episiotomies and homebirth?

[mumofKieran]

I just have a question: if you need an episiotomy does your midwife perform this at a homebirth? Is there less chance you'll need one due to being able to use upright positions etc? And if your midwife does decide an episiotomy is necessary, do you get local anaesthetic for it?

[AM]

I've NEVER heard of an epi being performed at a homebirth, and I have heard and read many, many HB stories. There is pretty much zero need for them period, and especially if you labour unhindered, roaming around, and yes, using position changes to keep labour going. Womens bodies DO NOT need to be cut to perform an action their bodies were specifically designed to do.

It is a very outdated and possibly completely redundant practise, and if you were to ever get to the stage of truly needing one (I am really struggling to come up with any senario where it would be needed) then I would hope you would have transferred to a hopsy anyway, as it would only be used as a life saving technique.

HB mw's are pretty much in agreeance with their clients, that tearing is completely superior to an epi (shudder), as it heals better, and prevention of tearing is even better than that.

[Tam-I-Am]

Episiotomies, from what I understand, are an outdated, outmoded medical intervention that are usually completely unnecessary, and the things that are encouraged in homebirth (ie active labour, staying upright, listening to your body's cues, not being 'coached' to push, no drugs etc lead to farrrrr better perineal outcomes and farrrrr less need for intervention like episiotomies.

I don't know if a midwife is actually qualified to do one - I would think not - and I don't think that homebirth middies carry local anesthetics - so I don't think that even if they DID do one that you would be anesthetized - but its far less likely that you'll 'need' one anyway.

HTH :)

[stellarella]

HB midwives VERY rarely need to perform episiotomies...they view birth a whole lot differently to OBs or midwives working in hospitals.

If there was a dire emergency (I'm not sure what kind of emergency would warrant one, except maybe needing to get bub out RIGHT NOW and no way of transferring) then yes she would perform one but I know that my midwife (BC midwife but extremely skilled and supportive of natural birth) had never performed one in her entire career.

The vast majority of episiotomies are totally unnecessary and avoidable.

And no she wouldnt use a local anaesthetic either, if its a true emergency there would be no time. My midwife told me if you have time for an epidural or local then they shouldnt be performing it anyway as it is not an emergency. An emergency means last resort, not time for anything.

[the_queen]

:iagree: Yup, what she said :D

[AM]

HB midwives CAN perform epis (but don't, as it goes against the HB philosophy) just as they can stitch tears and will use local for that, and they can administer synto for post partum bleeding if absolutely necessary, and will have O2 tanks for resus etc.

[mumofKieran]

Right. So when you hear of someone who had an epi because the bub's head just would not crown, and it was deemed there was no way they could stretch any more, then this was unnecessary? I was led to believe that an epi was better than severe tearing but worse than a slight tear.

[the_queen]

"Bub's head just would not crown" is more correctly defined as "Failure to Wait" :yes:

[AM]

It just isn't true that a baby will not crown, they do. It is an urban myth. (which Ob's and medwives LOVE to perpetuate)
And how are you going to know if you tear slightly, or severely, until after the fact anyway?

And tears do heal better. Think of lettuce. If you tear it, it will tear around the cells in an uneven pattern, leaving them intact and won't brown up so fast, if you cut lettuce it goes brown, as you have cut the cells in half. Skin etc muscle cells which tear, will be intact, and will heal better because of it. (Live cells can begin repair immediately) Epis came into favour as surgeons like to repair straight lines, and have it tidy, nothing really to do with emergency measures, or being better for women themselves.

[mumma bear]

Hmm, my Mum had a true emergency epi. She had no pain relief and i was crowning when the Dr walked in checked things and found my head was blue. He did and epi (no local) cut my cord and i was born at the same time. The cord was firm around my neck and i would have died had it not been performed. This was no a HB but clearly necessary intervention, so epi may be necessary in some situations.

[the_queen]

Hmm was she flat on her back, mumma bear?

[stellarella]

Mumma Bear - It may have been necessary at that point in time however I would question and critique all the events leading up the episiotomy before deeming it necessary in the scheme of the labour.

Intervention leads to intervention. And forcing women into unnatural birthing positions leads to complications.

[mumma bear]

Not sure.
I don't see how position could have stoped me being blue and her needing an epi. He did the epi so he had enough room to cut the cord before i was born. In his opinion continuing would have killed me.

[AM]

I'm not trying to discount your story mummabear, but I would like to point out some pertinent facts.

Many babies are born bluish, and will pink up when they begin to breathe, and the oxygen is distributed through their bodies via the lungs, rather than baby simply being 'fed' by the umbilical cord. (the very best senario is the baby beginning to breathe while still attached to the cord for a decent period of time, as it eases the transition from umbilical dependancy, to lung use)

Also a cord 'tightly wrapped' around a babies neck is not all that uncommon, and it is not a problem, unless the cord is severely compressed ie; pressed completely flat, allowing nothing to pass along it. Remember the lungs are not in use at this point, so something around the neck is not like strangulation. Umbilical cords are made to be very tough and durable, and to be able to handle the whole birth and labour process.

Of course emergencies do happen, but it is very debatable whether or not so 'many' of these interventions are true emergencies, or are misinterpreted by docs/obs/mw's many of whom actually don't know what normal natural birth looks like.

[mumma bear]

I agree completely that intervention is not necessary most of the time. I have had 3 births myself, 1 assisted and 2 natural, no drugs. I understand that there is a lot of un-necessary intervention that can lead to trauma for both Mum and Bub. I was just trying to point out a situation when it was completely necessary for an epi that is all.

[mumofKieran]

Thanks for the replies :thumbsup:

This is VERY interesting info to me, I am not someone who had ever considered homebirth before coming on Bubhub but have been reading/watching these posts with interest over the past few months and I must say my curiosity is sparked. My obstetrician told me that an episiotomy is better than a bad tear, hence why they sometimes perform them, if they think you are going to tear badly. That's why I was wondering about the home birth scenario but what you have all said makes sense. Next time I will be VBAC whether in hosp or not and would rather take the kindest option for my perineum which is as yet unmarked :eek:

[TwoBoysOnly]

It just isn't true that a baby will not crown, they do. It is an urban myth. (which Ob's and medwives LOVE to perpetuate)
And how are you going to know if you tear slightly, or severely, until after the fact anyway?


There are actually times where you can tell if the woman is going to tear badly (ie very short perineums that are buttoning, some perineums just don't stretch at all) and although I have never performed one I have seen them done in these situations to prevent a 3rd or 4th degree tear.

[AM]

Thanks, always nice to gather new info :) And of course the emphasis at HB is always to prevent tearing in the first place, stellarella posted a heap of info on the "Would you get your vagina surgically tightened" thread how to go about tear prevention.

[shed]

The rate of episiotimies at homebirths support the fact that they are hardly ever necessary.

People in hospitals might need them due to babies being at risk or the woman tearing too much, but there are usually contributing factors, such as stranded beetle birth positon, epidural etc.

They doesn't mean they are not sometimes necessary. It just means that hospitals can make them become "completely necessary" due to the way birthing women are treated there in the lead up to it.

My SIL had a "necessary" episiotomy in a hospital in Samoa, where they are performed quite routinely. How necessary it actually was will never be known, but I would never say anything because no one wants to realise that they were cut without a proper reason. everyone wants to think it really was necessary.

doesn't make it true though.

[mumofKieran]

Another question though, does an episiotomy always prevent tearing? Because I was reading the WHO website and it said that the rate of tearing was the same for women who had had them as for women who hadn't. Imagine having one and then tearing also :eek::eek:

[TwoBoysOnly]

No problems AM :) - I have done lots and lots of research re tear prevention as I try to educate the woman and protect the perineum during labour and birth and I do agree it is a lot about positioning :yes:



People in hospitals might need them due to babies being at risk or the woman tearing too much, but there are usually contributing factors, such as stranded beetle birth positon, epidural etc.


I love the stranded beetle birth :laughing: I am going to use that terminology from now on instead of "semi supine"

[TwoBoysOnly]

Another question though, does an episiotomy always prevent tearing? Because I was reading the WHO website and it said that the rate of tearing was the same for women who had had them as for women who hadn't. Imagine having one and then tearing also :eek::eek:

Additional tearing usually occurs when a large tear was happening but only a small episiotomy was cut :barf: (I wish there was a little emotion of a woman with her legs crossed I would have used that)

[ShadyCharacter]

Mumma Bear - It may have been necessary at that point in time however I would question and critique all the events leading up the episiotomy before deeming it necessary in the scheme of the labour.
This is very true. I had an emergency episiotomy (performed without waiting for another contraction or anesthetic) which was truly 'necessary'. My babies heart had just about stopped.

That said, it only took me two and a half years to realise that most probably the reason he got so distressed was that I had agreed to a syntocin drip. So while the episiotomy itself probably was life saving... it probably would not have become necessary without the earlier intervention.

[ShadyCharacter]

Another question though, does an episiotomy always prevent tearing? Because I was reading the WHO website and it said that the rate of tearing was the same for women who had had them as for women who hadn't. Imagine having one and then tearing also :eek::eek:
I also had massive internal tearing.... my episiotomy was not to prevent tearing, it was to get my baby born quickly. A babe born too quickly nearly always leads tearing.

[Sheer Bliss]

Another question though, does an episiotomy always prevent tearing? Because I was reading the WHO website and it said that the rate of tearing was the same for women who had had them as for women who hadn't. Imagine having one and then tearing also :eek::eek:

I had an episiotomy with DD, and didn't tear - it was a very small one, so maybe not totally necessary, but healed very well, and i felt almost completely normal again by 3weeks. Although it wasn't a true emergency and would be deemed by many to be unecessary intervention, I was VERY distressed & exhausted. My midwife & dr had tried to get me to push, but after 4 or so contractions of me in agony screaming to get the baby out with no pushing - he decided to help me out. I am a bit of a wuss, and perhaps education before hand may have prevented the situation, and i may have relaxed more and bubs been born on her own. She was 4 weeks premmie & i had toxemia, so i think the dr didn't want to risk my BP getting any higher. Long story short - although they may not always be necessary - not all episiotomies are bad.


I A babe born too quickly nearly always leads tearing.

Sounds like my second - no episiotomy for him - but born very quickly & blue, prob due to not reveiving enough oxygen due to toxemia second time around - second degree tear, and a much worse recovery.

Sorry, a bit off topic there, but just wanting to say that if it is needed to be done by the midwife, it is not the end of the world.

[BJelly]

I got a third degree tear during my first birth, and during my antenatal visits for my second pregnancy it was clear that the hospital was very keen on giving me an episiotomy. I wasn't keen on it because I'd read that it can cause more tearing or cause an injury where there otherwise would have been none.

In the end I didn't have my baby in hospital, because I had an unplanned homebirth due to a 1 hour labour - I did tear, but it was a 2nd degree tear. I'm glad I didn't get an episiotomy - I'd rather take my chances and try to avoid tearing rather than having them cut me and definitely getting a perineal injury.