From: oispeggy@ubvmsd.cc.buffalo.edu (Peggy Brown)
Newsgroups: sci.med
Subject: Episiotomy...What my doctor said...Is this true?  Anyone not have one?
Date: 11 Nov 92 16:06:00 GMT
Organization: University at Buffalo
News-Software: VAX/VMS VNEWS 1.41



Met my doctor's partner for the first time last night.  There is 
a 50% chance he will deliver my (first) baby, depending on who is 
on duty.  Unfortunately I did not like him near as much as I like 
my usual doctor.

He has a very authoritarian/paternalistic attitude and makes 
comments to the effect that its UP TO THE PHYSICIAN WHETHER OR 
NOT AN EPISIOTOMY IS DONE.  I of course nicely told him that since 
it is my body it is up to me to decide whether or not an episiotomy 
or anything else will be done.  I don't think he was listening.  
I suspect he figures I'll be in sufficient pain that I will accept 
anything he does without questioning it.  (Pain has a way of making 
people submissive.)

I think his idea of his role and patient rights is very outdated.

We discussed episiotomy for awhile.  He said that in most 
deliveries and nearly all first deliveries it must be done.  I 
pointed out that in other countries and in home labors they are 
not done nearly as often.  I said that I did not want any muscles 
cut.  He said that even without an episiotomy, the muscles are 
often damaged (sometimes to the point of breaking).  According to 
him, even if there is no tear there are invisible injuries to the 
muscles that will not heal as well as an episiotomy. Thus a woman 
can avoid an episiotomy and end up with weaker perineum muscles than 
she would have had if she had an episiotomy.  Does this make 
sense to anyone??????  Didn't make any sense to me.  Plus I've 
read that an episiotomy can tear even further than the actual 
incision, like through the rectum.  Sounds to me like starting a 
tear in a piece of clothe.  Once its started, rrrrriiiiiippp!

I also said that would not want an episiotomy automatically done. 
Instead I would want to wait and see if a tear started.  If it 
started and got to a certain size, then I'd consider an 
episiotomy.  He said that tears do not develop gradually.  They 
happen all at once, so unless you have an episiotomy ahead of 
time forget it - the tear will happen so fast it will be too late 
to do anything.  This makes no sense to me either.  I mean, 
doesn't it tear bit by bit with each contraction?  

As I said, I hope this guy doesn't deliver my baby.  I can tell 
already we will have some big problems regarding who is in 
control, regarding the episiotomy and anything else that comes 
up.  Its unfortunate to have to anticipate working with a 
doctor who is NOT supportive about what the patient wants and not 
willing to try perineal massage, and work with the patient to 
avoid an episiotomy.  My chances of having what I consider to be 
a good birth experience are low if I have to work with this 
doctor who does not support my preferences.

How accurate was his information, or is this a scare technique?  
Also, anyone have any statistics on episiotomy and homebirths or 
births in other countries with lower rates?

Anyone out there ever NOT have an episiotomy?  If so, how are 
your perineum muscles?  Did they get damaged as my doctor 
described?

I see fireworks ahead if he's on duty.

- Peggy -