Episiotomy ???

[Anonymous]

Do you get a choice or do most doctors at Sibley tell you to have one? I'm attempting a VBAC at Sibley. I'll ask my doctor at next week's visit but I was just curious what people have experienced. I'm assuming you can refuse one if you want.

[Anonymous]

i delivered at sibley with dr. picco (on call) who was not my regular OB. i had a birth plan that i shared with the hospital that said i would rather tear naturally than have an episiotomy. i'm not sure if dr. picco ever saw it, but i ended up tearing instead of her giving me the E. i think that unless there was some medical reason/emergency you should be able to refuse and/or just tell your doc in advance that you would prefer not to have one.

[Anonymous]

A doctor should not perform any procedure without asking for your consent first. Make sure your significant other knows this and can watch out for any procedure you may not have consented to - such as breaking of waters or an episiotomy.

[Anonymous]

I don't think most ask before cutting. From what a doula friend says, they just do it while you are pushing. It probably varies by doctor.
I waited until we were about half way through pushing and said "Don't cut me" to the doc in front of all the nurses. I believe if you make it that clear, they do have to have a verbal consent if they think it is needed. There is a chance that they will not read a birth plan, so I think it is best to say it at delivery so they will not forget it.

[Anonymous]

You should discuss it with your doctor and/or whoever is on call during your delivery. As far as consent, I don't know the Sibley procedures, but when I gave birth at GUH I had to sign a pretty general consent form upon being admitted basically saying I give Drs XYZ consent to perform necessary procedures. So in this situation the dr would probably have the legal right to perform whatever they deemed was necessary (of course legal doesn't mean ethical!). You can probably write on the form that you sign "No episiotimy" and/or you can say loudly that you do not consent if you see the dr getting ready to do it.

Good luck with your VBAC!

[Anonymous]

Anonymous wrote:You should discuss it with your doctor and/or whoever is on call during your delivery. As far as consent, I don't know the Sibley procedures, but when I gave birth at GUH I had to sign a pretty general consent form upon being admitted basically saying I give Drs XYZ consent to perform necessary procedures. So in this situation the dr would probably have the legal right to perform whatever they deemed was necessary (of course legal doesn't mean ethical!). You can probably write on the form that you sign "No episiotimy" and/or you can say loudly that you do not consent if you see the dr getting ready to do it.

Good luck with your VBAC!

You still retain the right to object to procedures as they come up.

[Anonymous]

Anonymous wrote:You should discuss it with your doctor and/or whoever is on call during your delivery. As far as consent, I don't know the Sibley procedures, but when I gave birth at GUH I had to sign a pretty general consent form upon being admitted basically saying I give Drs XYZ consent to perform necessary procedures. So in this situation the dr would probably have the legal right to perform whatever they deemed was necessary (of course legal doesn't mean ethical!). You can probably write on the form that you sign "No episiotimy" and/or you can say loudly that you do not consent if you see the dr getting ready to do it.

Good luck with your VBAC!

I'm attempting a VBAC at VHC. When I pre-register/register I am crossing through any line that says "I give drs. XYZ consent to perform necessary procedures". I will be replacing that line with a statement such as "The doctor must receive a verbal consent from the patient prior to performing any necessary procedures".

Its your body - if you don't want an episiotomy, make sure you don't consent to it and that you tell everyone.

[Anonymous]

PP- I'd be pretty surprised if you were able to get away crossing out the consent line completely and think it's a bad idea regardless. What if something were to occur and you ended up being unable to consent for some reason (I know more than one mother who fainted/passed out at some poing during labor or God forbid, something worse could happen to render you unconscious)??? Also, from the hospital's standpoint, if a lawsuit were to arise, it would become a he said, she said as to what you verbally consented to. That provision is there for your protection too. If you require a verbal consent for "any necessary procedure," they will have to obtain your consent to so much as touch you, take your temperature, insert an IV, etc. Should an emergency arise, every second counts and you don't want to waste them by having to verbally consent to everything the dr needs to do. What if the dr or hospital fails to administer some type of critical care and you suffer as a result??? The hospital would be protected by arguing that it's not their fault they failed to do xyz because they didn't have your consent and you would probably be without recourse.

Perhaps the administrator processing your pre-registration won't notice and/or won't care, but it's within the hospital's right to refuse to admit you if you don't sign the consent. You'd be much better off if you added to the blanket consent line something like, "Dr. needs patient's verbal consent before performing an episiotomy/C-section (whatever else you can think of that you don't want) unless patient is unable to give such consent, in which case, Dr. needs consent of patient's spouse/partner."

[Anonymous]

Also, if you don't trust your dr to follow your wishes, I would find another dr. I trust my dr enough to know that if I told him I didn't want an episiotomy, he wouldn't perform one without my permission. I feel perfectly comfortable signing my dr's consent form (which by the way, my practice requires or they won't take you as an OB patient) because I trust him.

[Anonymous]

Not to play devil's advocate but there are people who have had bad tears that might not have been as bad if the doctor made a cut that was more on an angle (so not to go straight back, etc) This whole subject was a big concern of mine and if you go to the original site link at the top and search for episiotomy you will see the thread I started-people had good imput. I was petrified of getting one too. (ended up having a c-section after 2 hours of pushing-I have to say I was almost relieved which is maybe weird considering I know I had major abdominal surgery but I thought the recovery was fine!)

[Anonymous]

Sibley doesn't have a policy on Es - it is up to your doctor so make sure you have a talk. Also, my doc told me that even though their practice almost never does Es, they won't ever guarantee that they would not do one because there are rare circumstances in which it is better to do one than to let you tear. Again, talk this through.

[cmkeough]

In the rare instance that your OB is not available to deliver your baby be sure to tell the on call doctor. My OB (Dr. Bridges) was of the mind set to let me tear, when I told him I wanted an episiotomy he said that wouldn't be a problem. Apparently these days having an episiotomy isn't the "thing" to do, but I was okay with having it done (had one years ago with my first and in February with my second). Best of luck!

[Anonymous]

Standard of care these days is NOT to cut an episiotomy unless necessary to protect the health of the mother or child. While many old-school OBs still cut them in normal deliveries, a retrospective review of research from the last half-century recently determined that episiotomies don't prevent bad tears, don't improve women's recovery, and don't make a difference in post-partum sexual function. In fact, there were small but statistically significant findings indicating that women with episiotomies fared more poorly than women who were allowed to tear. Here's a link to the study abstract:

http://jama.ama-assn.org/cgi/content/abstract/293/17/2141

So please talk with your OB and verify that he/she doesn't do routine episiotomies; if he/she says she does (or seems put off by the question), I'd want to consider switching physicians.

On an anecdotal level, I had 2nd degree tears with both deliveries and was out taking walks the day I came home from the hospital.

Good luck to you!

[Anonymous]

I'm the PP -- sorry about the weird html tags. I've copied and pasted the abstract below:

Outcomes of Routine Episiotomy

A Systematic Review

Katherine Hartmann, MD, PhD; Meera Viswanathan, PhD; Rachel Palmieri, BS; Gerald Gartlehner, MD, MPH; John Thorp, Jr, MD; Kathleen N. Lohr, PhD

JAMA. 2005;293:2141-2148.

Context Episiotomy at the time of vaginal birth is common. Practice patterns vary widely, as do professional opinions about maternal risks and benefits associated with routine use.

Objective To systematically review the best evidence available about maternal outcomes of routine vs restrictive use of episiotomy.

Evidence Acquisition We searched MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Collaboration resources and performed a hand search for English-language articles from 1950 to 2004. We included randomized controlled trials of routine episiotomy or type of episiotomy that assessed outcomes in the first 3 postpartum months, along with trials and prospective studies that assessed longer-term outcomes. Twenty-six of 986 screened articles provided relevant data. We entered data into abstraction forms and conducted a second review for accuracy. Each article was also scored for research quality.

Evidence Synthesis Fair to good evidence from clinical trials suggests that immediate maternal outcomes of routine episiotomy, including severity of perineal laceration, pain, and pain medication use, are not better than those with restrictive use. Evidence is insufficient to provide guidance on choice of midline vs mediolateral episiotomy. Evidence regarding long-term sequelae is fair to poor. Incontinence and pelvic floor outcomes have not been followed up into the age range in which women are most likely to have sequelae. With this caveat, relevant studies are consistent in demonstrating no benefit from episiotomy for prevention of fecal and urinary incontinence or pelvic floor relaxation. Likewise, no evidence suggests that episiotomy reduces impaired sexual function—pain with intercourse was more common among women with episiotomy.

Conclusions Evidence does not support maternal benefits traditionally ascribed to routine episiotomy. In fact, outcomes with episiotomy can be considered worse since some proportion of women who would have had lesser injury instead had a surgical incision.

[Anonymous]

Anonymous wrote:Not to play devil's advocate but there are people who have had bad tears that might not have been as bad if the doctor made a cut that was more on an angle (so not to go straight back, etc) This whole subject was a big concern of mine and if you go to the original site link at the top and search for episiotomy you will see the thread I started-people had good imput. I was petrified of getting one too. (ended up having a c-section after 2 hours of pushing-I have to say I was almost relieved which is maybe weird considering I know I had major abdominal surgery but I thought the recovery was fine!)

The most recent research indicates that episiotomies result in WORSE tears than if you tore naturally. I had one and ended up with 4th degree tearing - quite painful and took several months to heal (although I lived through it and would deliver vaginally again). If you think of a piece of cloth, it is easy to understand why... if you stretch the cloth, it is unlikely to rip. An episiotomy is like cutting a small incision in the side of the cloth. When you stretch the cloth. it will rip more.

My doctor did not ask ahead of time (to my recollection), but the baby's heartrate was going down after 2 hours of labor. They did the episiotomy to get the vacuum in there.