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!

Just to clarify the assault point, any medical treatment performed in the absence of consent is in law considreed to be assault (unless, of course, you are mentally incapable of consenting to treatment and the hospital has obtained a court order to enable it to treat you regardless).

Cote - can I just say that I think your comment abour rape was appalling. Have you ever been the victim of a sexual asault? Because I have, and I think that your comparison of rape with medical treatment is pretty fucking offensive.

To answer your question, in English law a vaginal exam carried out against the wishes of a woman would be classed as sexual assault.

Gee whiz I'm speechless!!

Why is that?

Getting back to the poster's point;
I wanted the whole natural shebang and being cut was THE thing I wanted to avoid. I ha. An epidural and was cut and I have a healthy baby and a cut that healed well. Birth plans can go out the window so fast, try not to fret about one day out of the rest of your life, enjoy the pregnancy and just take The Day as it comes.

Yes - have to say that my epis healed really well and has given me no problems whatsoever. I think it's one of those things where the thought is usually worse than the reality iyswim.

Midwives can't do anything to you without your consent, you can refuse anything you like. They have no more right to cut you or examine you without your permission than anyone off the street, it is assualt.

I had an episiotomy with a forceps delivery. Obviously didn't feel it at the time, and it healed very easily with minimal pain. They dosed me up with morphine on the post-natal ward anyway

the reason they are out of favour is difficulty in healing. 3rd and 4th degree tears are not sufficently common to warrant doing one without a good reason.

If you really want to avoid one and your pregnancy is low-risk, you can reduce your chance of birth injuries by having a home birth. Had you considered one?

When I had my first, I had an episiotomy and forceps delivery. The cut was nicely stitched up and it healed perfectly as though nothing had ever happened. I was back to normal very quickly with no problems.

When I had my second, I requested an episiotomy but due to short staffing, I didn't get one and instead tore. The tear was stitched up, healed well, but not perfectly as it was before.

I would choose the episiotomy. I think that it is easier to stitch a cut than a tear, but I might be wrong.

I had one because baby was in distress. I was also told if I didn't have it I would have had a third degree tear which would never heal.
I honestly had very little pain afterwards and didn't need painkillers at all.

I had read awful things about episiotomies and really didn't want one.

But after 2.5 hours of pushing, DD was getting distressed and wasn't coming out without one.

I got quite upset about it (went and hid in the toilet, had a little cry) but luckily had a doula who spoke to MW, realised it was needed and talked me round. I had to give my permission. Almost changed my mind when I heard MWs talking about the scissors being blunt

Had it, didn't feel a thing, and DD popped straight out. DD had her hands and arms wrapped around her head, which was why she was stuck. No way she was getting out of me without an episiotomy or a BIG tear.

I had internal tearing from the damage she'd done on the way down the birth canal (baby fingernails, etc) so had quite a lot of stitching, but the episiotomy was needed in my case. I also didn't want an epidural but ended up having one after the birth to enable the obstetrician to stitch me more comfortably (I managed on just gas/air/TENS for the birth itself but that wasn't enough for the stitches!). The epidural was also nowhere near as bad as feared.

Are things the same "down there" as before? No, but then they probably aren't for anyone who's had a vaginal delivery.

OP, educate yourself, know your preference, but please keep an open mind and be prepared to change your mind.

Zombie - Fgs get over yourself.

If, as you claim:
"Midwife gave me episiotomy without asking for my consent" = assault
... Then:
"Midwife gave me an internal exam / membrane sweep" = rape

It is perfectly logical and consistent. That you are shocked by the latter statement should show you the invalidity of the first one.

Of course I may be missing spirit of UK legal system here, so would be happy to hear about midwives prosecuted for assault, if you know of any.

It is also possible that you may change your mind during labour. I was very about episiotomy beforehand, but after dd's head had been stuck for an hour I pleaded for one. By the time the midwife got her hands down, I had already torn badly and very awkwardly.

I don't see why anyone should tell Zombie to 'FGS get over yourself'. What of the women who have been victims of sexual assault and rape? Can't you imagine that standard hospital procedures could be traumatic for them?

I don't know of any midwives prosecuted for assault but there was a quite well known case where the hospital went behind the woman's back and got a court order to give her a caesarean that she hadn't consented to. The woman sued them, and quite substantial damages were paid.
www.aims.org.uk/Journal/Vol10No2/trustGuilty.htm - the judges comments about consent are worth reading.

OK - not the same as an unwanted VE, or giving a baby formula without consent. But, the way I see it, it's part of the same mindset - that you don't need to ask the silly little woman - that the HCP/ hospital protocol makes the decision.

[awaits a flaming emoticon]

Cote - read section 1(1) of the Sexual Offences Act 2003:

"A person (A) commits an offence if?
(a)he intentionally penetrates the vagina, anus or mouth of another person (B) with his penis,
(b)B does not consent to the penetration, and
(c)A does not reasonably believe that B consents."

By its very definition, rape can only be committed by a man, by the insertion of his penis. Therefore your "perfectly logical and consistent" statement is (aside from being extremely offensive) quite simply untrue as a matter of English law.

I can only presume that you are fortunate enough to have not suffered a sexual assault or rape. I do not believe that anyone who has had such an experience would come out with such gems as "Lol at assault" and "FGS get over yourself".

Margles - thank you. I appreciate your support very much.

I do feel that I am the same "down there" after my vaginal delivery and episiotomy (except a very small and neat scar).

I've had 2 x home birth, with 2 x tears needing repair in Hospital, in one case under GA. Wouldn't change Home birth, but now 38 weeks with no 3 and expect to end up getting repaired in hospital. You don't know what will happen, but I think epis. is far less common in the UK now except with instrument deliveries

Zombie - What does penetration with a penis have to do with you saying a midwife performing an episiotomy without express consent is "assault"

I had one and I was made to have one really as the doctor laughed and said 'why are you so scared we do them all the time dont be so silly'

My husband begged for me to have more time pushing as it hadnt been two hours yet (they had a policy of two hours I could push for then they wanted him out). He wasnt in distress and his heart beat was fine. I found the healing afterwards and the subsequent pain worse than giving birth!

Cote - think it's time you shut up.

just to add my experiences that as a midwife I have only seen one episiotomy performed when it was not for an instrumental delivery.That was when I was a student. I have never performed one myself, so they are pretty rare in normal deliveries. There would be no option if forceps were used I'm afraid as the vagina is not large enough to accomodate them without the extra space an epis allows.

Cote - penetration with a penis is the definition of rape (so, just to join the dots for you, it is therefore not legally possible for an internal exam to be classed as rape, even if performed without consent - your analogy is flawed in addition to being offensive).

I'm afraid that if you refuse to accept the fact that, in English law, performing any medical procedure in the absence of consent is assault (unless in an emergency or where a court order is in place) then I can't really help you further. I am not "claiming" this to be true, nor is it an "assault" in quotation marks, it is assault, whether you like it or not.

I just think this is not helpful to the OP ...

The fact of the matter IS that sometimes during labour the unexpected happens and an episiotomy maybe necessary for medical reasons...not because anyone wants to assault you in the labour room...

Good luck OP

Zombie - Of course an internal examination is not rape. Just like a cut if doctor in charge deems it necessary is not assault.

My point was that saying it is assault is as ridiculous as saying the other is rape.

Sorry for the digression, OP. As someone who has suffered horrendously following an episiotomy, I would advise you to make it very clear to your doctor/midwife that you don't want one but when the time comes, trust them to do what is necessary. Good luck with it all.

Cote - I CBA with this anymore. You are wrong. If you don't believe me, read the first column of the July 2009 Clinical Negligence Briefing. It's a user-friendly summary of the legal position that has been produced by a leading chamber of barristers, followed by an interesting discussion re doctors' duties re discussing the risks of medical procedures with patients.

Anyway, I'm not going to waste any more of my time on this, I just wanted to make sure that the OP - and anyone reading this thread - is aware that doctors don't have the right to do whatever they like to you without first seeking your consent (although, obviously, if you end up in an emergency situation then your consent is implied).

Cote, I stand by my original comment to you, which is that your comparison of rape to a routine internal is offensive - it completely trivialises something that is a violent and traumatic experience. I am not sure why you appear to have such a problem with me, because loads of other posters (both on this thread and on others on this topic) have made the same point re assault yet you appear to have singled me out to have a go. I refuse to engage with this further.

OP - good luck with the birth. I hope all goes well for you. Please remember that if you do end up needing one, an epi is not normally awful - I have had one and it was fine - the stitches healed really well and I didn't even need to take any painkillers. I expect you've probably heard lots of horror stories, but it's worth bearing in mind that people by and large don't come on here to post about how well they recovered from their epi. If you want to hear some positive stories to get a more balanced view, you could start a thread asking for them and I'm sure lots of people would oblige.