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Why some doctors still cut an episiotomy?

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These are easy to read and understand and are beautifully presented.

I would like to know why I was given an Episiotomy during the birth of my twins. My husband said that twin one's head had crowned when the doctor cut me.  I had only been pushing for 15 minutes and he decided it was taking too long.  The babies were not in distress, yet the circus of medical professionals in the room rarely bothered to look at the monitor.

The doctor who cut you is the only one who can say why.

If the twins were premature, it may be that the doctor still believes in the old superstition that cutting the woman's perineum can prevent brain trauma in premature babies.  This issue is addressed at:


The relevant part is:

"When [low-birth-weight] babies of similar weight and age are considered, the use of episiotomy appears to hold no advantages. ... In the absence of data to support the routine use of episiotomy in pre-term delivery this potentially harmful procedure should be avoided."

Many obstetricians are very concerned about being sued, and since a twin birth is considered to be high risk, he might have figured it was in his best interests to cut an episiotomy, as liability protection.

I asked a midwife, and was told it was because my daughter was a brow presentation.
This doesn't make sense.  Part of the responsibility of a good birth attendant is to help the baby's head to be as flexed as possible, with chin tucked to chest.  This is trivial once the baby's head is crowning; you simply apply gentle pressure to the back of the baby's head to keep it tucked.  If there were many loops of tight cord around the baby's neck, this might have made it difficult to flex the baby's head.  Otherwise,
the issue of a brow presentation is irrelevant.
I asked a relative who is also a midwife and was told it was because they were six week premature.  My husband and I really feel it wasn't necessary, when the baby would've been out with one more push. I've been brooding over this ever since.  I feel as if I've failed, I didn't want any intervention.

My mother said its a common procedure, that everyone gets one, maybe in her day.

It certainly used to be a routine procedure; research shows there's no benefit to episiotomy (to the mom and baby anyway), so responsible birth attendants are no longer cutting them.

Some birth attendants have figured out that it is not politically correct to cut episiotomies, so they just let women tear instead. This is still better than cutting an episiotomy, but it would be really nice if they valued an intact perineum even half as much as the women generally do.

Many midwives have learned techniques to help women avoid tearing so that over 70% of women in their care are able to give birth without any perineal tearing.  Some have suture rates as low as 10%.

This is one of those funny differences between OB culture and midwife culture - OBs tend to be proud of using more of their surgical skills, and midwives tend to be proud of using preventive techniques that avoid the need for all surgical techniques, including suturing.  So the OB culture just doesn't seem to have figured out how to prevent tearing. OBs who are in practice with midwives will often have picked up a thing or two and might have lower suture rates.

When women are shopping around for a birth attendant, it is really important to ask about the provider's episiotomy rate, their suture rate, and what they're doing to lower it.

P.S.  It's odd to use the word "given" with something that most people wouldn't really want.  I guess it's like being given a black eye.

This Web page is referenced from another page containing related information about Perineal Protection - Avoiding Tears


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