Re: [ozmidwifery] Episiotomy
I happened across this study today while researching forceps- it indicated the cutting an episiotomy when using forceps increases the chance of 3rd 4th degree tears. I don't think it specifies midline. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrievedb=PubMedlist_uids=15957996dopt=Abstract Monica - Original Message - From: Susan Cudlipp [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Tuesday, June 20, 2006 12:55 AM Subject: Re: [ozmidwifery] Episiotomy Hi Alice This came to me but it was not me that posted the question, so don't know if you just maybe hit the wrong button? Sue. - Original Message - From: Alice Morgan [EMAIL PROTECTED] To: [EMAIL PROTECTED] Cc: ozmidwifery@acegraphics.com.au Sent: Monday, June 19, 2006 1:38 PM Subject: RE: [ozmidwifery] Episiotomy Hi Suzi, I have several studies that show thiscan't think of them all off the top of my head, but will find them for you and send you the info. I'll have to dig out my thesis (I've been somewhat pretending it doesn't exist at the moment). As a start, I think the recent (2005) JAMA published study talks about it, as do Thacker and Banta (1983) and Woolley (1995). There's also one that compares mediolateral and midline episiotomies (Thacker, 2000 from the British Medical Journal). Hope this helps as a start...I'll try to see what else I can find and send to you. Alice From: suzi and brett [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Episiotomy Date: Mon, 19 Jun 2006 09:28:24 +1000 Can anyone point me in the right direction for good evidence that episiotomys have an increased risk of extending to 3 or 4 th degree? or am i remembering - interpreting incorrectly and the best evidence that we have only conclude generally that restrictive epis. has lowered morbidity because the women mostly doesnt end up with as much truama as anticipated. Little discussion i am having with one of our doctors - who says mediolateral cut is not at an increased risk of extending, only midline. My arguement was that only fetal distress with no time to wait for streaching ( or well informed maternal request?) is the only reasons for episiotomy. Im sure if it was a slice down the eye of a penis and the posibility of the man having painful sex and other morbidity for the next year - some doctors may think twice. Love Suz x _ New year, new job - there's more than 100,00 jobs at SEEK http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fninemsn%2Eseek%2Ecom%2Eau_t=752315885_r=Jan05_tagline_m=EXT -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.394 / Virus Database: 268.9.0/368 - Release Date: 16/06/2006 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Episiotomy
Please send to the list as I am also interested : ) Päivi - Original Message - From: Alice Morgan [EMAIL PROTECTED] To: [EMAIL PROTECTED] Cc: ozmidwifery@acegraphics.com.au Sent: Monday, June 19, 2006 8:38 AM Subject: RE: [ozmidwifery] Episiotomy Hi Suzi, I have several studies that show thiscan't think of them all off the top of my head, but will find them for you and send you the info. I'll have to dig out my thesis (I've been somewhat pretending it doesn't exist at the moment). As a start, I think the recent (2005) JAMA published study talks about it, as do Thacker and Banta (1983) and Woolley (1995). There's also one that compares mediolateral and midline episiotomies (Thacker, 2000 from the British Medical Journal). Hope this helps as a start...I'll try to see what else I can find and send to you. Alice From: suzi and brett [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Episiotomy Date: Mon, 19 Jun 2006 09:28:24 +1000 Can anyone point me in the right direction for good evidence that episiotomys have an increased risk of extending to 3 or 4 th degree? or am i remembering - interpreting incorrectly and the best evidence that we have only conclude generally that restrictive epis. has lowered morbidity because the women mostly doesnt end up with as much truama as anticipated. Little discussion i am having with one of our doctors - who says mediolateral cut is not at an increased risk of extending, only midline. My arguement was that only fetal distress with no time to wait for streaching ( or well informed maternal request?) is the only reasons for episiotomy. Im sure if it was a slice down the eye of a penis and the posibility of the man having painful sex and other morbidity for the next year - some doctors may think twice. Love Suz x _ New year, new job - there's more than 100,00 jobs at SEEK http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fninemsn%2Eseek%2Ecom%2Eau_t=752315885_r=Jan05_tagline_m=EXT -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Episiotomy
Hi Alice This came to me but it was not me that posted the question, so don't know if you just maybe hit the wrong button? Sue. - Original Message - From: Alice Morgan [EMAIL PROTECTED] To: [EMAIL PROTECTED] Cc: ozmidwifery@acegraphics.com.au Sent: Monday, June 19, 2006 1:38 PM Subject: RE: [ozmidwifery] Episiotomy Hi Suzi, I have several studies that show thiscan't think of them all off the top of my head, but will find them for you and send you the info. I'll have to dig out my thesis (I've been somewhat pretending it doesn't exist at the moment). As a start, I think the recent (2005) JAMA published study talks about it, as do Thacker and Banta (1983) and Woolley (1995). There's also one that compares mediolateral and midline episiotomies (Thacker, 2000 from the British Medical Journal). Hope this helps as a start...I'll try to see what else I can find and send to you. Alice From: suzi and brett [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Episiotomy Date: Mon, 19 Jun 2006 09:28:24 +1000 Can anyone point me in the right direction for good evidence that episiotomys have an increased risk of extending to 3 or 4 th degree? or am i remembering - interpreting incorrectly and the best evidence that we have only conclude generally that restrictive epis. has lowered morbidity because the women mostly doesnt end up with as much truama as anticipated. Little discussion i am having with one of our doctors - who says mediolateral cut is not at an increased risk of extending, only midline. My arguement was that only fetal distress with no time to wait for streaching ( or well informed maternal request?) is the only reasons for episiotomy. Im sure if it was a slice down the eye of a penis and the posibility of the man having painful sex and other morbidity for the next year - some doctors may think twice. Love Suz x _ New year, new job - there's more than 100,00 jobs at SEEK http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fninemsn%2Eseek%2Ecom%2Eau_t=752315885_r=Jan05_tagline_m=EXT -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.394 / Virus Database: 268.9.0/368 - Release Date: 16/06/2006 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Episiotomy
Hi Suzi, I have several studies that show thiscan't think of them all off the top of my head, but will find them for you and send you the info. I'll have to dig out my thesis (I've been somewhat pretending it doesn't exist at the moment). As a start, I think the recent (2005) JAMA published study talks about it, as do Thacker and Banta (1983) and Woolley (1995). There's also one that compares mediolateral and midline episiotomies (Thacker, 2000 from the British Medical Journal). Hope this helps as a start...I'll try to see what else I can find and send to you. Alice From: suzi and brett [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Episiotomy Date: Mon, 19 Jun 2006 09:28:24 +1000 Can anyone point me in the right direction for good evidence that episiotomys have an increased risk of extending to 3 or 4 th degree? or am i remembering - interpreting incorrectly and the best evidence that we have only conclude generally that restrictive epis. has lowered morbidity because the women mostly doesnt end up with as much truama as anticipated. Little discussion i am having with one of our doctors - who says mediolateral cut is not at an increased risk of extending, only midline. My arguement was that only fetal distress with no time to wait for streaching ( or well informed maternal request?) is the only reasons for episiotomy. Im sure if it was a slice down the eye of a penis and the posibility of the man having painful sex and other morbidity for the next year - some doctors may think twice. Love Suz x _ New year, new job there's more than 100,00 jobs at SEEK http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fninemsn%2Eseek%2Ecom%2Eau_t=752315885_r=Jan05_tagline_m=EXT -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] episiotomy resource from Vic PDCU
FYI: This is the latest in a series of reports from the Consultative Council on Obstetric and Paediatric Mortality and Morbidity entitled Morbidities associated with childbirth in Victoria Topic 2: Episiotomy and perineal lacerations. This report is on the website at http://www.health.vic.gov.au/maternitycare/index.htm This report is recommended to those hospitals and clinicians concerned with practice issues around episiotomy and rates of 3rd and 4th degree tears. As well as extensive data analysis, the report includes a comparison with other populations, trends and an examination of the related literature. It concludes with a section on implications for maternity service providers. It would be great if you could take a few moments to distribute this email. Wendy Dawson Senior Project Officer, Acute Programs Programs Branch, Metropolitan Health and Aged Care Services Division phone: 9616 2152 fax: 9616 2880 Find local movie times and trailers on Yahoo! Movies. http://au.movies.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] episiotomy resource from Vic PDCU
Dear Jen Thank you for sharing this with ozmid. I am impressed by the document on this web site if the Victorian government follows through on the questions asked and the implications of these documents birthing services in victoria could lead Australia into a new age of real evidence based practices?? Thank you Denise Hynd Never believe that a few caring people can't change the world. For, indeed, they are the only ones who ever have. Margaret Mead - Original Message - From: Jen Semple [EMAIL PROTECTED] To: [EMAIL PROTECTED] Sent: Sunday, August 15, 2004 2:20 PM Subject: [ozmidwifery] episiotomy resource from Vic PDCU FYI: This is the latest in a series of reports from the Consultative Council on Obstetric and Paediatric Mortality and Morbidity entitled Morbidities associated with childbirth in Victoria Topic 2: Episiotomy and perineal lacerations. This report is on the website at http://www.health.vic.gov.au/maternitycare/index.htm This report is recommended to those hospitals and clinicians concerned with practice issues around episiotomy and rates of 3rd and 4th degree tears. As well as extensive data analysis, the report includes a comparison with other populations, trends and an examination of the related literature. It concludes with a section on implications for maternity service providers. It would be great if you could take a few moments to distribute this email. Wendy Dawson Senior Project Officer, Acute Programs Programs Branch, Metropolitan Health and Aged Care Services Division phone: 9616 2152 fax: 9616 2880 Find local movie times and trailers on Yahoo! Movies. http://au.movies.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Episiotomy - when to cut?
It is amazing that not everyone tears apart under these conditions!! - Original Message - From: Robin Moon To: [EMAIL PROTECTED] Sent: Tuesday, June 10, 2003 2:47 PM Subject: Re: [ozmidwifery] Episiotomy - when to cut? oh, arent protocols cruel everything is wrong for her there, Jo. As Nikki says, pushingat her own pace and in a position that allowed gravity to help all help.IN the position you describe, she's actually pushing uphill, with the coccyxbeing sat on which reduces available space and her body and lungs are all compressed. I guess the protocols also dictated that she must start pushing from the minute 2nd stage begins? So she's dead exhausted when the head finally hits the peri? And has no energyto actually slow the head down during it's exit? I have found that slowing the head down even just by a contraction or two helps enormously. It allows the surrounding tissues to accomodate this sudden insult. Let the head spend more time stretching the perineum, and let the head bejust breathed out, rather than pushed will go a long way toachieving a gentle exit. If we're exercising we dont achieve maximum stretch the first time we try the splits. We get better with each little effort. In a compact way this is the same with the peri. If the women are told ( both during labour and very gently and encouragingly at the time) they understand that it will be beneficial to them afterwards and usually are very keen to help themselves. Heat applied to the peri and birthing in water also help this scenario. The stranded beetle position you describe Jo, will be ingrained on you forever as you learn first hand the horrible effects it has on women. I cant think of one good thing about it. Robin - Original Message - From: JoFromOz To: [EMAIL PROTECTED] Sent: Wednesday, June 11, 2003 12:55 AM Subject: Re: [ozmidwifery] Episiotomy - when to cut? Hi Nikki. As most women are where I work, she was semi-sitting; she was "chin on your chest, big breath, PUSH, quick breath and push again!" style pushing; and she was not following her own urges - that would have taken too long! 3 big long pushes per contraction. Anyone pushing more than 1 hour needs intervention... Jo - Original Message - From: Nikki Macfarlane To: [EMAIL PROTECTED] Sent: Tuesday, June 10, 2003 8:29 PM Subject: Re: [ozmidwifery] Episiotomy - when to cut? Jo, What a frustrating situation for you, her other caregivers and of course the woman herself. Can I ask what position she was in when she was pushing. Also,how she was pushing - following her own urge with everyone following her pace or with counting, held breath and purple pushing? Nikki MacfarlaneChildbirth Internationalwww.childbirthinternational.com [EMAIL PROTECTED] Distance training for the world's childbirth educators and doulas - Original Message - From: JoFromOz To: [EMAIL PROTECTED] Sent: Tuesday, June 10, 2003 7:59 PM Subject: [ozmidwifery] Episiotomy - when to cut? Hi all fellow midwives and students and all :) Looking after a woman last night who was a primigravida, term, induction for SROM, not in labour. RMO needed birth experience, so he did the catching. He did not cut an episiotomy, and nor would I have, but this woman ended up with horrible tears, in all directions, almost to the clitoris on both sides. We were 'scolded' by the consultant for not doing an episiotomy.
Re: [ozmidwifery] Episiotomy - when to cut?
It's sad, isn't it :(
Re: [ozmidwifery] Episiotomy - when to cut?
I believe that tearing has a lot to do with the condition of a womans tissues. Diet plays a hugh role in this and research shows when all things are considered, ie position, diet, perineal massage about 25% of women will still tear. There is so much we don't know! For instance was she scared and did she push the baby with a shove so to speak. Was there a hand in the road, was she on her back. I don't know but maybe changing some of those things may have helped. Dierdre
Re: [ozmidwifery] Episiotomy - when to cut?
Jo, I am actually on holiday and travelling so have no references with me but there is a lot of info out there on physiological pushing as well as proper upright positioning etc. Chase up the work of Constance Benyon who wrote about physiological pushing vs the valsalver manouver in 1952. Cheers Judy - Original Message - From: JoFromOz To: [EMAIL PROTECTED] Sent: Wednesday, June 11, 2003 12:55 AM Subject: Re: [ozmidwifery] Episiotomy - when to cut? Hi Nikki. As most women are where I work, she was semi-sitting; she was "chin on your chest, big breath, PUSH, quick breath and push again!" style pushing; and she was not following her own urges - that would have taken too long! 3 big long pushes per contraction. Anyone pushing more than 1 hour needs intervention... Jo - Original Message - From: Nikki Macfarlane To: [EMAIL PROTECTED] Sent: Tuesday, June 10, 2003 8:29 PM Subject: Re: [ozmidwifery] Episiotomy - when to cut? Jo, What a frustrating situation for you, her other caregivers and of course the woman herself. Can I ask what position she was in when she was pushing. Also, how she was pushing - following her own urge with everyone following her pace or with counting, held breath and purple pushing? Nikki Macfarlane Childbirth International www.childbirthinternational.com [EMAIL PROTECTED] Distance training for the world's childbirth educators and doulas - Original Message - From: JoFromOz To: [EMAIL PROTECTED] Sent: Tuesday, June 10, 2003 7:59 PM Subject: [ozmidwifery] Episiotomy - when to cut? Hi all fellow midwives and students and all :) Looking after a woman last night who was a primigravida, term, induction for SROM, not in labour. RMO needed birth experience, so he did the catching. He did not cut an episiotomy, and nor would I have, but this woman ended up with horrible tears, in all directions, almost to the clitoris on both sides. We were 'scolded' by the consultant for not doing an episiotomy. Get mobile Hotmail. Click here -- This mailing list is sponsored by ACE Graphics. Visit to subscribe or unsubscribe.
[ozmidwifery] Episiotomy - when to cut?
Hi all fellow midwives and students and all :) Looking after a woman last night who was a primigravida, term, induction for SROM, not in labour. RMO needed birth experience, so he did the catching. He did not cut an episiotomy, and nor would I have, but this woman ended up with horrible tears, in all directions, almost to the clitoris on both sides. We were 'scolded' by the consultant for not doing an episiotomy. Any comments? Am happy to clarify things off list if it would be easier to comment. Thanks I had a nightmare about it, needed to debrief! Jo --Babies are Born... Pizzas are delivered.
Re: [ozmidwifery] Episiotomy - when to cut?
Jo, What a frustrating situation for you, her other caregivers and of course the woman herself. Can I ask what position she was in when she was pushing. Also,how she was pushing - following her own urge with everyone following her pace or with counting, held breath and purple pushing? Nikki MacfarlaneChildbirth Internationalwww.childbirthinternational.com [EMAIL PROTECTED] Distance training for the world's childbirth educators and doulas - Original Message - From: JoFromOz To: [EMAIL PROTECTED] Sent: Tuesday, June 10, 2003 7:59 PM Subject: [ozmidwifery] Episiotomy - when to cut? Hi all fellow midwives and students and all :) Looking after a woman last night who was a primigravida, term, induction for SROM, not in labour. RMO needed birth experience, so he did the catching. He did not cut an episiotomy, and nor would I have, but this woman ended up with horrible tears, in all directions, almost to the clitoris on both sides. We were 'scolded' by the consultant for not doing an episiotomy.
Re: [ozmidwifery] Episiotomy - when to cut?
Hi Nikki. As most women are where I work, she was semi-sitting; she was "chin on your chest, big breath, PUSH, quick breath and push again!" style pushing; and she was not following her own urges - that would have taken too long! 3 big long pushes per contraction. Anyone pushing more than 1 hour needs intervention... Jo - Original Message - From: Nikki Macfarlane To: [EMAIL PROTECTED] Sent: Tuesday, June 10, 2003 8:29 PM Subject: Re: [ozmidwifery] Episiotomy - when to cut? Jo, What a frustrating situation for you, her other caregivers and of course the woman herself. Can I ask what position she was in when she was pushing. Also,how she was pushing - following her own urge with everyone following her pace or with counting, held breath and purple pushing? Nikki MacfarlaneChildbirth Internationalwww.childbirthinternational.com [EMAIL PROTECTED] Distance training for the world's childbirth educators and doulas - Original Message - From: JoFromOz To: [EMAIL PROTECTED] Sent: Tuesday, June 10, 2003 7:59 PM Subject: [ozmidwifery] Episiotomy - when to cut? Hi all fellow midwives and students and all :) Looking after a woman last night who was a primigravida, term, induction for SROM, not in labour. RMO needed birth experience, so he did the catching. He did not cut an episiotomy, and nor would I have, but this woman ended up with horrible tears, in all directions, almost to the clitoris on both sides. We were 'scolded' by the consultant for not doing an episiotomy.
Re: [ozmidwifery] Episiotomy - when to cut?
oh, arent protocols cruel everything is wrong for her there, Jo. As Nikki says, pushingat her own pace and in a position that allowed gravity to help all help.IN the position you describe, she's actually pushing uphill, with the coccyxbeing sat on which reduces available space and her body and lungs are all compressed. I guess the protocols also dictated that she must start pushing from the minute 2nd stage begins? So she's dead exhausted when the head finally hits the peri? And has no energyto actually slow the head down during it's exit? I have found that slowing the head down even just by a contraction or two helps enormously. It allows the surrounding tissues to accomodate this sudden insult. Let the head spend more time stretching the perineum, and let the head bejust breathed out, rather than pushed will go a long way toachieving a gentle exit. If we're exercising we dont achieve maximum stretch the first time we try the splits. We get better with each little effort. In a compact way this is the same with the peri. If the women are told ( both during labour and very gently and encouragingly at the time) they understand that it will be beneficial to them afterwards and usually are very keen to help themselves. Heat applied to the peri and birthing in water also help this scenario. The stranded beetle position you describe Jo, will be ingrained on you forever as you learn first hand the horrible effects it has on women. I cant think of one good thing about it. Robin - Original Message - From: JoFromOz To: [EMAIL PROTECTED] Sent: Wednesday, June 11, 2003 12:55 AM Subject: Re: [ozmidwifery] Episiotomy - when to cut? Hi Nikki. As most women are where I work, she was semi-sitting; she was "chin on your chest, big breath, PUSH, quick breath and push again!" style pushing; and she was not following her own urges - that would have taken too long! 3 big long pushes per contraction. Anyone pushing more than 1 hour needs intervention... Jo - Original Message - From: Nikki Macfarlane To: [EMAIL PROTECTED] Sent: Tuesday, June 10, 2003 8:29 PM Subject: Re: [ozmidwifery] Episiotomy - when to cut? Jo, What a frustrating situation for you, her other caregivers and of course the woman herself. Can I ask what position she was in when she was pushing. Also,how she was pushing - following her own urge with everyone following her pace or with counting, held breath and purple pushing? Nikki MacfarlaneChildbirth Internationalwww.childbirthinternational.com [EMAIL PROTECTED] Distance training for the world's childbirth educators and doulas - Original Message - From: JoFromOz To: [EMAIL PROTECTED] Sent: Tuesday, June 10, 2003 7:59 PM Subject: [ozmidwifery] Episiotomy - when to cut? Hi all fellow midwives and students and all :) Looking after a woman last night who was a primigravida, term, induction for SROM, not in labour. RMO needed birth experience, so he did the catching. He did not cut an episiotomy, and nor would I have, but this woman ended up with horrible tears, in all directions, almost to the clitoris on both sides. We were 'scolded' by the consultant for not doing an episiotomy.
