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?

BTW midwives can put a slant on things. I was strongly encouraged to consider an induction at 40 weeks a number of times by midwives and consultants and they really put the pressure on by implying I might lose my baby if I didn't consent. I spoke to my midwife who said that yes, placentas can fail but she gave me lots of research papers to read and when I reviewed them I realised that there was no clear evidence of increased risk in my circumstances. I was patronised terribly by some midwives and accused of not caring for my baby because I didn't agree to be induced immediately at 40 weeks.

@CaptainButtock no, episiotomy is primarily done to reduce the risk of an anal sphincter injury - episiotomies are directed away from the anus, whereas a tear is more likely to go straight down. They are most often done when forceps or vacuum is used because that is more likely to cause a tear.

Midwives don’t often do episiotomies during a normal birth - you can ask hospitals for their episiotomy rates for spontaneous deliveries to see that. I trained around 25 years ago and it was frowned on even then to do an episiotomy unless there was a very, very good reason. In fact there is some thinking that midwives should be more open to performing episiotomy to reduce rates of anal sphincter injury. It’s really not enjoyable to perform this procedure and no one does it lightly.

If you don’t want an episiotomy then of course you have the right to decide that - if you withhold consent and they did it anyway then the doctor/midwife would be on very tricky ground. I would say however that there are sometimes good reasons to perform an episiotomy, and it would be worth sitting down with a midwife and chatting through those scenarios. Ultimately however, if you say you will only accept it in the case of medical need, then you are placing your trust in the midwife/doctor to make that call.

@spotlessmind You sound v professional and caring, but sadly this is not always the case with midwives/doctors.
Something else happened (not the episiotomy) at the birth of Dd that.... I struggle to think of it now. It’s been 14 years. I can’t even write it but suffice to say I wouldn’t have thought it possible to feel so powerless/livid and humiliated at the same time.
And yes I did complain, and was told the doctor had been ‘spoken to’.

@CaptainButtock I’m really sorry that happened to you and apologise if my post appeared dismissive. I realise that these experiences stay with women forever and there’s no excuse for it really. I don’t know if you’ve ever thought about birth debriefing? Some women get some closure on similar experiences from that, though appreciate it can’t make things ‘unhappen’

Some very distressing stories on here. Yes I agree that the injuries and emotional trauma from these are hidden. Childbirth and the aftermath were dark times for me too.
Long labour resulting in c section and then infection with DC1. Episiotomy and 2 tears and forceps delivery with DC2, followed by infection and very ill baby. Some have better births, some worse. You can’t control it. That’s life. Very glad to never have to go through it again. Vagina is now quite deformed. Incontinent at times.
But we survived.

I had forceps for my first (meconium, presumed foetal distress). Had an episio & quite long 2nd deg tear going up inside. Can't say which healed better as I couldn't distinguish which was where. Recovery largely fine & sex etc fine, but ive had some prolapse since and I have a suspicion the tearing/episio weakened everything down there. Of my antenatal group I think 3/8 had episio, 3 had C sections..1 girl had no episio and tore quite badly.

I had a planned section for my 2nd (No choice, due to pregnancy complications). Recovery was different, better in some ways, worse in others.

Overall what made recovery bad first time more than anything, was the blood loss, I was barely above threshold for needing a transfusion and with hindsight should have had one, I was really debilitated!