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.

Hey OP, I was the one who said about not taking it out on your patients and I'm sorry about that, it was uncalled-for. I know from your usual posts that you are a really caring MW. But I do think it doesn't seem accurate from a layman's POV to say it's not routine when upthread someone is quoting rates from 20-40% from individual hospitals. tbh having a roughly 1/3 chance of having a procedure does make it pretty routine in my book. If those stats are right that is.....

figures i've found are 8.3% with spontaneous birth (ie not instrumental) that's 2009-10 NHS maternity stats. i assume it varies widly between units.

And I never said writing a birthplan was a bad thing. I love a birthplan.

HaveYouTakenLeaveOfYourCervix I think women can write whatever they like in their birth plan. No need for you to be patronising about a perfectly legitimate preference. Maybe lose the "I know best" attitude.

The female version of vasectomy is tube tying surely, done by keyhole surgery?

. Ffs I do know that it doesn't stop you from having babies, I meant reaction wise it's tge female version. Kinda makes you cross your legs when it's mentioned.

Rhinestone. Read what I actually wrote. Twice. No where was I patronising.

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

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

that's all.*

Sounds pretty bloody patronising to me - questioning our rationale, assuming that we don't know things that you do, and a "that's all" as if your point of view is the final say in the matter.

And now you're instructing me to read what you wrote "twice" as if I'm so stupid I couldn't possibly work it out if I only read it once.

You have ably demonstrated why it is so important to state your wishes in writing because there is a certain type of healthcare professional who quite frankly needs to be reminded that they do not have carte blanche to override the wishes of the patient.

I can't back this up with a link as the original data no longer appears to be online, but it MUST be out there if someone can find it.

Dr Foster used to have a maternity comparison section. Sadly it is no longer there. Some hospitals provide rates of episiotomy. Some didn't. Of those that did there was an enormous and quite frightening range. My local hospital had a rate of over 20%. However it was no means the worse. One of the ones in Nottingham - I forget which - had a rate of nearly 40% if I remember correctly as it made my jaw drop. The data was for around 2008 ish... Some hospitals had single figure rates. 40% most definitely is routine...

Indeed it was also something that was picked up in the recent study about location of birth. You were far more likely to have a an episiotomy if you were having a home birth compared to a hospital. Bare in mind the study tried to study low risk women.

Which makes me seriously question the idea of whats routine and whats not routine. And what's an emergency and what's not an emergency. If there is such a big difference then I'm inclined to believe that certain hospitals most certainly use them more routinely and the idea that they are only for emergencies becomes a contenious one in the same way that rates for c-sections vary so much.

The only data I can currently find which is broken down by location is only to strategic health authority. The rate in England in 2010/2011 was 15.1%. The best performing area was the south west with 14%. The worst were South Central and London both with 16.1%. The figures for 2008/2009 the difference was more marked. The overall rate was 14.4% 11.9% for South West and 15.7%. Just a couple of years difference...

As for historical use of episitomies and why women might think they are routine. The overall figure for 1975 was 51%. In 1980 it was 52%. It steadily decreased to stablise in the late 90s around the 15% mark.

I do find it very frustrating though that finding information for individual hospitals now seems impossible. I know it was available a couple of years ago (on Dr Foster) but now I can't find it anywhere. I feel it should be as freely and easily available as other information such as cs rates. If anyone does know where I can this information I would be interested to know where.

So in answer to the OP. Yes I think you are being extremely unreasonable, and your attitude does very little to alleviate the fears of women. Instead its rather belittling. If someone puts something like that on their birth plan it should be being discussed and treated sympathetically early on before it gets to the crucial point in labour where it might be needed. I find it utterly appalling that any fears are just so easily dismissed. No wonder women feel like they are not being listened to or just ignored to suit doctors and midwives.

OP I think that I could be given an episiotomy when it isn't absolutely necessary because that's what my midwife tried to do. She started spouting off about a epis and a ventouse before I had even started pushing and without even examining me. It was only because I actually watched her every move that she didn't get away with doing one without my consent and in the end it was not needed, at all.

I appreciate that you might be very careful about keeping your patients fully informed and ensuring that you have their consent but many midwives take the "I'm in charge and you'll shut up" approach.

I didn't consent to mine - they didnt even tell me they had done it.

First I knew was when they spent over half an hour stitching me back up

Given a distressed DS who had the cord round his neck was being dragged out with forceps it wasnt top of my list to mind about

DS was fine (all that matters) and my fanjo has made a full recovery (does matter a bit as am shallow)

'You were far more likely to have a an episiotomy if you were having a home birth compared to a hospital'. Thats the wrong way round!

<a class="break-all" href="http://www.birthchoiceuk.com/BirthChoiceUKFrame.htm?www.birthchoiceuk.com/England.htm" rel="nofollow" target="_blank">birthchoice Gives statistics for maternity units.

Episiotomys hurt and make it impossible to sit comfortably for a couple of weeks, I can't say as I blame women for saying "don't come near me!" in their birth plan.

I had in mine "please give me a c-section if there is even a threat of forceps" because I had been told of my mums own forceps deliveries back in the day when you didn't get a spinal block.... i still hold firm to this (One born every minute and having previously had an episiotomy have instilled 100% that no fucker is coming at me with forceps)

BadDayAtTheOrifice apologies that was a typo. You are correct.

I do have to say my Episiotomy didnt hurt, did heal quickly and was not too uncomfortable afterwards.

after about 2 weeks it was not sore at all and after 4 i was able to resume sexual relations (albeit gingerly)

sorry if thats tmi but i would not want women to be terrified of a procedure, which whilst you wouldnt have it done for fun, is not that bad and in my case helped make sure DS was born alive and well.

Not everyone gets a spinal block before forceps, I didn't but didn't really want one, I am uncomfortable with the idea of any spinal needles.

smithville - the stats are on the birthchoiceuk site. You have to go to 'index of national statistics' and then down to the bottom of the page. It's on the Healthcare Commission's Maternity Services Review (2007).

I had a failed ventouse with one of mine, legs were thrown into stirrups and medics hands were dragging DC out of me. Luckily no forceps though.

But my stitches burst. I got an infection. I ended up with a hole where the stitches had burst that needed repairing and I am still not right down there years later, however there is no point it being repaired until after I've finished my family and as such I will ask for an episiotomy with my next one so that the repair can be done there and then.

That is the exception not the norm though from what I understand.

<a class="break-all" href="http://birthchoiceuk.com/BirthChoiceUKFrame.htm?birthchoiceuk.com/HCSurvey.html" rel="nofollow" target="_blank">here

Includes info on pain relief and many, many other things, including birth position. By hospital!

YANBU to be irritated by anything if you're on nights. >
Nights to bad things to anyone's tolerance level, you're quite right to come and have an innocuous rant on here as a coping mechanism.
Anyone calling you "inflammatory" or "patronising" is being ridiculous, and has obviously never done nights!
Hope you have a good shift

once i get there i actually really like nights. all quiet and dark and cave-like. I hate the thought though, and when i truly think i am going to die at 4am, and the effects on my bowels and skin.

I agree with Sauvignon - nights are the work of the devil! Yes I hate the 3 - 4 am dip too.

FWIW I had an episiotomy with just gas and air and no spinal It was fine actually, after the pain of labour I honestly didn't really feel it I was so off my nut on hormones and nitric oxide! Felt it was worth it for safe delivery of DD whose heart rate was dropping.

Don't think you are being patronising at all Cervix!

I used to do just nights when the DCs where tiny (the joys of expressing midway through).
I did internal rotation for years but I think I went for promotion as a subconscious escape!

Thanks Shagmundfreud. Thats a help, though it only breaks the information to Trusts rather than individual hospitals (unless its hidden somewhere else on the site which is a total nightmare to navigate).

Incidentally the Trust that covers my local hospital, omits it. Its not the first time, I've noticed that data seems to be missing for it. Plus the data is now starting to date a little. (A lot of the neighbouring hospitals Its almost as if they don't want to publish recent information about episiotomies. Its something that does little to help women or to raise important questions about why and when they are being performed.

Even the OP attitude seems to back that feeling. If so many women are writing that on their birth plans, its clearly a concern thats not properly being addressed.

I sincerely hope the OP does some serious thinking about her approach as a result of this thread though.

I put it on my birth plan as I wanted them to stop and consider if I really needed an epis should ventouse or forceps be needed. Worked out well because I did need a ventouse in the end and they didn't cut me and by some bloody miracle I didn't tear and got away with a small graze so I was quite glad I put that on as a bit of an after thought. Also at the time (8yrs ago!) all the baby mags were still suggesting putting stuff like this on the birth plan.

Smithville - you have missed my point entirely.

I asked the question - 'Why is it on so many birthplans?' because In my experience it is not routine practice. It is not what I was taught, It is not in any policy, protocol or guideline I have ever come across. I therefore asked why women think it is routine practice. I am genuinely interested. If it is percieved as routine then why? where is this happening, because it shouldn't be. Many people have answered me. I am confused how you interpret this as patronising, and then suggest I do some serious thinking about my approach (if this is not patronising I don't know what is).

OP I guess people (evidently wrongly) took you as being patronising because in their experience it is routine and not done only in emergencies, so being told it was felt like 'You silly hysterical women, it's for your own good!'

Appreciate you didn't mean it like that. I s'pose also lots of women do get spoken to that way by HCPs in real life and get a bit defensive - I have seen 4 male consultants in my life and 3 of them spoke to me like I was a complete moron because I was a woman. I think you come to expect it and get a bit uppity-in-advance about it.

Also, have you ever thought about the role of past experiences of sexual violence in this? Cos IMO quite a fair proportion of young women will have experienced sexual violence at some point in their lives. I have not had an epi but the idea of one being done without consent brings back horrid memories of a man holding me down trying to do something to me which hurt when I was asking him not to.

I just wonder if there might be similar sexually derived fears in other women?