Episiotomy?

c*bear · November 2010

I went to my last childbirth class this weekend, and the instructor informed us all that at the hospital I am delivery just about 100% of women who deliver vaginally get an episiotomy. When I tried to question this she said you are not really given a choice on the matter, it "just happens because it is easier". She said she wasn't telling us to scare us, just to prepare us for what it. She told us we won't even know about it until after it is done anyway.

I have a regular appointment with my doctor today so I am going to ask her about this, but wouldn't they need your permission to perform any procedure on you?

Also, she made a comment about medical students in the room, and when I questioned this she said you have no choice in this matter that they are there to learn and will be in the room whether you like it or not. Does this sound right? Wouldn't they have to leave if I did not want them there?

Sorry if these are stupid questions, just want to hear others opinions.

yourmom5309 · November 2010

I had a small tear so the doctor fixed mine without me knowing or giving any go-ahead. As far as the students, I was asked if students could be in my room. I would talk to your doctor before hand about both of those things. I have issues with hospitals bossing me around when I (my insurance) is paying for the services.

NorcalLinds · November 2010

1. The episitomy rate of 100% seems strange to me. Its also something you should talk about with your OB and or the practice. Its not a hospital policy.

2. It sounds like you are delivering at a teaching hospital. you can excuse people from the room, but thats how they learn. For your next delivery you might want to find an OB that doesn't deliver at that hospital, find one that isn't a teaching hospital.

njshar · November 2010

I ended up with an episiotomy and to this day, I don't know why. DD was only 7.08 lbs. I am talking to the OB about the fact that I want to know & understand any medical procedure, no matter how insignificant he feels it is, PRIOR to it being done. I also had an internal monitor put into DD, had her turned inside of me, and a choice procedure performed afterwards that I won't write about here.

On the form for my hospital it stated that they might take photos for "educational purposes." I crossed it out when I signed up and wrote that no photos were to be taken (not that I think they were the first time).

I think it's your body, your choice. I think you are very smart to ask questions up front and encourage you to let your OB know that you want to be aware of everything that goes on and want input into any medical procedures/decisions, as long as you are capable of deciding. In terms of others being present - I don't go to a teaching hospital, but I would think that should be your choice.

J+MS · November 2010

Don't do it.

babyike · November 2010

On the episiotomy... I would definitely bring this up with your provider. Let her know if you would prefer to tear or to have the episiotomy. Put it in writing (birth plan) as well for when you are admitted.

As for students in your room... I'm delivering at a teaching hospital as well, but you are not required to allow students in your L&D room. In fact, you must give consent before any non-essential personnel can come into your room. I would ask about this as well, but I think your childbirth instructor might be mistaken (at least I hope she is).

designermusings · November 2010

At a teaching hospital you might be asked to allow students in. The 100% episiotomy thing is kind of strange. I would think it's a per-doctor thing, rather than a hospital policy.

missesru · November 2010

This instructor sounds like a real winner. I definitely recommend taking her advice and "information" with a grain of salt and posing these questions to your doctor. You do have a choice when it comes to medical procedures that are used (for the most part). You may be more comfortable with the thought of an episiotomy when you discuss this further with your doctor.

The instructor in my prenatal class is a doula and she seems really behind the times in her information about what really goes on in the hospital. It's quite obvious that she is not a big fan of many of the goings-on in the hospital setting, so for the most part I'm just smiling and nodding throughout the class.

Good luck!

~Flossie~ · November 2010

I agree that the 100% episiotomy rate is strange. At my prenatal/birthing class that I took at the hospital I am delivering at, the instructor told us that it is hardly ever done at my hospital.

MallratsMom · November 2010

I gave birth at a hospital with my first and I wrote in my birth plan that no episiotomy was to be given unless there was going to be a clitoral tear. I ended up with a 2nd degree tear that took just a few stitches to fix. I think it's more what your OB does vs what the hospital does.

c*bear · November 2010

J+MS:
Don't do it.

Ask the doctor or the episiotomy? I DO NOT want one unless for some reason it was medically necessary, that's why it concerned me when she said you are not given a say in the matter.

J+MS · November 2010

c*bear:
J+MS:
Don't do it.
Ask the doctor or the episiotomy? I DO NOT want one unless for some reason it was medically necessary, that's why it concerned me when she said you are not given a say in the matter.

Don't let them do one if its not medically necessary...you don't have to do anything you don't want to. Make sure you are very clear wth your doctor.

whizgrady · November 2010

I would definately talk to your dr about that. An episiotomy should definately require patient approval. I have done quite a bit of research about episiotomies and most of the information that I read said that it takes longer to recover from an episiotomy than it does from a natural tear. I have 2 friends that had an episiotomy and they both had to go back and have surgurery to fix the scar tissue that it caused. I took atleast 4 months to recover. On the issue of students being in the room, you do have a choice. I don't think that having a student in the room is a bad thing though. They have to learn somehow and with someone. Good luck.

c*bear · November 2010

Thanks, my doctor appointment is in an hour so I'll talk to her when I go in.

PunkyBooster · November 2010

Hmm. It depends on the hospital and doc then. Mine said she cannot even remember the last time she did an episiotomy. You can ask her to, if you prefer, but she said it's easier to tear after one, so she doesn't do them unless requested.

We can opt to have residents in the room or not. I do not have an issue with having 1-2 students in there, but no more than that. There is a form in our pre-admin package that you sign stating your preferences.

That instructor sounds like a looney tune. "You have no choice" um, who is having the baby here? What a b!tch!

AshasaurusRex · November 2010

When you check into the hospital (or during pre-registration) most of the time written somewhere on the papers you sign is a blanket permission for them to do any and all procedures on you, so unless you cross that out (which is completely within your right to do) the Dr. doesn't HAVE to ask your permission. I would definitely bring it up with your Dr. if you don't want an episiotomy and have it written in your birth plan as well. Remember, you ALWAYS have a choice, and if they tell you "it's hospital policy" then ask to see it in writing.

BakerMommy · November 2010

My recovery with a tear was WAY easier than a friend who had an episiotomy (as in I was up and moving just fine a day or two later, she had trouble walking for a month!). I would definitely talk to your doctor about it! Also read admittance paperwork very carefully (assuming you can pre-register for the hospital) and if necessary write in that you will have advance consent for all procedures. Additionally, your DH can be on alert--if anything metal goes near your nether-regions, ask why!

Penguin81 · November 2010

That is the dumbest friggin thing I've ever heard at least this week. As far as the episiotomies go, it isn't 100% of births, because that doesn't explain the several outliers I know personally who never tore on any of their births.

And as far as medical students don't ever let anybody tell you, you don't have a choice who is in your birthing room. Yes these folks do have to learn from observation and practice at some point, BUT YOU HAVE A CHOICE! Sorry I don't mean to be caps crazy, it just drives me friggin nuts when when instructors misinform folks like that... /end rant

EmjayTheHunted · November 2010

You have a right to decline medical students at any time. IF they were to violate your wishes, and keep them in there, it is a violation of HIPAA because these people will be receiving information about you that you do not authorize.

It's considered to be accepted, but if you say no, it's no. If you don't like a certain nurse, you can have her removed. You have rights as a patient. When I was doing my clinicals, if a patient said "No students", we politely said have a nice day and left the room with no questions asked. NONE.

I had students in there when my son was born but I can't tell you how many, what they were doing, or anything else. I didn't care. It was push time. Usually, unless they are doing an internship or residency, they are just observing, and they are told to be quiet and stay out of the way.

Even so, you have a right to choose who is involved in your care. Simple as that.

Also, I think your childbirth educator sounds like an idiot. If you don't need an episiotomy, they don't do one. I had one with my first, not with my second. It's doctor preference, not hospital policy. And guess what... the doctors keep the doors open.

jmmiller28 · November 2010

I work in patient care at a hospital (not in OB) and am well-versed on patient rights. You absolutely have to give consent to have an episiotomy performed! It might not come, however, in a neat consent form to sign. In the moment, it might be thrown out as a "I need to do this, okay?" that you might not even hear. Be upfront with your OB (or the MD that ends up delivering your baby if you don't see your OB) when you go to the hospital. I would tell everyone you meet (RNs, MDs, etc.) that you don't want this done and don't worry about repeating it and annoying people. They can forget in all the busy-ness.

As far as the medical students, under no circumstances would a student be allowed to stay in your room if it's against your wishes. That lady was full of beans. Again, be upfront when you arrive at the hospital and get roomed; you don't want any non-essential members of your care team present and THIS INCLUDES STUDENTS. They have no choice but to follow that wish and it's a major legal issue if they don't (HIPPA violation).

lizsites · November 2010

While I know you can refuse to have students in the room anywhere (as PP stated, it's a violation of HIPPA), make sure you double check with your Dr and the facility about the episiotomy bit. Apparently some places have a policy of "routine episiotomy", and they might just do it unless you specifically request otherwise. If you don't want it done, make sure that your wishes are clear with *everyone*.

JLSmith124 · November 2010

c*bear:
I went to my last childbirth class this weekend, and the instructor informed us all that at the hospital I am delivery just about 100% of women who deliver vaginally get an episiotomy. When I tried to question this she said you are not really given a choice on the matter, it "just happens because it is easier". She said she wasn't telling us to scare us, just to prepare us for what it. She told us we won't even know about it until after it is done anyway.
I have a regular appointment with my doctor today so I am going to ask her about this, but wouldn't they need your permission to perform any procedure on you?
Also, she made a comment about medical students in the room, and when I questioned this she said you have no choice in this matter that they are there to learn and will be in the room whether you like it or not. Does this sound right? Wouldn't they have to leave if I did not want them there?
Sorry if these are stupid questions, just want to hear others opinions.

Both of these are OPTIONS, not mandatory. She cannot tell you that you have no choice, you are the patient. The doctor can medically give you a strong suggestion of what to do, but if you do not want it done, then he cannot do it unless it is an emergency. Students (whether they are nursing or medical students) are only allowed in the room with the permission of the patient. You can refuse to have a student if you are not comfortable with it.

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