episiotomy 2nd time round? [Archive] - Bub Hub Pregnancy & Parenting Forum

JanetF

16-09-2005, 10:11

I'm so sorry if this happened to you. There is no medical evidence to support episiotomy in the first place so there is usually no need for it at all. So avoiding one the second time around is going to be a mix of simply saying very clearly to your careproviders 'DO NOT CUT MY VAGINA OPEN!!!" (put it in your birth plan and hav it attached to your records) and making sure that you're in a position where they can't anyway, such as upright, and also clueing in your support people to shoout NOOOOOOOO at anyone approaching with scissors. Most women find that if they birth their babies upright, spontaneously without coached pushing, and at their own pace, they do not tear at the original cut.

Try these for more information.

Routine episiotomy shows no benefits, only harm
Source: Journal of the American Medical Association 2005; 293: 2141-8
Comparing maternal outcomes with routine versus restrictive use of episiotomy in a systematic review of the literature.

Routine episiotomy does not appear to provide the benefits traditionally credited to it, and, in some cases, is more damaging than a spontaneous tear, say researchers.

Episiotomy was initially introduced on the assumption that a deliberate incision would heal more quickly and with fewer complications than a spontaneous tear, and that it would lead to less pelvic floor problems, such as fecal or urinary incontinence or impaired sexual function, later on.

To determine whether this is actually the case, researchers led by Katherine Hartmann, from the University of North Carolina at Chapel Hill in the USA, conducted a systematic review of the best quality trials available comparing routine with restrictive use of the procedure.

The 26 articles selected for detailed study were consistent in finding that routine episiotomy did not reduce the severity of laceration, pain, or pain medication use, compared with restricted surgery. There was also no evidence to support the longer-term outcomes ascribed to episiotomy, including prevention of fecal or urinary incontinence or reduced impaired sexual function. In fact, pain during intercourse was more common in women who underwent the procedure.

Study co-author John Thorp Jr. summarized: "In most cases, episiotomy doesn't do any good, and it can harm women. Why would one want a surgical procedure that's worthless?"[/QUOTE]

[QUOTE]tearing - is prevention always the best cure?

http://www.withwoman.co.uk/contents/info/tears.html

http://www.hencigoer.com

When is an episiotomy not necessary?
All of the standard reasons given for the frequent or routine use of episiotomy have been discredited by medical research (3, 6, 8, 20, 25, 26). These include:

Preventing serious tears: Midline episiotomies cause, not prevent, serious tears. Tears into the anus or upper vagina almost never occur in the absence of midline episiotomy. In the sole trial in which women were randomly assigned* to liberal or restrictive use of midline episiotomy, of the 58 women experiencing tears into the anus or upper vagina, only one occurred on its own, rather than as an episiotomy extension (12). Anyone who has ever snipped a piece of cloth in order to tear off a length will understand why this should be so. Mediolateral episiotomies neither cause nor prevent tears (3).
* randomized controlled trial -- In a randomized controlled trial, participants are assigned by chance to the treatment group versus a standard care or no treatment - control -- group. Randomized controlled trials produce the strongest research evidence.

Preventing overstretching or injury to pelvic floor muscles, ligaments, and nerves: The pelvic floor is a complex group of muscles that form a hammock suspended between the pubic bone in front and the base of the spinal column in back. The urethra, vagina, and anus all pass through it. Pelvic floor weakness or injury can lead to:

Sexual dysfunction (unsatisfactory sexual relations)

Urinary stress incontinence (leakage of urine when there is a sudden increase in abdominal pressure, such as when you cough, laugh, sneeze, or lift a heavy object)

Anal incontinence (gas incontinence, urgency, or fecal incontinence)

Uterine prolapse (the uterus sags into the vagina)
Episiotomy itself is an important source of injury in that it cuts muscles and nerves. A study found that even an episiotomy that did not extend, tripled the risk of fecal incontinence and nearly doubled the risk of gas incontinence (1. As for preventing overstretching and subsequent weakness, episiotomies are not done until the baby's head is about to be born, which means the vagina is already fully expanded. The trial, randomly assigning women to liberal or restrictive use of midline episiotomy, found that women with no episiotomy or tears had the strongest pelvic floors, followed by women with spontaneous tears (13). Women having episiotomies, and especially those whose episiotomies extended, had the weakest pelvic floors.

Easier repair and improved healing: The deep tears episiotomies can cause are certainly more difficult to repair than the minor ones that may occur when no episiotomy is done. A study looking at healing in women with and without episiotomies reported that delayed healing occurred four times more often in women who had episiotomies (eight percent versus two percent) (16). The difference remained even after removing women with an intact perineum (no injury to the block of tissue between the vagina and the anus) from consideration, which suggests that spontaneous tears heal faster.

Reduction in pain: The random assignment trial evaluating midline episiotomy reported that women with no tears experienced the least pain in the postpartum period, followed in order by women with spontaneous tears, women with episiotomies, and women whose episiotomies extended (13).

Improved newborn outcome: None of the trials randomly assigning women to liberal or restrictive use of episiotomy have found any differences in newborn outcomes (2, 12, 19). Two studies of premature babies found that episiotomy did not affect the incidence of brain hemorrhage or low Apgar scores (15, 21). If episiotomy has no value even for these fragile babies, it isn't likely to benefit a healthy, full-term infant.

Facilitation of instrumental delivery: Studies have shown that reducing the use of episiotomy with forceps deliveries decreases the number of anal tears (7, 10, 22).The American College of Obstetricians and Gynecologists recommends not doing an episiotomy with a vacuum extraction until the head is "almost delivered" (1). But if the head is almost delivered, there isn't any reason to do one.