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?

[Red Kryptonite]

The more I learn about giving birth in hospitals the more I lean toward home birth/birthing center. Don't know if I would do it for my first, but maybe my second.

I apologize for the quotes without the poster's name, the quote function on the app isn't working correctly right now.

Anyway, about 1/3 of American babies enter the world by cesarean. Once they make sure you get that first cesarean, you're largely screwed. Go to a birth center for your FIRST. Primary cesarean prevention is key to lowering our ridiculous rate.

[Elvish, BSN, DNP, RN, NP]

Wondering if anyone has an opinion on pulling out the placenta vs letting the body deliver it naturally i.e. the last stage of birth? When I was in nursing school I saw the OB doc do this and I was wondering if this is normal practice to prevent part of placenta from possibly remaining in the uterus and causing issues?

The more I learn about giving birth in hospitals the more I lean toward home birth/birthing center. Don't know if I would do it for my first, but maybe my second.

As much we get right at my place, I'm sad to say this does happen. They crank up the pit right after birth and give gentle traction (or so they call it) to deliver the placenta. It's impatience, nothing more. Rarely might it actually be necessary for retained placenta.

[klone, MSN, RN]

I apologize for the quotes without the poster's name, the quote function on the app isn't working correctly right now.

Anyway, about 1/3 of American babies enter the world by cesarean. Once they make sure you get that first cesarean, you're largely screwed. Go to a birth center for your FIRST. Primary cesarean prevention is key to lowering our ridiculous rate.

Or alternatively, do a lot of research on the hospital(s) and if possible, choose one with a low C/S rate and a thriving midwifery practice. The facility I work for has a C/S rate of 8% (lowest in the country - there was an article about us last year in U.S News and World Report) and the highest TOLAC/VBAC rate of all the hospitals in the state.

Unfortunately, in a lot of communities, shopping around for a hospital is not an option. Where I had my youngest, there was ONE hospital, and no FSBCs, and no midwifery practices. Finding a better hospital would have meant moving at least 90 miles away. For a lot of women, that's the reality.

[AspiringNurseMW]

Is insulting necessary? I go by what I see at work and by I hear from patients themselves.

Hearing from patients does not constitute evidence. There is overwhelming amount actual scientific evidence that shows that natural tearing is far better for women than episiotomies. I hope that for the sake of your patients you take some time to look for and read such evidence.

[AspiringNurseMW]

[quote=Lev

Please please please do not shy away from homebirth /birth center the first time around. It's unfortunate that to have a evidence based birth experience often requires a combination of a carefully selected OB and hospital, the draw of luck of a nurse, and how strong your birth support is..... To me, it's just so much easier, lot less fighting people and unnecessary procedures at a home /birth center.

I sincerely wished I had considered those options with my first, as I likely wouldn't have ended with my primary section.

[klone, MSN, RN]

Is insulting necessary? I go by what I see at work and by I hear from patients themselves.

Part of learning how to be an RN is being able to let go of preconceived ideas and use critical thinking and evidence based practice, rather than anecdotal experience.

If you have the ability to do so (i.e. have access to healthcare databases), you should look at the literature regarding episiotomies. Particularly, there was a huge systematic review done about ten years ago (Hartmann, et al) published in JAMA that looked at studies published over the last 50 years. The result of this review found that there was no benefit to episiotomy.

Specifically (cut and paste from the abstract):

Evidence does not support maternal benefits traditionally ascribed to routine episiotomy. In fact, outcomes with episiotomy can be considered worse since some proportion of women who would have had lesser injury instead had a surgical incision.

[klone, MSN, RN]

Here's the abstract conclusion from another systematic review (Cochrane) published in 2000 (Carroli & Belizan)

Restrictive episiotomy policies appear to have a number of benefits compared to routine episiotomy policies. There is less posterior perineal trauma, less suturing and fewer complications, no difference for most pain measures and severe lady partsl or perineal trauma, but there was an increased risk of anterior perineal trauma with restrictive episiotomy.

[Red Kryptonite]

And I wonder just how many of those women were in any kind of favorable pushing position instead of the ridiculous travesty that is purple-pushing, breath-holding lithotomy "coached" by people who wouldn't know a physiological birth if one fell out of the sky and landed on their face.

[OrganizedChaos, LVN]

And I wonder just how many of those women were in any kind of favorable pushing position instead of the ridiculous travesty that is purple-pushing, breath-holding lithotomy "coached" by people who wouldn't know a physiological birth if one fell out of the sky and landed on their face.

You would think, by just common sense, that that position wouldn't be as helpful as say standing & pushing. What is the Evidence for Pushing Positions?

[Red Kryptonite]

You would think, by just common sense, that that position wouldn't be as helpful as say standing & pushing. What is the Evidence for Pushing Positions?

Common sense left American birthing about 125 years ago.

[OrganizedChaos, LVN]

Common sense left American birthing about 125 years ago.

Yikes.

[AspiringNurseMW]

I think we should all get together, hound some celebrities for some money, and open a birthing center together, lol.