Cut/tear? - Page 4

Mitsuko · Jan 2nd, 2010, 11:14 AM

Quote:

Originally Posted by trumpetbum

Quote:

Originally Posted by Jan34

my understanding is that they wait until the head is on the verge of being born so that they can see how much the perinium is stretched. If it's likely to tear or baby likely to get stuck then they will make the decision to perform an episiotomy at this point. Probably a little difficult to ask for consent at this stage I'd imagine.

There are very few circumstances where there would not be time to say 'we think we need to cut to help you have your baby safely, can we do that?' it takes the same time as it takes to fetch and open sterile scissors. If a tear happens in that time, it would have happened regardless. It's very poor practice to cut the patient out of their own care and excuse it by saying there isn't time.

I totally agree with you but the fact is, when you read birth stories, you realise they don't always tell you...

That's why I've asked my OH to be "my voice" during the birth!

trumpetbum · Jan 2nd, 2010, 11:25 AM

Quote:

Originally Posted by alibaba24

im too scared to even think about it

Iv heard natural tears heal better than a cut so they try to avoid cutting?

not sure how true this is though

xx

Well it really depends on the tear/reason for the cut. Current evidence shows that there is no indication or benefit from routine episiotomy over restrictive use and that outcomes with routine episiotomy can be considered worse since a significant proportion of women who would have had a lesser injury instead had a surgical incision. This evidence is one reason that in the UK episiotomy rates have dropped significantly, rates are also lower where birth is midwife led and less medicalised. E.g Rates are 13% in scotland for example, 8% in holland as opposed to 50% in the US and 99% in Eastern Europe.
If it is something that scares you, it might be a good idea to bring it up with your health care provider antenatally to discuss strategies to minimise the risk and how frequently they perform episiotomy and for what reasons.

trumpetbum · Jan 2nd, 2010, 11:34 AM

Quote:

Originally Posted by Mitsuko

Quote:

Originally Posted by trumpetbum

Quote:

Originally Posted by Jan34

my understanding is that they wait until the head is on the verge of being born so that they can see how much the perinium is stretched. If it's likely to tear or baby likely to get stuck then they will make the decision to perform an episiotomy at this point. Probably a little difficult to ask for consent at this stage I'd imagine.

There are very few circumstances where there would not be time to say 'we think we need to cut to help you have your baby safely, can we do that?' it takes the same time as it takes to fetch and open sterile scissors. If a tear happens in that time, it would have happened regardless. It's very poor practice to cut the patient out of their own care and excuse it by saying there isn't time.

I totally agree with you but the fact is, when you read birth stories, you realise they don't always tell you...

That's why I've asked my OH to be "my voice" during the birth!

I always think it's a good idea to have a good advocate like that in case someone oversteps their authority. I would be furious if my consent wasn't asked for any clinical procedure, with the exception of emergency resuscitation, since no registered nurse, dr or M/w in the UK can claim to be ignorant of the fact that a competent patient has an absolute right to refuse treatment and has to be given the opportunity to do so.

JenStar1976 · Jan 2nd, 2010, 11:54 AM

Not sure if you're planning a water birth or not, but NCT classes told us that there's a 30% less chance of tearing in water. Keep massaging with gel/oil in advance too to keep the skin supple. xx

LouLou78 · Jan 2nd, 2010, 14:08 PM

After reading majority of these posts I get the impression that some of you think episiotomies, like in the dark ages, are performed at a certain point to avoid tearing. Any midwife practising/learning in the UK should not be performing episiotomies based on this.

Episiotomies are peformed when their is fetal distress and the cut will assist in delivering, to aid instrumental delivery or you are having an elective episiotomy because of a previous 3rd/4th degree tear, but this isn't always necessary either.

In my experience 3rd/4th degree tears are rare, there are some midwives I know who have never experienced one yet and those who have never needed to perform an episiotomy either. Personally, I avoid Episiotomies, not had to perform many compared to the large number I deliver and luckily can only count a few 3rd degree tears amongst this. 1st and second degree tears are more common but don't always need suturing. I think it is better to just leave the perineum be.

hattiehippo · Jan 2nd, 2010, 16:26 PM

My little man was born 10 days ago on 23rd December. I had a 2nd degree tear due to him having a hand round his face as he was born and had 6 stitches in all. Yes they stung the first day or 2 but everything is swollen down there at that point anyway so it wasn't that noticable - in fact I forgot they were there to start with. Now I can't tell at all that I had any.

I was terrified of tearing and kept asking the midwife if I was going to. But the actual sensation of giving birth and the head coming out was so intense that I didn't notice the tearing happening and it was a tiny part of the whole experience.

moomin_troll · Jan 3rd, 2010, 07:52 AM

Quote:

Originally Posted by JenStar1976

Not sure if you're planning a water birth or not, but NCT classes told us that there's a 30% less chance of tearing in water. Keep massaging with gel/oil in advance too to keep the skin supple. xx

i heard this too which was one of the reasons i wanted a water birth but not long ago i was told by a mw that water births can increase the chance of tearing as the water takes away ur natural lubrication so theres a higher risk of tearing.

u just cant win everyone has a different story when it comes to childbirth

moomin_troll · Jan 3rd, 2010, 07:56 AM

Quote:

Originally Posted by LouLou78

After reading majority of these posts I get the impression that some of you think episiotomies, like in the dark ages, are performed at a certain point to avoid tearing. Any midwife practising/learning in the UK should not be performing episiotomies based on this.

Episiotomies are peformed when their is fetal distress and the cut will assist in delivering, to aid instrumental delivery or you are having an elective episiotomy because of a previous 3rd/4th degree tear, but this isn't always necessary either.
In my experience 3rd/4th degree tears are rare, there are some midwives I know who have never experienced one yet and those who have never needed to perform an episiotomy either. Personally, I avoid Episiotomies, not had to perform many compared to the large number I deliver and luckily can only count a few 3rd degree tears amongst this. 1st and second degree tears are more common but don't always need suturing. I think it is better to just leave the perineum be.

zane wasnt in any distress and i was given a epis because she said i would tear if she didnt. i guess it all depends on the mw

Rmar · Jan 3rd, 2010, 08:14 AM

Quote:

Originally Posted by moomin_troll

Quote:

Originally Posted by JenStar1976

Not sure if you're planning a water birth or not, but NCT classes told us that there's a 30% less chance of tearing in water. Keep massaging with gel/oil in advance too to keep the skin supple. xx

i heard this too which was one of the reasons i wanted a water birth but not long ago i was told by a mw that water births can increase the chance of tearing as the water takes away ur natural lubrication so theres a higher risk of tearing.

u just cant win everyone has a different story when it comes to childbirth

Just wanted to add on this point. In certain cases, the risk of tearing is increased during a waterbirth, not usually because of the lesser natural lubrication but because the water can provide a bit more pain relief for some women and they forget to breath out the baby and instead push a bit harder than they would normally do outside of the water.

LouLou78 · Jan 3rd, 2010, 09:31 AM

Quote:

Originally Posted by moomin_troll

Quote:

Originally Posted by LouLou78

After reading majority of these posts I get the impression that some of you think episiotomies, like in the dark ages, are performed at a certain point to avoid tearing. Any midwife practising/learning in the UK should not be performing episiotomies based on this.

Episiotomies are peformed when their is fetal distress and the cut will assist in delivering, to aid instrumental delivery or you are having an elective episiotomy because of a previous 3rd/4th degree tear, but this isn't always necessary either.
In my experience 3rd/4th degree tears are rare, there are some midwives I know who have never experienced one yet and those who have never needed to perform an episiotomy either. Personally, I avoid Episiotomies, not had to perform many compared to the large number I deliver and luckily can only count a few 3rd degree tears amongst this. 1st and second degree tears are more common but don't always need suturing. I think it is better to just leave the perineum be.

zane wasnt in any distress and i was given a epis because she said i would tear if she didnt. i guess it all depends on the mw

That is a shame you had a cut if that is the case. She may have seen evidence that you were going to tear but she wouldn't have known how significant if would be.

Jan 2nd, 2010, 11:54 AM	#34
JenStar1976 Mum (Mom) Chat Happy BnB Member Join Date: May 2009 Location: Chelmsford, Essex, UK Posts: 1,027	Not sure if you're planning a water birth or not, but NCT classes told us that there's a 30% less chance of tearing in water. Keep massaging with gel/oil in advance too to keep the skin supple. xx

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Jan 2nd, 2010, 14:08 PM	#35
LouLou78 Mum (Mom) Chat Happy BnB Member Join Date: Nov 2009 Location: currently England Posts: 1,069	After reading majority of these posts I get the impression that some of you think episiotomies, like in the dark ages, are performed at a certain point to avoid tearing. Any midwife practising/learning in the UK should not be performing episiotomies based on this. Episiotomies are peformed when their is fetal distress and the cut will assist in delivering, to aid instrumental delivery or you are having an elective episiotomy because of a previous 3rd/4th degree tear, but this isn't always necessary either. In my experience 3rd/4th degree tears are rare, there are some midwives I know who have never experienced one yet and those who have never needed to perform an episiotomy either. Personally, I avoid Episiotomies, not had to perform many compared to the large number I deliver and luckily can only count a few 3rd degree tears amongst this. 1st and second degree tears are more common but don't always need suturing. I think it is better to just leave the perineum be.

Status: Offline

Jan 2nd, 2010, 16:26 PM	#36
hattiehippo Mum (Mom) Chat Happy BnB Member Join Date: Jun 2009 Location: Essex Posts: 2,153	My little man was born 10 days ago on 23rd December. I had a 2nd degree tear due to him having a hand round his face as he was born and had 6 stitches in all. Yes they stung the first day or 2 but everything is swollen down there at that point anyway so it wasn't that noticable - in fact I forgot they were there to start with. Now I can't tell at all that I had any. I was terrified of tearing and kept asking the midwife if I was going to. But the actual sensation of giving birth and the head coming out was so intense that I didn't notice the tearing happening and it was a tiny part of the whole experience.

Status: Offline

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