I just want to point out that episiotomies are NOT routine birth practice.

[HaveYouTakenLeaveOfYourCervix]

on pretty much every birthplan i see it is written

I do not want an episiotomy unless absolutely necessary.

Why do women think that they would be given an episiotomy if it wasn't absolutely necessary and an emergency situation?

Do women think midwives are scissor weilding harpies who routinely cut perineums because they want to?

Episiotomy is NOT a routine procedure. You will NOT be given one unless you really really need one.

that's all.

OP, how many births did you attend and how many deliveries have you supervised personally?

But what if forceps were the only option?! Your baby could have descended far enough down the birth canal to make emcs unsafe, but ventouse failed...that leaves you wth forceps surely?

ghoul exactly and much more succinct

My antenatal classes and books I read (and those mags that exist in antenatal clinics) suggested you may well get asked if you prefer an epi to reduce risk of more severe tearing, or if you would prefer a natural tear which may well heal better even if bigger - but no guarantee.

In that context, saying in general you want option 2 rather than 1 makes perfect sense.

I think I did have the offending sentence in my plan, but was also advised to put 'happy to have students observe/do exams under supervision, but if I do need cutting or stitches I want an expert!'

Result - ds, ventouse in theatre as distressed, epis, stitches admired by MWs etc the next day, totally recovered in under 2 weeks.
dd - ventouse in theatre as easiest option, 2nd degree tear + tiny epis, docs made effort to do even better stitching, didn't even know I had a tear until told 2 days later!
Conclusion: epidurals ROCK!

You might not have done many, but as soon as doctors get involved does it turn out like that?

The consultant wanted to give me an episiotomy with DS1. His birth had not gone according to plan at all and I just had a bit of a hissy fit with her and said no outright. The midwife delivered a tiny 6lbs6 DS1 with not even a tear. I could have hugged her! :)

I was given an episiotomy even though I categorically asked to be left to tear by the way (both in birth plan and by stating it at the time). It was just as my DD's head was about to come out so I don't this there was any real urgency for it. I did get the impression that they thought the epi was the best thing and were rather scissor happy.

I'm surprised it is not routine, I have just had a count up of how many friends I know that have had them - loads!

There is some study somewhere showing that if you tell the midwife you don't want an episiotomy you're less likely to end up having one! Must rack brain to think where I read that.

In answer to your question - I think you'll find episiotomy rates vary from midwife to midwife in quite startling ways. Some midwives are much more likely to do them than others. And some hospitals have higher episiotomy rates than others serving similar populations. The national average is that 23.8% of women will have an episiotomy. However, there are MANY hospitals with a rate of over 30%, a few with rates of over 40%, an some with rates well under 20%.

So I think it's worth pointing out to the midwife that you don't want one, as practice is clearly not consistent across all care settings.

valium "routine" in the 80s meant that the scissors were deployed as soon as you spread your legs. doesn't mean that now majority of women do not get them - it is usually covered under a necessary procedure.

have to clarify ..."doesn't mean that now majority of women do not get them - it is usually covered under a "necessary procedure" in some hospitals".

Hey Ghoul, sorry not trying to derail thread and really hope you don't mind my asking you this, but ...

Did you actually say, 'No, I don't want one' and they just shrugged n snipped? Are they legally allowed to just override your wishes like that??

Oo my episiotomy was great. Even I have to search a bit for the scar the doc was so neat. Can't believe people would rather tear!

I had one because of forceps.

I would have had an episiotomy for no reason if I had let the registrar cut when just before my ventouse delivery with DD1. I have a bit of phobia of episiotomies (my mum had a front to back epi [up to urethra and done to anus] with my DB and had it stitched very badly so still has problems even though DB is in his 30s) so had all over my birth plan 'No Episiotomy' and DH was on scissor watch.

I had the ventouse delivery and didn't even tear - just skid marks too small for a single stitch - if I had consented to the epi I would have had lots of stitches and a shredded pelvic floor for nothing.

The seemingly widespread contempt of women in labour by HCP's pisses me off big time.

It's attitudes like this which left me with PTSD after DD's birth.

RP - It was more like I said "please don't cut me I'd rather tear" they looked at each other and one said. "OK give me one more push and if she doesn't come out we'll need to cut you" I pushed and baby didn't appear. So they gave me a local anaesthetic and cut me and baby's head popped out so she was very much about to be born. I'm still not sure why they were so keen to cut me. Perhaps they thought the tear would be bad or perhaps there was literally no room for the baby to come out. As it happened it was quite a small cut and healed well so I haven't worried too much about it since.

I think legally they were probably on dodgy ground as I hadn't consented (the opposite) and they hadn't even explained properly why it was needed.

Maybe it depends on the hospital. Literally everyone I know had to have one round here. Maybe they have a scissor fetish round here, or we're just unlucky sods. I tore all the way through anyway, so fat lot of good it did!

Well out of my NCT group of 8 there were 5 epis, 1 planned CS (breech), 1 EMCS and 1 unassisted birth (mine, midwife wasn't in the room because apparently I wasn't really pushing).

So I guess it depends on the competency of the hospital. Scarily mine has a really good reputation, but its because they have high intervention levels to keep labour "safe" and use epis rather than CS where they can to keep the CS route low. They always try an epi and forceps before going for EMCS. Needless to say the physio waiting list for help with incontinence is enormous.

Sounds like the same hospital as me happy camel!

I didn't want one.
I had to have one - HB and no forceps or owt available.

I assume mine was an emergency....
(bloody child with hand clamped to head, getting in the way of her coming out! Did she not realise it was difficult enough as it was without her getting in the way?!)

Are episiotomies always done with scissors, DH swears they used a scalpel for mine but he may have been hallucinating from lack of food as I wouldn't let him leave the room to go and get food and I was in the delivery suite for 17 hours before delivering. I wasn't fussed about having or not having one, on balance I think I would rather have a neat cut if the alternative is an uncontrolled tear or baby getting stuck in the birth canal and becoming distressed.

My understanding is that they are given to speed things up.
I realise that obviously you still have to push but if the gap is larger from which to descend, it will shave time off no?

I was given an episiotomy during my first birth, I hadn't even been pushing that long but they insisted.

I specified no epistiomies for births 2 and 3 for this very reason.

p.s. I healed much better with far fewer problems when I tore rather than when I was cut