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New Episiotomy Study

Posts: 2608
6/25/05 5:59 P

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I think when the doc cuts you he/she is opening up an avenue for you to tear when you might not have torn naturally. That's my personal opinion though, I'm not doctor.


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6/25/05 2:30 P

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I had an episiotomy and the baby still ripped me. Doctors won't do it unless they have to but I am sure glad that he did it. Just don't sneeze, cough, or laugh the first week. LOL

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6/25/05 10:58 A

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Ooooh - great thread. I will DEFINITELY add this topic to my list of questions to ask my OB.

Thanks, Ladies!

Allen, TX
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6/25/05 10:49 A

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My sister ended up getting an epis with both her kids. She actually had extremely quick labour. (both kids out under 4 hours) which was quite scary. she had an epis with both and did not even feel them cutting her. the docs did this both times as the felt the baby needed out asap and did not have time for a c-section. It took them more time/pain to sew her up with her first than the labout did.

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6/25/05 10:39 A

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Very interesting thread to read! Iam scared sh*tless to have an epi. With my 1st I had one not knowing any different. It must have been what is described as a 4th degree or whatever. Horrible experance! I was cut & I tore! I could give the details but it probally make someone vomit including me. Sorry but unless it is a medical emergency absolutely no epi! No one should have to endure this unless 150% necessary!


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6/25/05 9:28 A

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I really lucked out with my OB. My biggest requirement for my doc is to be female. I've had too many bad experiences with "older, male" doctors to be comfortable with them. She is the only female OB in town that is covered under my insurance. She's really nice. I think that if I met her under "other" circumstances we would be friends. We have a lot of the same life experiences and she keeps very up to date on birthing methods. She tries to balance the 'No, you can't do that' with what happens in the real world. I completely trust her instincts. Oh, andher clinic and the hospital are a 5 minute drive in rush hour traffic.

Edited by: MAPGEEKSKI at: 6/25/2005 (09:28)

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6/25/05 4:28 A

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I asked my OB/GYN about this issue---he said the current practice is not to perform them unless absolutely necessary. He says he rarely performs them, but would if he had to.

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6/25/05 2:38 A

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I don't think anyone is raving about an episiostomy...who would be? However, I was warned by my doc that the perineum isn't the only place you can tear. You can also tear by your urethra, which is a much nastier tear that's much harder to repair. I'm not exactly thrilled about getting cut either but I'm not opposed to it if I had to choose between cutting and tearing my urethra.

Our little Hong Kong Fooey kicker, is due Sept 4, 2005.

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6/25/05 12:31 A

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Tearing is a natural thing. Cutting is not. And there are many many things you can do to help stretch the area during labor to lower the risk of tearing.

I've heard some horror stories about episios. So no thanks for me.


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6/24/05 11:57 P

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My doctor doesn't routinely do episiotomies either. It was one of my requirements for choosing an OB. I figured anyone who does them routinely isn't very up to date on things.

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6/24/05 11:37 P

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My doc was describing a 4th degree tear that she witnessed. She couldn't get the woman to listen to what she was saying. The woman wanted to try an "on all fours" delivery, but things weren't progressing the way they should have been progressing to make it possible, but the woman stayed that way anyway. She said it was the worst pregnancy she ever delivered. She was practically crying by the time she got to the end of the story.

I had asked bout alternative positions and whether or not she supported them. She said yes and no. She'll try alternative positions up until the "actual delivery" to help things progress and get things started (she actually recommended to me the birthing ball), but when the time comes, she wants me in the "traditional position" with the back of the bed adjusted for the best position.

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6/24/05 11:20 P

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In my prenatals they told us that most tears are 1st or 2nd degree- which doesn't even need stitching. So yeah, I'm defenatly going to say no to the episiotomy.

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6/24/05 10:59 P

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The thought of tearing used to scare me. Now the episiotimy does.

I made the mistake of asking my dr what the different degrees were... I think that's something that I would rather be ignorant of...

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6/24/05 10:54 P

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I'm SOOOOOO glad my episiotomy is a distant memory!!!!

*crosses legs....bead of sweat drips from brow*

Just the thought.....ugh!!

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6/24/05 10:47 P

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I spoke with my doc about it today. She tries not to them unless it's absolutely necessary. ie, if hse has to use forceps or a vacuum or if it looks like there are going to be multiple tears in multiple directions. She would rather control the direction of the tear.

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6/24/05 10:36 P

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If I knew then what I know now I would have insisted on ABOSOLUTLY NO epi - sex still hurts. And the site still bleeds from time to time and I'm two and a half months in. Make sure if you have a OB group and you're not sure who may deliver you that you have a written birth plan in your file! Very Important!

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6/24/05 6:21 P

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Thanks for posting that. I requested that my doctor not do an episiotomity during my first labor and use perineal massage. If I were to tear, I wanted it to happen naturally. Thankfully the massage helped and I only had one tiny tear that didn't near repairing.

This time around I will also request no episio. Massage all the way baby!


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6/24/05 5:20 P

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I'm only a little over 5 weeks along and I've heard of episiotomies before, but I've never heard the negative side about them. I'll definitely know to ask my doctor next week when I see him. Thanks.

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6/24/05 5:05 P

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5/10/05 10:00 A

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5/6/05 11:12 A

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Very interesting stuff! Thanks for the update.

I must have been one of the lucky ones. My son was born early (he's 12 now), at around 33.5 weeks. I remember when it was time for me to push him out, the dr. went to give me a local for the epi. She felt that, given his size and how early I was, she didn't want any undue pressure on him coming out. I said "No problem". He was out in 3 pushes (he was only 4-12!). I didn't tear any more than the cut.

I healed very nicely. Kiegels and sitz baths helped. I did experience some uncomfortableness (is that a word?!) with sex for a few months... like the study says, but nothing more than that.

So, I completely understand the point of the study, and I empathize with the ladies who have had horrible experiences... that's just awful! But it's not always that way, either. But, then again, why take the chance, right? I liked the analogy with the fabric... that was good!


(PS, this time I have to go c/s due to a marginal previa, so it's not an issue... but I'll have a much bigger scar!!)

Laughing at something or another! March 2007

Dylan Scott Farrer
DOB: 5/14/05 (6 weeks early); 5#/9 oz, 17"

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5/6/05 5:22 A

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This is from From the Today Show on Thurs. 5/5

Is episiotomy really
a necessary surgery?
Doctors are now questioning the need for this common procedure performed during childbirth. Gynecologist Iffath Hoskins explains
Today show
Updated: 11:14 a.m. ET May 5, 2005One of the most commonly performed surgeries in the country, the episiotomy, could actually cause more harm than benefits, according to a recent federally funded study. Undergone by more than a million women a year during labor to prevent tearing, the results have caused doctors to question the need for the procedure. Dr. Iffath Hoskins, the executive director of the Women's Health Institute at Memorial Health University Medical Center in Savannah, GA, was invited on “Today” to explain what this study means for women and to answer some commonly asked questions about the procedure.

What is an episiotomy?
It is a simple cut in the perineum, the area of the body between the opening of the vagina and the rectum. It is usually performed to create more room in that area to assist in the delivery of the baby's head, and to avoid that area from tearing during the birth process.

How large is an episiotomy incision?
Usually the cut is planned to be as small as possible, approximately 1-1/2 inches long, but sometimes it can extend a bit. It usually does not cause pain to the mother because the doctor anesthetizes that part of the body.

In the past, why were episiotomies performed? What did doctors hope they would prevent?
The general opinion was that the more controlled episiotomy would be as short as possible, not jagged like a tear, and easier to repair and heal than a tear.

What are some of the more adverse side effects of an episiotomy?
There are several side effects. Although most of these are rare, they are still known to occur.

The cut extends and gets longer, sometimes going as far as the rectum area
Infection is possible, and in very rare cases it may result in an abscess
Bleeding, which may result in a hematoma, a collection of blood in the tissue, although this is very rare
Future pain in that area. For example, while sitting, horseback riding or during intercourse
Fistula formation — a small opening between the outside area, i.e. the surface, and the inside of the vaginal area.
A federally sponsored study showed that many episiotomies were unecessary. Can you further explain these results?
In short, they found what we have known for a long time — it seems to be better to "take a chance" and get a tear than to cut an episiotomy in advance of the baby's birth. You're trading a 100 percent chance of getting a cut, i.e. the episiotomy, versus a chance of getting a tear. The tear, if it does occur, may not be as long as the episiotomy cut, so why cut more than needed?

Although this all has been found before, this particular study is a good thing because the numbers are large and they reiterate what we have known and have tried to practice for many years.

What other options do women have instead of an episiotomy?
The most important tip for women is to discuss all options with your doctor ahead of time. You can accept that there might be a tear and that it will be stitched up correctly. We now know the tear is usually only what's needed by the baby's head. The doctor or delivery person can also support the perineum and use massage, too, which may help avoid a tear.

When should an episiotomy be performed?

If the delivery has to occur faster than it would naturally; for example, if the baby's heartbeat drops
If additional room is needed for the baby's head
If the patient says she doesn't want a tear
If there are medical conditions, such as warts that would bleed
If a tear occurs, then the episiotomy can be more controlled in length and also in direction. It doesn't always have to be a straight line going down toward the rectum. There are other options
If a baby is being delivered by forceps or vacuum, the doctor may intentionally do one (though not always).
What advice do you have for women who are preparing for childbirth and may be faced with having an episiotomy?
I tell them first and foremost to discuss their wishes with the doctor, and to understand the doctor's policy on episiotomies. Try to do this long before labor, which is the worst time to discuss important information like this. Accept that if you do need an episiotomy or get a tear that it is not a failure in your ability to have a successful birth, because the ultimate goal is a healthy baby and mother. If this is what is needed to get to that end, then it’s a good thing.

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5/6/05 2:50 A

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When I had my son I tore. My doctor said she would have done and epi seeing how she could see that there was no way I was going to be able to stretch except that I have a very small periniem ?? Anyway she said I would have tore even if I had an epi so why make it worse. I am grateful for her. I tore and only just missed my rectum. If I had an epi I would have been torn right around. I am moving interstate and am going to request that I don't have an epi and that they just let me tear. It worked well the first time.

Daniel Isaac born 7th November 2005
Mark Christopher born 23rd March 2003

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5/5/05 10:04 A

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My husband is currently a 3rd year medical student, who has already done his OB/GYN rotation. He said they are no longer doing/teaching episiotomy there. He said the doctors believe it is better to let the woman tear and just repair that, than to have to repair the cut and the tear. Also, I asked my OB/GYN if he will do an episiotomy, and he said NO. He feels the labor/delivery nurses at the hospital do a good job of stretching, so there is less tearing. All very encouraging news as far as I am concerned!

Eden Isabel Johnson, born May 25, 2005 !!!! Baby #1, and first grandchild on each side! Our little angel.
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5/4/05 9:24 P

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I agree that I hope it raises awareness to all doctors. With my son's delivery, my doctor and I had talked ahead of time about her philosophy. She does an episiotomy only when she deems it "medically necessary," which sounded good to me. Well, my son got stuck and she had to use the vacuum extractor to get him out. I had a small episiotomy that turned into a 4th degree tear into my rectum. It took her well over 90 minutes to repair the tear. It took me over a year to heal to the point that daily life (sitting, bending, having a bowl movement) was no longer painful. It has affected my sex life, left me with incontinence issues for about 6 months after delivery, and has been, by far, the most difficult thing I've ever had to recover from physically and emotionally.

Luckily, my new doctor has a very different approach about the use of an episiotomy (like, never). She believes, after reading my file, that it was not necessary with my first delivery, and is doing all she can to help me deliver this baby without re-injuring the tear. I'm sure in many cases it never gets this bad, but I hope more doctors will re-think the use, so something like this doesn't happen to other women.

Thanks for sharing this article, which I'm sure should spark some discussion.

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5/4/05 5:23 P

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Yeah, it's not really a new study, more of a meta-analysis of exisiting studies. But at least it might get the attention of those docs who perform them out of habit!

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5/4/05 5:08 P

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This one may be a new study, but if anyone starts digging, there's plenty of research, that is not so new, that shows the same thing.

The comparison that makes sense, and it's been used for a while now.

Shoulder distocia can be fixed without doing one. There's very few instances in which an episiotomy is actually warranted.

Kinda like C/S, they are practiced way more than they should, just out of convenience, or routine.

*remembering the triplets*

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5/4/05 5:01 P

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This was reported in today's Washington Post. The research is due to be published in the Journal of the American Medical Assn. The short version is that the researchers looked at every study done on episiotomies and found that in most cases they do more harm than good. What does everyone think?

The long version follows below:

Washington -- One of the most common surgical procedures performed in the United States -- an incision many pregnant women receive to make childbirth less damaging -- has no benefits and actually causes more complications, according to the most comprehensive analysis to evaluate the practice.

Contradicting the long-accepted rationale for the operation, called an episiotomy, the analysis found that it increases the risk of tissue tears during delivery, leading to more pain, more stitches and a longer recovery after childbirth. In addition, it increases the risk of sexual difficulties later and does not reduce the risk of incontinence, the federally sponsored study found.

As a result, the researchers concluded, routine use of the procedure undergone by more than 1 million U.S. women each year should be discontinued, and the incision should be considered only to speed delivery when the health of the baby is at risk.

"The evidence is clear: Routine use of episiotomy is not supported by research and should stop," said Katherine Hartmann, director of the Center for Women's Health Research at the University of North Carolina in Chapel Hill, who led the analysis published in today's issue of the Journal of the American Medical Association.

An episiotomy is an incision that doctors make before childbirth in the perineum -- the skin between the opening of the vagina and anus. The idea is that the incision will make delivery easier and that a deliberate surgical incision will heal more quickly and with fewer complications than tears that occur spontaneously, minimizing the risk of sexual problems and other complications, such as incontinence.

The number of episiotomies began to decrease in the United States in 1980s when studies started raising questions about its value. But the procedure is still estimated to be performed in about one-third of the roughly 4.2 million vaginal births that occur each year, making it more common than hysterectomies and cesarean-section deliveries. The rate varies widely around the country, but overall about 70 to 80 percent of first-time mothers undergo episiotomies.

For the study, Hartmann and colleagues scoured the medical literature for all studies on the subject between 1950 and 2004, finding 986. The researchers then identified 45 studies that provided the best data, including 26 that provided the most useful information on benefits and risks, and they pooled that information for the new analysis.

Based on that data, the researchers found that women who had not undergone the procedures were no more likely to experience spontaneous tears during childbirth than those who had. In fact, those who underwent the procedure appeared somewhat more prone to tears, the researchers found.

"If you have a piece of fabric, it doesn't tear well until you get it started," Hartmann said. "The episiotomy can have that effect of actually being the starting place for a tear."

As a result, women who have had episiotomies tend to need more stitches and experience more pain after childbirth, the researchers found.

Moreover, women who had episiotomies were no less likely to experience urinary or fecal incontinence in the three months to five years after delivery, the study found. In fact, women with episiotomies were twice as likely to suffer fecal incontinence in first three months.

Those with episiotomies were also 53 percent more likely to suffer pain during intercourse three months after delivery.

"There's a lot of unnecessary suffering occurring to women because of the use of episiotomies," said Carol Sakala of the Maternity Center Association, a private, nonprofit group based in New York. "It's really tragic."

Since 1983, the American College of Obstetricians and Gynecologists has said episiotomies should not be done routinely. Dr. Laura Riley, of ACOG's obstetrical practice committee, said most doctors already know they should be done only when the baby is in distress.

"I think the message has been out there a while," she said.

Of the new analysis, Hartmann said: "Just in time for Mother's Day. ... This is a big gift for future mothers."

Baby boy on the way, estimated at 11/7/05
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