From: clare@nynexst.com (Clare Chu)
Newsgroups: misc.kids
Subject: Re: Episotomy...What my doctor said...Is this true?  Anyone NOT have one?
Date: 13 Nov 92 14:53:26 GMT
Article-I.D.: nynexst.1992Nov13.145326.13797
Organization: Nynex Science and Technology

In article <BxK9r8.7wr@acsu.buffalo.edu> oispeggy@ubvmsd.cc.buffalo.edu (Peggy Brown) writes:
>
>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.

  Yikes!  I had that happen too in my first pregnancy, not that
  I liked my doctor that much, but at least she didn't care.
  She probably would have done it anyway, but she didn't care to
  discuss things ahead of time.  At least these guys are up front
  about their intentions!
>
>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.)

  But she had a partner who was of the elderly type.  He would tell
  me "You don't want to know." for any questions I had about
  labor or delivery, and then pat my hands.  "Trust me, you don't
  want to know."
>
>I think his idea of his role and patient rights is very outdated.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!

  Bull, bull, bull.  This is controversial.  You're right about the
  studies.  It's a lot like ripping cloth.  I've always wondered
  why they cut straight down towards the rectum when that is exactly
  what you don't want to tear!

  Episiotomies are done for the convenience of the doctor because you
  have a faster quicker delivery.  They're only justified if they
  need to get the baby out, right now!  But a lot of times, it's the
  doctor's golf game starting right now.

  You can do Kegel exercises to strengthen your muscles.  Besides,
  many tears are only skin tears, not muscle tears.  Skin tears
  heal a lot faster.  I know, I was the only mother on my floor
  walking around a few hours after delivery.  In fact I made several
  trips to the nurses station to get Tylenol or Codeine for my roommate
  who was in pain.  (This is not New York City bashing, this is my
  experience).  I also had to return trays since they forgot to pick
  them up.  I also thought it was quite funny that they had Combat
  roach traps under all the beds!  :-)
>
>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?  

  Well you need to be taught to ease up (or told to ease up at the
  last minute).  An experienced midwife can help you.  I had
  a tear because I wanted to get it over with so I didn't listen
  when she said "Easy, easy."  I just gave a big push and it
  happened all at once.  But nothing that a little stitching
  couldn't take care of.  Besides I didn't have muscle tears,
  and I had several little tears instead of ONE BIG ONE.
  [I hijacked a midwife, BTW, so the she I'm referring to is
  the midwife, not the OB].
>
>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.

  You're absolutely right on this respect.  I don't know what to
  tell you.  It seems that the earlier you check yourself into a
  hospital the more damage they can do.  Most of my friends checked
  themselves in at the first sign of labor.  They ended up getting
  their bag popped, and then as labor didn't progress, they ended
  up getting a C-section.  Labor doesn't always progress.  I had
  a 24 hour lapse between my 10-15 minutes apart labor and my
  3-5 minute (2-3 minute) labor.  If I had checked myself into
  the hospital early, I would no doubt have had a C-section, as
  well as an IV, probably Demerol, and various other interventions.
  The only thing I can tell you is to not go in until you're almost
  there.  That way, they won't have time to prepare, and you might
  get delivered by a resident or a medical student (whom you can probably
  boss around a bit more), or if you luck out, a midwife who happens
  to be there hanging around.  Doctors only come in at the last minute
  and they like to "get it over with fast".  So there may be midwives
  hanging around with their other patients, walking the floor with them
  that can do your delivery at the last minute.
>
>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?

  I think it's intimidation to not take the patient's wishes or
  concerns seriously.  It's also convenience for the doctor, mostly.
>
>Anyone out there ever NOT have an episiotomy?  If so, how are 
>your perineum muscles?  Did they get damaged as my doctor 
>described?

  My perineum muscles are just fine.  I'm not dripping urine,
  walking around with my insides hanging out.  I don't have
  any scars (that I can feel, I haven't looked).  The hemmorhoids
  I got from pushing disfigured me more and are more bothersome.
>
>I see fireworks ahead if he's on duty.

  Hopefully he won't answer his beeper.  I would have been a drugged
  out zombie if my doctor answered hers.  :-)
  [This is not doctor-bashing, my husband is a doctor and he is well
  aware of their practices.  In fact he'd just go ahead and cut too,
  since his time is so valuable.  He almost grabbed the scissors and
  cut me!  Luckily he had some professional ethics about not interfering
  with someone elses patient.]

  Doctors are taught to intervene.  They feel extremely uncomfortable
  doing nothing, or letting nature take it's course. 
>
>- Peggy -

  Good luck, Peggy.  I agree with you and hope you luck out.  I would try
  and get some more information or talk to midwives so that you are confident
  in your decisions and not let the doctor's railroad you.  Of course if
  they grab the scissors, you can't very well kick it out of their hands.
  But they should not say that it is routinely done, only when necessary
  to facilitate quick delivery due to real fetal distress or to use forceps.
  (BTW, the interesting thing about my friends who got railroaded into
  C-sections was that they all supposedly had fetal distress, according
  to the doctor).  One even had his baby put in the NICU because she (baby) had
  a temperature of 100 (which they later said she didn't have).  All my
  friends have private insurance (the type that can charge anything), 
  whereas I have an HMO, so they wouldn't do these things unless totally
  medically necessary.  The C-section rate in Westchester county is 40%
  and in nearby Bronx it is only 10% (mostly indigent patients).
Newsgroups: misc.kids