work often we see patients who are needing the episiotomy and the dr would stahl doing it to give them

a chance. Then this on dr was not only rude but did a procedure that was absolutely not necessary. That baby was already at the perineum crowning when he started cutting away. So happy that out dr's are nothing like this!

[Red Kryptonite]

At work often we see patients who are needing the episiotomy

This is true for basically no one.