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    Questions? Ask Henci!


    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Archived User
    Oh, I am not done:
    In what situations would you say that episiotomies are necessary?
    Thanks,
    maria. By: maria
    Archived User
    The research does not support any of the reasons given for the routine or frequent use of episiotomy. It would be interesting to ask a clinician who almost never does them under what circumstances she or he does do them. I invite anyone in this category who reads these posts to respond.

    -- Henci By: Henci Goer
    Archived User
    Hi! I'm a mom of three. And I've had episiotomies with all of them. If episiotomies are not really necessary, how come many obstetricians routinely do that? (well at least, here in our country) Almost everyone I know who have given birth have had episiotomy. Thanks so much! By: pretty_mom_me
    Archived User
    From Childbirth Connection:

    Despite compelling research evidence, many maternity care providers still use this procedure liberally. This happens for many reasons. These include:
    high-intervention standards for childbirth
    practice style and values of individual providers
    practice style and values in specific birth settings
    influence of colleagues
    influence of medical education.
    Women themselves may not be aware of the harms caused by episiotomies and their lack of benefit. And providers may not obtain women's informed consent or informed refusal for the procedure.

    maria. By: maria
    Archived User
    That about covers it.

    -- Henci

    P.S. Just out of curiosity, what country are you in? By: Henci Goer
    Archived User
    As an educator and an actively working L/D RN I have seen liberal use and conservative use of episiotomies......Currently we have one physician who does them on everyone. I had one Labor patient who knew this and she had that particular physician on that day.....In the midst of her pushing as the resident was supporting the perineal area as the baby was crowning this Dr. over the resident was reaching for the scissors and the laboring mom stopped pushing and literally sat up out of the bed shouting "You will not cut me!"

    The Dr. was so taken back that she left the room mom delivered her baby and the resident repaired a small laceration......

    I just felt so saddened that during this woman's delivery she had to literally stand up in the bed to keep from getting cut........This Dr. has a very hard time with informed refusal so much so that she really does not thoroughly address the patients wants or desires at all. Also she will not let the RN's do the cervical check on patients because I hate to say this but I think she exagerrates the dilitation, ruptures membranes, and puts them on Pitocin so that they all get epidurals and she can control the delivery.....

    We have had a few discussions .....professionally....but little has changed and I believe she is discouraging clients from taking Lamaze Class which is also disheartening.......

    Any words of wisdom to win this Dr. over to evidence based practice???? By: Casey
    Archived User
    I am so sorry for your frustration and for the women and residents she treats so abusively. My first thought is to tell you to take care of yourself. The fact that you are taking care of these women and you are then helpless to prevent this assault can have negative effects on you up to and including symptoms of posttraumatic stress.

    Based on your description of this ob's behavior when she is crossed, it is clear that a straight-on approach will not work. I'm not a nurse myself, so I don't know anything about the culture, politics, and social dynamics of doctor-nurse hospital relationships and therefore how a nurse can introduce change in physician practice. If anybody out there does know about this, please chime in! Here are my ideas for what they are worth:

    * If there is any mandate at your hospital to practice evidence-based care, you could start with whoever has responsibility to implement that policy.

    * If there is an "opinion leader," that is, someone who is respected and trusted by his or her colleagues, at your hospital, and that person does not do episiotomies frequently, you might have a heart-to-heart talk with that person and see if you can't get some peer pressure exerted. There may also be something you can do with whoever supervises the residency training since this doctor is, in effect, teaching residents to practice unsafe and ineffective care.

    * If you want to try a non-confrontational approach, tell her that you have noticed that she routinely performs episiotomies while others don't. Ask her what she sees as the value in doing episiotomies. I'm sure you'll get a list. Then say that as a childbirth educator, you want to be up on the best practices so could she give you the research that supports those rationales. There won't be any. Her reaction to the request and the lack of research or both will tell you how much further you can go with her.

    -- Henci By: Henci Goer
    Archived User

    Hi,

    I am in the UK, I am expecting my 7th baby. My previous births have never required an episiotomy, nor have I torn. My largest child was 4kg (9lbs). With all deliveries I was lucky to be in a loving relaxed care based environment, even in hopital, with my wishes listened to and acted upon. All babies delivered in under 6 hours as I was able to focus on my body and go with the flow. I feel this natural birthing reduced body tension and allowed such easy births.

    Teresa

    Henci Goer

    Even when women do tear, the tear is often smaller than the episiotomy would have been. Tears have been shown to hurt less and heal better than episiotomies.

    -- Henci


    All Times America/New_York

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