To think that episiotomies are more common than my midwife claims at hospital births?

[Lovinglife2019]

I don't know that many people who've had children recently at a hospital, maybe 6, but ALL of them "had to have" an episiotomy. 1 of them was due to requiring a forceps delivery, but the rest seem to be because the staff told them they would tear really badly otherwise and this was the best thing for them. None of them found the recovery that easy and most of them aren't convinced they actually needed one after talking to other friends who didn't have them and delivered at a midwifery led unit or at home. Don't know how true this is.
When discussing birth preferences, I raised this with the midwife and she said it was just coincidence and actually episiotomies aren't that common.
For medical reasons I will have to deliver at the hospital, and would like to avoid an episiotomy unless medically necessary but am concerned it might be pushed on me.
Am I being unreasonable to doubt the midwife or have lots of people out there had hospital births without episiotomies and it is just coincidence?

Yes I had one too. I don't recall being asked permission more that it had to be done as they needed to get DS out quick. I lost a lot of blood and fainted after but other than that it healed really well.

Hi OP

I believe interventions lead to more interventions? So if you're had pain relief and are lying down being monitored then you are more likely to have a slow labour and have an episiotomy.

I had one first birth and a tear second birth. The episiotomy took 12 weeks to heal and was very painful but they cut to the side muscle. The second birth I tore downwards into the perineum and it wasnt as painful, healed in half the time, but I had continence issues while it healed.

You can stretch the area by doing perennial massage, it's meant to reduce the chance of tearing. Although you have to have a hospital birth you could ask if you can keep as active as you can eg birthing ball and walking around and see if you can give birth in a better position than lying down eg all fours, I think that means intervention eg pain relief is less likely and the whole thing is quicker and there will be less chance of an episiotomy

Prettypumpkin are you me?

I had an episiotomy with my first baby which healed really well. My second baby gave me 'a little graze' and that was a lot more painful!

I had one, was definitely needed. I didn’t find the recovery bad at all - to be honest barely noticed it either at the time or in the days afterwards!

I had ventouse (sp?), followed by forceps and I needed one. I only had a first degree tear. The Dr did it. It healed fine and I have no ongoing issues. Son is now nine months old. If you need one, you need one.

Midwife here.
Qualified 12 years.
Done 2 episiotomies in that entire time. Both for severe fetal distress where time was absolutely vital.
In all my time as a midwife, episiotomies done for a non instrumental birth is absolutely uncommon. Very rarely seen. I can't remember the last time I looked after a woman who had one who had not had an instrumental birth. I have worked in 3 Trusts. So isn't Trust specific either.
Hope that is reassuring for you.

I've had two big babies (10lb and 9lb12oz) and no episiotomy either time. 2nd degree tears but both healed well.

I also work on LW and aside from instrumental deliveries they are indeed rare. And to the pp who said they might not be documented, everywhere I've worked has a proforma the MW fills in about the birth which includes a section on tears/episiotomy/sutures, so it should be easily available information.

@mindutopia
It's not something women have to give consent for (one of the few procedures in fact where that is the case!).

Please don’t ever let anyone lead you to believe this is true. No one can ever do anything to you during your birth without consent. In fact in all of medicine there are very few situations where this is true and generally involve lose of the conscious mind/unconsciousness.

It is assault to perform an episiotomy without consent.

However it is usually a high pressure situation when an episiotomy is being performed and the giving/gaining of consent is often implied (I’m not condoning this, which explaining) thus people of feel they have to/health care professionals will assume the response is consent. But from a legal perspective, consent has to be gained.

Two babies, both delivered by ventouse - one with shoulder dystocia. No episiotomies - much to my current midwife's amazement.

I had it specifically written into my birth plan that I didn't want one. My fear was that they are sometimes carried out unnecessarily.

I had one because I needed forceps. I was walking like a duck for a week or so and needed regular pain relief but it healed perfectly well. I was the only one in my NCT group who had one (only one who had an instrumental birth - so my experience is the same as others that they’re very rare unless an instrumental birth)

Thank you all for your kind responses. Makes me feel a lot better, especially those who ended up having them and found the recovery not that bad.
Interesting that they don't need your consent...
I have just checked the statistics for my trust and about 1 in 3 deliveries (excluding c sections) had a medical intervention, which is definitely higher than the national average (I checked) but still means 2 in 3 don't so the odds are in my favour. Guess I'll just have to wait and see!
Thank you everyone

Excuse the typos

That should say ‘loss’ not ‘lose’
And ‘just explaining’ not ‘which explaining’

And also another midwife checking in to say, between training and practicing I’ve beeb in midwifery 7/8 years, and only ever had to perform one which was not also part of an instrumental delivery

I had one with my ds - weighed 9lb 10oz and was short (so very, very wide!). I was desperate, been pushing on my back for 4 hours. Didn’t heal well and still suffer 9 years on.

Another midwife here and @babycatcher411 has summed it up nicely - you ABSOLUTELY have to give consent for an episiotomy. Most of the time when they are being recommended though, the alternative is worse and so women consent to avoid this.

I don't believe they are common. I'm a midwife that has been qualified quite a while, I can count the number that I have done on one hand. The majority of the time, they are done during instrumental deliveries. I think older school midwives are more likely to perform them as they used to be more routine, now the research shows that natural tearing heals better and so midwives who qualified more recently will practice according to this.

I met one woman who had a tear right through to her anus. She had all kinds of infections after that and she had incontinence problems years after the fact. I think an episiotemy would have been better in her case. They really don't do them for fun, and the stitching gives them extra work to do. If you need one, then they'd better give you one, it's better than the alternative.

I had one for my first baby as he was stuck and heart rate slowing too much. I still tore a bit but at least it was in the right direction. A forwards tear sounds awful.
The next 2 babies I had no episiotomy but small tears ( backwards luckily).
The episiotomy scar is definitely a big thick line, whereas the tears healed neatly but I preferred an episiotomy to a c-section to save my babies life.

I had one with no other interventions. DS was back to back with his head at a funny angle.

I was told she was going to do it giving me time to respond but I wasn't asked explicitly for consent but I would have given it anyway.

Healed okay, the wound got infected but cleared up quickly with antibiotics

I had to have one with my first born years ago,the days when women seemed to only have the lying down position for a birth. I was in labour for about 48 hours,and really struggling,and it was deemed that things were getting serious,with a stuck baby so to speak. I recovered well though,with only a little pain for a couple of weeks.

Had my second baby four years later, all quite rushed,as she was born on the back seat of our car,and delivered by my husband,and I tore quite badly, so had to be stitched up later.

I didn’t want one because I knew someone who had one and tore around it. They talked about it with DC1 but in the end they decided not to. I tore anyway, third degree. Needed a year of physio after.
Completely different experience with DC2. Quicker labour. 2nd degree tear. There is a world of difference between 2nd and 3rd degree tear. Recovery with DC2 was weeks.
Despite this I’m still glad I didn’t have one.

I had one for a ventouse birth and honestly barely noticed it afterwards. To be fair that whole area feels swollen like a baboons arse afterwards so if it’s done well and your healing okay it just kind of gets lost in the general aftermath I think.

I had one for a tricky delivery, meconium waters, forceps needed. Healed within a couple of weeks, no issues, no pain.

I know 2 women who have had episiotomies. Both babies were 10lb+ and both needed forceps deliveries. That’s out of maybe 10ish hospital deliveries I can think of, a combination of women who started out high risk and those who started low risk and been transferred to hospital.

As far as recovery goes, it was tricky at the time. I had trouble sitting for a while because of pain. That got better after a couple of weeks. The sharp twinges now and then lasted for months. However, I am fully recovered now and had no problems with my second birth. No need for any interventions.
I would rather not have a very bad tear- some women never recover from that fully.

I’m amazed. I’ve been a midwife for 15 years and only done one episiotomy during that time and that was for quite a low fatal heart rate. I’d say most of my colleagues are very similar. It’s very unusual for a midwife to do one....I can’t think of the last time I’ve known it happen. Instrumental delivery with a doctor is obviously different.