refusing episiotomy

[violet59]

Unless the baby is in distress, can you refuse an episiotomy to 'prevent tearing' I'd rather take my chances as I've read they cause more pain when healing, increase risk of extending and causing 3rd/4th degree tears. Plus its a guaranteed injury needing stitches whereas you might get lucky and tear much less or not at all. Makes me think 'I'll push you down the stairs myself, to prevent you to falling on your own' is silly logic. Plus, psychologically, having my vagina cut is pretty harrowing! Baby causing tearing is somehow more acceptable

Do they ask/tell you before doing it? Maybe they do only do it when baby is distress (in which case its OK!)? I don't want to be cut just so its over quicker so the staff can go on their merry way! Tell me they don't do that!

With me, they did ask me before and needed my permission. I was determined not to have one and to tear naturally. But after a long labour and over 4 hours of pushing it's very hard to say no. My baby's heartbeat was the same but the mw's were convinced that his head was large. They always kept me informed and I felt that I had to have an episiotomy, it turned out his head was in the top 2% of size so I don't regret my choice although the implications afterwards for myself have been immense.

Basically, I think they do it when the pushing stage is very long or when the baby is in distress, they don't do it lightly but the after care could be better.

To reassure you they are not performed as often as you think. Personally, I feel it is an old school way of practising - not to be detrimental to any mature midwives- but I think the training has had different emphasis in recent years.

I really want to comment on the cut to avoid tearing thing. How on earth this can be foreseen is beyond me and is never ever something I have witnessed. Unless there is fetal distress, an epis is rarely done and should be performed with explanation and your consent. The use of local is a difficult one - all depends on the timing and the anatomy. I had an epis with my second baby for fetal distress and she didn't have time to give local. But my fab midwife did it at the right time and it felt no worse from when you cut your finger in the kitchen. Please don't worry - they are rare!

Ps was just updating my birth register and out of 301 deliveries I have done 4 episiotomies.

Hi I didn't tear on either of mine and a epistomy was not suggested. They only suggest a epistomy if you look like you will tear or are having trouble pushing the baby out for whatever reason, in which case most of the time it reduces the risk of a large tear and is neater and easier to stitch at least that is the theory.

No matter what procedure is performed it will be better for some and worse for others and sadly there is no way of knowing whether tearing or epistomy will bebetter for you can you look up rates of 3rd degree tears with epistomy and without and see which is more likely to result in more damage for you.

My mum made this decision over 30 years ago, so I'm sure you can specify not to be cut. She had a bad episiotomy the first time, and then put it in the birth plan for subsequent births that she did not consent to one and would tear. Apparently this was at a time when they were performing episiotomies routinely rather than letting people tear. For what its worth she still reckons all these years later that it was a good decision and tearing was much easier to cope with.

It appears I am thinking of the old skool aproach which has been disproven but looking it up things have changed and they are not performed much now.

I was told (but not asked) when they did it and two seconds later it was done. I had only pushed about 3 times and have never really understood why they felt the need to cut, a mw (was not present at birth) recently suggested the baby may have been in some distress that i was unaware of as they were also threatening imminent use of instruments if i didn´t give it some welly and get him out.

I am due soon with ds2 and will say I prefer not to have one but at the same time you do kind of have to put your trust in them that if it is really necessary, then its necessary, no?

My sister had a third degree tear that required repair surgery under GA and she had it miles worse than me so you just never know how its all going to pan out.

Make it very clear you don't want one, and make sure your birth partner is also briefed on this!

But remember - you can always change your mind. I wouldn't make too many hard and fast plans, birth can be unpredictable.

I tore a bit, it was no big deal.

I would suggest that you accept one if it is strongly recommended. I had one and also tore in 3 other places. One of the tears was straight down and without an episiotomy I am fairly confident that I would have had a 3rd or 4th degree tear.

you need one I think if it's an instrumental delivery but otherwise just write in notes that you prefer not to have one. fwiw I had epi for ds2 and tore with dd1 - didn't feel the cut, had no problems with it, healed fine. tear was a nightmare. so they're not always the end of the world

I had no birthplan as such but stressed to midwife that the only thing I didn't want was an episiotomy.

After 2 and a quarter hours pushing I was exhausted. Midwives were very patient and understanding and took the time to explain why they thought cutting me would be for best. They also made sure that I understood and agreed.

It didn't hurt at the time and ds was born after the next couple of pushes. It did hurt afterwards and took several months before I forgot about it completely.

On balance, I would try to avoid it if not absolutely necessary but also think that it is well worth keeping an open mind about childbirth.

I was taken to theatre and told I would probably need one (forceps delivery). They just did it and didn't ask me at the time though as they had to get the baby out. Under those circumstances you wouldn't really refuse as there was no other option.

my tale's so similar to feedthegoat that I wobn't bore you with it - but despite hating the whole idea, and objecting even at the "crunch" time, when it was explained that a small one could be made and at a sideways angle, saving me a third/fourth degree tear during ventouse delivery, I have to say it was nowhere near as bad as I feared. As others have said, lots of small abrasions and tears after ds2 was way way more painful and for significantly longer, than a small episiotomy with one stitch, done immediately.

I had a small epi with my 1st and it was fine. She was becoming distressed though so was probably necessary. I have to say it was a clean cut and healed well. Beforehand I was terrified of being cut and begged to be allowed to tear. I had v small tears after my 2nd and was much more upset by the changes this had on my body.

Bad tears can be really bad though. I think your stairs analogy is more like I can drag you roughly down the stairs but this will prevent you falling.

I would relax about it, really

trust them, they ONLY do it if its needed

and episotomy pain is better than a major tear

I know how scary it it when you are PG, but they are NOT the end of the world

Just for balance I had a 2nd degree tear, well
two one a have never felt again, the other that was I believe the one that was 2nd degree I still feel sometimes now almost three years later.

I'm sure you can refuse one if you want to. I was asked permission beforehand.

However, I had one and I don't regret it one bit. I was having trouble pushing DD out and the episiotomy made it so much easier and she was out about 10 mins after, if that.

I can imagine that without being cut the next step would have been some kind of instrumental intervention which I did not want.

My sis in law gave birth at a similar time to me and ended up tearing (an episiotomy was never suggested to her). By all accounts, her healing was much worse than mine as she had tore in two directions. However, I have a small neat and hardly noticeable scar. I didn't find the healing too bad, was stiched well and all in all not a negative experience whatsoever.

I'm now pregnant with DC2 and intend to put in my birth plan that I would prefer an episiotomy again rather than being left to tear.

However, of course this is your personal choice.

I tore quite badly with DS2, including into the vaginal wall(DS1 was a CS). It took ages to stitch, and it seemed to take ages to heal. I felt like I had a bag of raw liver strapped to my fanjo for weeks.

With DD, I asked for an episiotomy - partly because of my bad experience, and partly becasue of DSis's worse one, with a tear into her anus, and 6 months of faecal incontinence. It was a quick, trouble-free experience, opening me up to one side, and she was able to stitch me quickly and neatly, and it healed quickly too.

I'm all for episiotomies, rather than uncontrolled tearing. I'm not sure why they're so out of favour.

My episiotomy was horrendous and seriously traumatizing. When told I had a 50% chance of needing another large episiotomy in 2nd pregnancy, I went for elCS.

However, now I look at friends who say they leak a bit when sneezing & an avoid trampolines, and think that maybe there was a point to the episiotomy.

Try not to worry too much, or make any hard and fast plans. Births are hugely unpredictable. In my experience no-one wants tocut you, or do it to speed things up. It's usually done because the bAby is distressed or physically you can't get the baby out.

Mine was unpleasant and traumatic as they needed to use forceps too. Two drs performed everything, no midwives at this stage. They said I needed both the episiotomy and the forceps. They said there was no way I'd have got the baby out without one. It was something that had to be done. Good luck.

Bear in mind that they might not say "would you like an episiotomy" The language might be more like "we're going to do an episiotomy, ok" So there won't be the 'option' of consent at that point.

PorkChopSter - that is technically assault (unles it is an emergency situation in which there is no time to seek consent and they are unaware of your wishes). IME it is far too common for HCPs to say to women in labout "I'm just going to xxx" and do it before the woman has time to say anything. The moral of the story is to brief your birth partner and also tell HCPs in advance if there's anything you feel really strongly about (don't rely on them reading the birthplan).

Assault? eh?

'Wishes' often go out of the window during birth...lets not mislead the op.. My first priority was my baby when i was in labour...if they had to do anything to help my baby, then so be it. That is often the case with episiotomy.....

LOL @ "assault"

So, what do we call it when a midwife internally examines a woman in labour - "rape"?

I think if you agree to an instrumental delivery, an episiotomy is considered part of it.

FGS of course it's not rape, don't be ridiculous. But I think it's important that people are aware that during childbirth HCPs have to obtain your consent before performing procedures on you (emergencies aside) in exactly the same way as they have to in non-birth situations. That is not misleading, it is a fact.

It's certainly true that, in an emergency, the doctors will do what they have to - if there isn't time to seek consent, then they will work on the assumption that you would want them to do the best thing for you and the baby. But that's not to say you can't insist on certain things (e.g. JWs can insist on no blood even if they have a PPH and a doctor can't go against that).

I am speaking from personal experience when I say that sometimes midwives 'forget' that they need to seek consent (specifically, during an internal, the midwife said "oh, I'm just going to break your waters" - she didn't ask me, just reached for the hook, and if I hadn't reacted really quickly it would have been done - luckily I was quick enough to stop her. I did go on to have my waters broken, but that was after a full discussion with the registrar and after having an epidural sited).