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.

I would love to know what OP's experience is. I am amazed she is so unaware of how her opening statements come across and I am amazed that she is seemingly unaware of the history of obstetrics and current practices around the world.

I am having an unheard of and very rare break

bemybebe - I am amazed you are amazed. I'm not talking about history of 'obstetrics' or practices around the world. I am talking normal midwifery practice.

I think some posters are mixing up national and international maternity care practices with what the average uk mw does.
: uk mws do not (except very rare circs) do instrumental dels.
:These are the remit of obstetrician who the mw would call when needed. Most forceps and some ventouse will have epis
: uk mws do have more autonomy than in some countries to supervise and conduct dels & therefore avoid obstetric control and direction to cut
:in some units in the uk in the past (1970s), drs exerted a great deal of control over mws practice and required epis for all primips! I was lucky to train in one with a different philosophy.
:uk obs views and practice are changing eg at one time all instrumentals would have a whopping epis now a lot less (though some overseas drs can make my eyes water at times)
:talking to clients who have delivered in other countries, the practice is still similar to 1970s in some places

Hi Nappy

That is the number of normal vaginal deliveries I have done - I don't include instrumentals in that number.

talking of consent, and the wording that a lot of midwives seem to use ("we're going to have to give you a little cut")...

My MW was (IMO) perfect on this - imagine that I'm in a lot of pain, totally exhausted because the child won't budge! and I've been pushing for nearly 3 hours at this stage.
the baby was crowning, and had been doing so for a while. The position i preferred wasn't working, she wasn't budging, so they got me to try a number of positions to see what helped it move. The only position I went into that made the baby move at all was on my back, which was the one position I did not want to be in.
They explained to me that it was the only way it was moving, and that all the others we'd tried weren't working.
MW2 couldn't get a heartbeat reading, either - the baby was so far down in my pelvis, that even when I went on my back, she couldn't find the heart. Of course, everyone was panicking at this (but doing a good job of being very calm about it!)
It was explained to me that it was now getting critical, they couldn't tell if the baby was in distress because they couldn't find its heart, and they had to call an ambulance - that if the baby didn't come out on its own accord, I would be sent to hospital (8 miles away, bumpy roads, labour etc), and that because they don't carry things like forceps or ventouse, they couldn't do much else.
Of course, my major panic then was that there might not be enough time to get there, or that I would be in distress by this action.
MW1 said that the only thing she could try to keep me at home a bit longer would be an episiotomy - explaining again that the baby wasn't moving and time was ticking on.
There was no "we will have to do this procedure", it was just explanation that it was getting dangerous.
The control was always given to me, even though, obviously, I didn't have much choice about it - it was always explicitly clear from them that I had to make the decision.
and they didn't do anything at all until I told them it was okay to do so.
I don't know whether this situation would have been so calm, collected and my choice if we had been in the hospital. But I'm not willing to dwell on that.

"I'm not talking about history of 'obstetrics' or practices around the world. I am talking normal midwifery practice."

But *cervix" with all due respect (of the most sincere nature as I have read and agreed with your earlier posts) you are missing the fact that collective memory is passed from generation to generation. It is not so far ago that mother were plunged into "twilight sleep" whilst giving birth, shaved, given routine enemas and episiotomies. Also, we are not living in isolation from the outside world, we travel ourselves and have family and friends who live abroad. I seem to remember the stats (which maybe inaccurate, so sure someone will correct me) that only 2% of babies in the US are delivered by MW and 75% of consultant deliveries in the US have episiotomies.

Also, the tone of your OP is unreasonable and patronising:

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

So far so good, but then you write:

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

By bringing it to the height of absurdity, you turn this phrase into a statement implying that women (ie those outside medical profession, of course) have irrational hysterical fears based on nothing.

But rather than reassure you decide to just to act as a judge in high court:

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

that's all."

Bang with the Gavel.

May I ask how old are you?

Couldn't agree more bemybebe and it actually upsets me to hear midwives ask why on earth aren't women more educated and why don't they trust the judgment of healthcare staff more without question.

Do I actually need to point out the highly publicised cases recently where entire maternity departments have been found to have serious and major failings to the point that they have been / or may be closed down?

Do I have to point out the number of threads on here weekly from distressed women who feel their care has been substandard and they were not thoroughly talked through what was happening to them and end up with some sort of trama as a result?

Do I need to point out the other major failing in other health departments that have shaken the faith of people in this country to be treated with respect, dignity and fully informed consent?

Do I need to point out that maternity care not only accounts for the majority of NHS litigation payout outs but also that it accounts for the most number of successful claims - suggesting there are a lot of errors / misjudgements being made?

Do I need to point out the rising number of women who are hiring doulas and independant midwives and the number of women on MN who recommend others to do so, so they have someone to act as an advocate and to improve their experience because they feel that the NHS is lacking in some way?

And that doesn't even start on the various horror stories women tell each other.

And the OP is annoyed because women put something on their birthplan that isn't routine and is only performed in emergenices when there actually is statisically information does give cause for women to question just how accurate her statement is?

Too bloody right we don't live in iscolation. I find it an incredibly blinkered point of view that is only looking at her experience from her point of view and take absolutely no account or no common sense about why women might be particularly sensitive about having one of the most sensitive and intimate parts of their bodies cut when they don't necessarily have full understanding of why nor full trust in the people they entrust to their care!!!!

I am totally gobsmacked at her attitude and the fact she seems to think I'm picking a fight. I'm not. I just think she's somehow got her head massively buried in the sand and is somewhat out of touch with public perceptions and the fears and concerns of women. And thats hugely disappointing and slightly disturbing in my book.

This might be one small issue, with regard to maternity, but its part of a massive much wider overall issue that even recognising and accepting that there are clearly a lot of women who are not being given the care they deserve - even if she personally hasn't witnessed it - would go a long way to reassuring and helping the situation. Define emergency. Define under what circumstances it is used. Inform women. Don't just bitch that everyone's putting it on their birth plan on an internet forum cos you've had a bad day at work. They wouldn't be putting it on their birthplan if they weren't scared and frightened and to simply be so dismissive is to be dismissive of their emotional and psychological needs. Something like that on a birthplan should be treated as a red flag of sorts.

You want to know what needs addressing enormously in maternity care OP? Mental health and related issues in maternity need bumping up the priority list massively. Why do you think we have an 'epidemic' of women requesting ELCS following a traumatic birth? (Not my words by the way - one that has been used in several newspapers quoting maternity units). Or so many women otherwise seeking additional private support to have a VB either at home or in a hospital setting?

With regard to instrumental deliveries and various units. To the majority of women it matters not a jot. They don't know the differences between rates in units and loads of women just go to the nearest place regardless of whether they are high or low risk.

The fact that a low risk woman is more likely to have an instrumental delivery in some units than others, is a concern as it potentially highlights a policy and skill issue that ISN'T in her best interest.

Good post Smith. There is a direct correlation with number of midwives on a unit and intervention rates.
I'm so sad and angry about what is happening to maternity services in this country. So many women getting such poor care is having very serious, expensive ramifications to families, health and society.
We desperately need more mw's!

Crevix, I don't normally say this but .. 'I haven't read the whole thread' but i do want to answer your question from my point of view *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?*

In very basic terms it's fear, fear of the unknown.

About 20 years before I gave birth a colleague of mine told me very graphically exactly what an episiotomy was, - I have never been able to shift the image from my mind nor her description of what it felt and sounded like, - it makes me shudder every time I hear the word 20 years and two childbirths later.

When I was completing my birth plan with my midwife I brought up the subject of an episiotomy and she very kindly did her best to explain it better and reassure me whilst I fought the urge to go "la la la la" with my fingers in my ears

So I personally blame mothers who had their children years ago and like to frighten half to death those expectant mothers.

I was also very reassured to hear that they don't routinely give you an enema prior to childbirth anymore, - thanks for that one Mum

The implication that midwifery practice and obstetrics are separable is laughable. Women experience transitions between the two, often beyond their control. OP do you want women to prepare separate birth plans for an normal midwife led birth and one for in case the obstetricians take over? I would have loved a MW led normal birth. But I got the heavily medicalised type instead. Do you work in a MWLU or do you work ins hospital unit? I promise you that the MW in the consultant led unit I delivered in will have seen a lot more episiotomies than you have.

W0rmy you should be also grateful to the generation of women like your Mum for getting rid of some of those practices that were routine once. For example, if you gave birth in the 70s your partners would not be present, you would be admitted, shaved, given an enema (no discussion) and put on your back in the bed in the room with other 6-10 labouring women. When the time was right as assessed through regular vaginals, you would be wheeled into the the birthing suite, legs in stirrups and given instructions when to push and when not to with convoluted threats to use instruments if they feel you loose the grip/timing is off. The attitudes within the medical profession towards women in labour changed partly or mostly due to the pressure from them.

I was a medical student in the 80s when I worked on maternity ward and witnessed close to 180 births over several months. These particular unit was very well known for its hands off approach so I was absolutely horrified to discover that the hospital next door that I attended the next year absolute majority of women were cut as soon as heads started crowning (and well before it was clear that woman was v likely to tear)... it was that normalized.

Because with my eldest, I was threatened with one -- the exact words being "If you don't push hard enough for me, I WILL cut you".

And my mother had one routine with all of us. Gave me graphic discussion about it and the handy hint to pee with my hands on the floor to avoid peeing on stitches. Thankfully, I've never needed it.

Though, I didn't actually put it on my birth plan for DC4. His was basically "Some of your colleagues have been absolute harpies to me. I am absolutely freaked out to be here. So could you just please be nice to me and give me my baby asap (I know this is usually standard - but after the homebirth midwife held DD2 across the room for me while the other dealt with the placenta by yanking on it while I screamed for a good 5-10 minutes before letting me try to nurse (and only let me due that for a few minutes before yanking her back out of my arms). Didn't even tell me she was a girl for a while and was telling off my DH since he couldn't remember where we put the hats while watching his wife screaming and bleeding. I still get really upset about it 2+ years later). I think I may be one of very few people to have a hospital birth because of a horrible homebirth experience!

So yeah, some of us put stuff there because shit has happened to us even if we know it falls into standard care.

Totally with you smith
And as someone embarking on pg2 after a traumatic birth that resulted in mental health issues, and am now considering ECLS, I think talking with MWs and HCP who really try to understand/explain/communicate is key. I find the OP post really patronising and unhelpful.