Re: [ozmidwifery] when to cut an episiotomy
Congratulations, Andrea, way to go! What's that old quotation? ? A good ob has a big broad behind and knows how to put his hands under it and sit on them! We could apply that to mws, too. Love Gloria Quoting Andrea Quanchi [EMAIL PROTECTED]: Threads like this come back to haunt you. Last night I cared for a primip who I took over on night duty as she was about to enter second stage after having laboured all day and having had no sleep the night before. Given lots of time she progressed very slowly to having the head distending the peri and there it sat through several contractions with no further progress despite maternal effort ( and yes I did think oh no hear goes I'm going to have to eat my words and cut an epis. I looked at the scissors and decided to leave them where they were and listen to the FH instead which was strong. Then her body decided that it needed a rest and we sat for about 15 min with no contractions and listening to the FH while she slept. Then she woke up had one contraction where she birthed the head over an intact peri and a second soon after which birthed the body before she lay back and said that all I had to give! What more did she need. I had a student with me who was completely baffled and we spent quite some time afterwards discussing what had just happened because that had never been in anything she had heard or read. One very happy mum and one midwife with her stats intact!!! Andrea Quanchi On 22/08/2005, at 11:35 PM, Katrina Flora wrote: Not entirely sure I want to know, but Mary what is buttonholing? Katrina - Original Message - From: Mary Murphy To: ozmidwifery@acegraphics.com.au Sent: Monday, August 22, 2005 10:03 AM Subject: RE: [ozmidwifery] when to cut an episiotomy Because you asked: I have cut 3 in 22 yrs as a homebirth midwife. 1 for foetal distress, 1 for buttonholing the other I cant remember. It was all so long ago. Working with a group of 7 other midwives, I have never heard of them cutting episiotomies either. MM Who else would like to celebrate their lack of desire or interest in cutting a woman's perineum. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] when to cut an episiotomy
Thank you so much for your answers regarding the episiotomy. I have been reading about it, and always knew how unneccessary it is, but I guess I didn't realise howlittle it is needed, when the birth is cared in a correct way. I must say I was supprised about your epis rates, and it gave me even more courage to fight against it over here... Thank you for sharing your experience. Paivi
Re: [ozmidwifery] when to cut an episiotomy
Not entirely sure I want to know, but Mary what is "buttonholing"? Katrina - Original Message - From: Mary Murphy To: ozmidwifery@acegraphics.com.au Sent: Monday, August 22, 2005 10:03 AM Subject: RE: [ozmidwifery] when to cut an episiotomy Because you asked: I have cut 3 in 22 yrs as a homebirth midwife. 1 for foetal distress, 1 for buttonholing the other I cant remember. It was all so long ago. Working with a group of 7 other midwives, I have never heard of them cutting episiotomies either. MM Who else would like to celebrate their lack of desire or interest in cutting a woman's perineum.
Re: [ozmidwifery] when to cut an episiotomy
In my training, in UK in '79, the episiotomy rate was very high. Of my 30 obligatory deliveries, 29 had epis, the 30th being a multip who delivered too quickly for anyone to push scissors into my hands. I was only taught how to deliver with one, no effort was made to teach how to protect the perineum.Mind you, we were excellent at infiltration and cutting! The obs at the time's view was " all primips need one and all multips who have previously had one!" Over the years my incidence of performing them reduced, and of the past 250 births I have performed epis on 7 occasions, almost without exception for fetal compromise. Sadly, we once again seem to be coming up against the (medical) viewpoint that we are not doing enough! None of my colleaugues perform routine epis, and our rate is low, and lately we have had several 'remarks' from doctors who have been asked to suture tears, that we should have done an epis. I have even heard the physio telling women that they are a good idea! Interestingly, I have seen far fewer 3' tears since seeing a huge reduction in epis rates, used to see them on a regular basis. Sue "The only thing necessary for the triumph of evil is for good men to do nothing"Edmund Burke - Original Message - From: Andrea Quanchi To: ozmidwifery@acegraphics.com.au Sent: Monday, August 22, 2005 6:06 AM Subject: Re: [ozmidwifery] when to cut an episiotomy I think many midwives can claim very good episiotomy rates. Mine over twenty years in "0". My virginal scissors get taken to each birth but have never been out of the packet except to be put in a new packet and re sterilised. Who else would like to celebrate their lack of desire or interest in cutting a woman's perineum.Andrea QuanchiOn 21/08/2005, at 6:57 PM, Janet Fraser wrote: I'm not one of the professionals in here, Paivi but hi anyway. : )I've read in a few places about how episiotomy rates suddenly drop when studies into them begin. A hb MW I know does less than one a year so I figure that's a good guide.Mostly in hospitals they're performed for no reason at all but the damage they do to women's bodies and psyches horrifies me. It's sanctioned genital mutilation. In birth planning meetings I run I suggest to women that they never put their bodies in a position that can be easily reached by someone with scissors. Our rates are very high in Australia. Well IMO, any rate of episiotomy is too high unless it's negligible.Just my 2c ; )Janet - Original Message -From: Päivi To: ozmidwifery@acegraphics.com.au Sent: Sunday, August 21, 2005 6:31 PMSubject: [ozmidwifery] when to cut an episiotomyA mom asked me when is episiotomy really needed. She had asked from many professionals, and all just gave her the answer, that "They will try to avoid episiotomy, but will cut just in case, if not sure". In Finland the episiotomyrates arefrom 4% to 50%, and for firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will know best. (That is a medicalaized hospital midwife in most cases).I already know, that you have a different opinion on when it is needed, but it would be interesting to know from you, who work as midwifes, how oftenhave you performed episiotomies? Does anyone know, what is the national average in the Australian hospitals?Paivi No virus found in this incoming message.Checked by AVG Anti-Virus.Version: 7.0.338 / Virus Database: 267.10.13/78 - Release Date: 19/08/2005
Re: [ozmidwifery] when to cut an episiotomy
This reminds me of a time when I had a primi with an intact peri in Saudi. I got called over to see her in the ward many hours later as she was in great pain. Inspection showed a HUGE haematoma starting high in the vagina, needed emergency draining and haemostasis as well as blood transfusion. I was chastised by the OB for not doing an epis. I am sure the damage was done ages before the head was on the peri and an epis 'cuttable'. They just don't think, just trot out their over used comments. Needless to say, it hasn't changed my practice. Cheers Judy --- Susan Cudlipp [EMAIL PROTECTED] wrote: In my training, in UK in '79, the episiotomy rate was very high. Of my 30 obligatory deliveries, 29 had epis, the 30th being a multip who delivered too quickly for anyone to push scissors into my hands. I was only taught how to deliver with one, no effort was made to teach how to protect the perineum. Mind you, we were excellent at infiltration and cutting! The obs at the time's view was all primips need one and all multips who have previously had one! Over the years my incidence of performing them reduced, and of the past 250 births I have performed epis on 7 occasions, almost without exception for fetal compromise. Sadly, we once again seem to be coming up against the (medical) viewpoint that we are not doing enough! None of my colleaugues perform routine epis, and our rate is low, and lately we have had several 'remarks' from doctors who have been asked to suture tears, that we should have done an epis. I have even heard the physio telling women that they are a good idea! Interestingly, I have seen far fewer 3' tears since seeing a huge reduction in epis rates, used to see them on a regular basis. Sue The only thing necessary for the triumph of evil is for good men to do nothing Edmund Burke - Original Message - From: Andrea Quanchi To: ozmidwifery@acegraphics.com.au Sent: Monday, August 22, 2005 6:06 AM Subject: Re: [ozmidwifery] when to cut an episiotomy I think many midwives can claim very good episiotomy rates. Mine over twenty years in 0. My virginal scissors get taken to each birth but have never been out of the packet except to be put in a new packet and re sterilised. Who else would like to celebrate their lack of desire or interest in cutting a woman's perineum. Andrea Quanchi On 21/08/2005, at 6:57 PM, Janet Fraser wrote: I'm not one of the professionals in here, Paivi but hi anyway. : ) I've read in a few places about how episiotomy rates suddenly drop when studies into them begin. A hb MW I know does less than one a year so I figure that's a good guide. Mostly in hospitals they're performed for no reason at all but the damage they do to women's bodies and psyches horrifies me. It's sanctioned genital mutilation. In birth planning meetings I run I suggest to women that they never put their bodies in a position that can be easily reached by someone with scissors. Our rates are very high in Australia. Well IMO, any rate of episiotomy is too high unless it's negligible. Just my 2c ; ) Janet - Original Message - From: Päivi To: ozmidwifery@acegraphics.com.au Sent: Sunday, August 21, 2005 6:31 PM Subject: [ozmidwifery] when to cut an episiotomy A mom asked me when is episiotomy really needed. She had asked from many professionals, and all just gave her the answer, that They will try to avoid episiotomy, but will cut just in case, if not sure. In Finland the episiotomy rates are from 4% to 50%, and for firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will know best. (That is a medicalaized hospital midwife in most cases). I already know, that you have a different opinion on when it is needed, but it would be interesting to know from you, who work as midwifes, how often have you performed episiotomies? Does anyone know, what is the national average in the Australian hospitals? Paivi -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.338 / Virus Database: 267.10.13/78 - Release Date: 19/08/2005 Do you Yahoo!? Make free PC-to-PC calls to your friends overseas. You could win a holiday to see them! http://au.docs.yahoo.com/promotions/messenger/ -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] when to cut an episiotomy
Buttonholing is when the babys head stretches the perineum to the point of splitting before it tears at the vaginal opening. Ie closed at the vagina, closed at the rectal end and split in the middle, like a buttonhole. It can (and did) cause delayed healing because of the blanching of the skin. (no circulation) It can also extend to 3rd and 4th degree tears because the vaginal opening holds firm. That is a simple explanation. Others might have a more concise one. Sue, it would be good to learn to suture the tears yourselves. It is an essential midwifery skill. Get Chris White from KEMH to do a professional development day. She does our updates every year. Otherwise it is obvious that Obs find episiotomies easier to stitch than tears because they are so used to the straight edge. It stretches their skills a bit to do tears. Surely there should be less repairs all round? MM Not entirely sure I want to know, but Mary what is buttonholing?
Re: [ozmidwifery] when to cut an episiotomy
Threads like this come back to haunt you. Last night I cared for a primip who I took over on night duty as she was about to enter second stage after having laboured all day and having had no sleep the night before. Given lots of time she progressed very slowly to having the head distending the peri and there it sat through several contractions with no further progress despite maternal effort ( and yes I did think oh no hear goes I'm going to have to eat my words and cut an epis. I looked at the scissors and decided to leave them where they were and listen to the FH instead which was strong. Then her body decided that it needed a rest and we sat for about 15 min with no contractions and listening to the FH while she slept. Then she woke up had one contraction where she birthed the head over an intact peri and a second soon after which birthed the body before she lay back and said that all I had to give! What more did she need. I had a student with me who was completely baffled and we spent quite some time afterwards discussing what had just happened because that had never been in anything she had heard or read. One very happy mum and one midwife with her stats intact!!! Andrea Quanchi On 22/08/2005, at 11:35 PM, Katrina Flora wrote: Not entirely sure I want to know, but Mary what is buttonholing? Katrina x-tad-bigger- Original Message -/x-tad-bigger x-tad-biggerFrom:/x-tad-biggerx-tad-bigger /x-tad-biggerx-tad-biggerMary Murphy/x-tad-biggerx-tad-bigger /x-tad-bigger x-tad-biggerTo:/x-tad-biggerx-tad-bigger /x-tad-biggerx-tad-biggerozmidwifery@acegraphics.com.au/x-tad-biggerx-tad-bigger /x-tad-bigger x-tad-biggerSent:/x-tad-biggerx-tad-bigger Monday, August 22, 2005 10:03 AM/x-tad-bigger x-tad-biggerSubject:/x-tad-biggerx-tad-bigger RE: [ozmidwifery] when to cut an episiotomy/x-tad-bigger x-tad-biggerBecause you asked: I have cut 3 in 22 yrs as a homebirth midwife. 1 for foetal distress, 1 for “buttonholing’ the other I can’t remember. It was all so long ago. Working with a group of 7 other midwives, I have never heard of them cutting episiotomies either. MM/x-tad-bigger x-tad-bigger /x-tad-bigger Who else would like to celebrate their lack of desire or interest in cutting a woman's perineum.
Re: [ozmidwifery] when to cut an episiotomy
I'm not one of the professionals in here, Paivi but hi anyway. : )I've read in a few places about how episiotomy rates suddenly drop when studies into them begin. A hb MW I know does less than one a year so I figure that's a good guide.Mostly in hospitals they're performed for no reason at all but the damage they do to women's bodies and psyches horrifies me. It's sanctioned genital mutilation. In birth planning meetings I run I suggest to women that they never put their bodies in a position that can be easily reached by someone with scissors. Our rates are very high in Australia. Well IMO, any rate of episiotomy is too high unless it's negligible. Just my 2c ; ) Janet - Original Message - From: Päivi To: ozmidwifery@acegraphics.com.au Sent: Sunday, August 21, 2005 6:31 PM Subject: [ozmidwifery] when to cut an episiotomy A mom asked me when is episiotomy really needed. She had asked from many professionals, and all just gave her the answer, that "They will try to avoid episiotomy, but will cut just in case, if not sure". In Finland the episiotomyrates arefrom 4% to 50%, and for firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will know best. (That is a medicalaized hospital midwife in most cases).I already know, that you have a different opinion on when it is needed, but it would be interesting to know from you, who work as midwifes, how oftenhave you performed episiotomies? Does anyone know, what is the national average in the Australian hospitals? Paivi
RE: [ozmidwifery] when to cut an episiotomy
Title: Bericht Hoi Païvi, This was on the list a while ago. greetings Lieve Routine episiotomy shows no benefits, only harmSource: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 Lieve Huybrechts vroedvrouw 0477/740853 -Oorspronkelijk bericht-Van: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Namens PäiviVerzonden: zondag 21 augustus 2005 10:31Aan: ozmidwifery@acegraphics.com.auOnderwerp: [ozmidwifery] when to cut an episiotomy A mom asked me when is episiotomy really needed. She had asked from many professionals, and all just gave her the answer, that "They will try to avoid episiotomy, but will cut just in case, if not sure". In Finland the episiotomyrates arefrom 4% to 50%, and for firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will know best. (That is a medicalaized hospital midwife in most cases).I already know, that you have a different opinion on when it is needed, but it would be interesting to know from you, who work as midwifes, how oftenhave you performed episiotomies? Does anyone know, what is the national average in the Australian hospitals? Paivi --No virus found in this incoming message.Checked by AVG Anti-Virus.Version: 7.0.338 / Virus Database: 267.10.13/78 - Release Date: 19/08/2005 -- No virus found in this outgoing message. Checked by AVG Anti-Virus. Version: 7.0.338 / Virus Database: 267.10.13/78 - Release Date: 19/08/2005
RE: [ozmidwifery] when to cut an episiotomy
I will only do an episiotomy if I am really concerned about getting the baby out quickly. I have done one on a peri that was really tight, and didn't stretch up. I think I have done three in my career, Nicole C. -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Janet FraserSent: Sunday, August 21, 2005 6:57 PMTo: ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] when to cut an episiotomy I'm not one of the professionals in here, Paivi but hi anyway. : )I've read in a few places about how episiotomy rates suddenly drop when studies into them begin. A hb MW I know does less than one a year so I figure that's a good guide.Mostly in hospitals they're performed for no reason at all but the damage they do to women's bodies and psyches horrifies me. It's sanctioned genital mutilation. In birth planning meetings I run I suggest to women that they never put their bodies in a position that can be easily reached by someone with scissors. Our rates are very high in Australia. Well IMO, any rate of episiotomy is too high unless it's negligible. Just my 2c ; ) Janet - Original Message - From: Päivi To: ozmidwifery@acegraphics.com.au Sent: Sunday, August 21, 2005 6:31 PM Subject: [ozmidwifery] when to cut an episiotomy A mom asked me when is episiotomy really needed. She had asked from many professionals, and all just gave her the answer, that "They will try to avoid episiotomy, but will cut just in case, if not sure". In Finland the episiotomyrates arefrom 4% to 50%, and for firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will know best. (That is a medicalaized hospital midwife in most cases).I already know, that you have a different opinion on when it is needed, but it would be interesting to know from you, who work as midwifes, how oftenhave you performed episiotomies? Does anyone know, what is the national average in the Australian hospitals? Paivi
Re: [ozmidwifery] when to cut an episiotomy
Hi Nicole, That is so awasome, how many births have you done in your career? I read about a midwife, who had performed 6 episiotomies in 650 births. Two of these were when she was taught how to make them as a student. Paivi - Original Message - From: Nicole Carver To: ozmidwifery@acegraphics.com.au Sent: Sunday, August 21, 2005 12:55 PM Subject: RE: [ozmidwifery] when to cut an episiotomy I will only do an episiotomy if I am really concerned about getting the baby out quickly. I have done one on a peri that was really tight, and didn't stretch up. I think I have done three in my career, Nicole C. -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Janet FraserSent: Sunday, August 21, 2005 6:57 PMTo: ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] when to cut an episiotomy I'm not one of the professionals in here, Paivi but hi anyway. : )I've read in a few places about how episiotomy rates suddenly drop when studies into them begin. A hb MW I know does less than one a year so I figure that's a good guide.Mostly in hospitals they're performed for no reason at all but the damage they do to women's bodies and psyches horrifies me. It's sanctioned genital mutilation. In birth planning meetings I run I suggest to women that they never put their bodies in a position that can be easily reached by someone with scissors. Our rates are very high in Australia. Well IMO, any rate of episiotomy is too high unless it's negligible. Just my 2c ; ) Janet - Original Message - From: Päivi To: ozmidwifery@acegraphics.com.au Sent: Sunday, August 21, 2005 6:31 PM Subject: [ozmidwifery] when to cut an episiotomy A mom asked me when is episiotomy really needed. She had asked from many professionals, and all just gave her the answer, that "They will try to avoid episiotomy, but will cut just in case, if not sure". In Finland the episiotomyrates arefrom 4% to 50%, and for firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will know best. (That is a medicalaized hospital midwife in most cases).I already know, that you have a different opinion on when it is needed, but it would be interesting to know from you, who work as midwifes, how oftenhave you performed episiotomies? Does anyone know, what is the national average in the Australian hospitals? Paivi
RE: [ozmidwifery] when to cut an episiotomy
Hi Paivi, Not as many births as some of my colleagues. However, I have been to a Dennis Walsh workshop called something like Evidence Based Care in Normal Labour. He stated that the ONLY evidence based reason for episiotomy is in severe fetal distress. They are sometimes required for manoevres to get a baby out with severe shoulder dystocia, but in most cases not. Certainly, I have had a couple of tears personally, and I didn't find them a problem. However, the thought of someone taking scissors to my perineum fills me with terror! Kind regards, Nicole. -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of PäiviSent: Sunday, August 21, 2005 9:53 PMTo: ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] when to cut an episiotomy Hi Nicole, That is so awasome, how many births have you done in your career? I read about a midwife, who had performed 6 episiotomies in 650 births. Two of these were when she was taught how to make them as a student. Paivi - Original Message - From: Nicole Carver To: ozmidwifery@acegraphics.com.au Sent: Sunday, August 21, 2005 12:55 PM Subject: RE: [ozmidwifery] when to cut an episiotomy I will only do an episiotomy if I am really concerned about getting the baby out quickly. I have done one on a peri that was really tight, and didn't stretch up. I think I have done three in my career, Nicole C. -Original Message-From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Janet FraserSent: Sunday, August 21, 2005 6:57 PMTo: ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] when to cut an episiotomy I'm not one of the professionals in here, Paivi but hi anyway. : )I've read in a few places about how episiotomy rates suddenly drop when studies into them begin. A hb MW I know does less than one a year so I figure that's a good guide.Mostly in hospitals they're performed for no reason at all but the damage they do to women's bodies and psyches horrifies me. It's sanctioned genital mutilation. In birth planning meetings I run I suggest to women that they never put their bodies in a position that can be easily reached by someone with scissors. Our rates are very high in Australia. Well IMO, any rate of episiotomy is too high unless it's negligible. Just my 2c ; ) Janet - Original Message - From: Päivi To: ozmidwifery@acegraphics.com.au Sent: Sunday, August 21, 2005 6:31 PM Subject: [ozmidwifery] when to cut an episiotomy A mom asked me when is episiotomy really needed. She had asked from many professionals, and all just gave her the answer, that "They will try to avoid episiotomy, but will cut just in case, if not sure". In Finland the episiotomyrates arefrom 4% to 50%, and for firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will know best. (That is a medicalaized hospital midwife in most cases).I already know, that you have a different opinion on when it is needed, but it would be interesting to know from you, who work as midwifes, how oftenhave you performed episiotomies? Does anyone know, what is the national average in the Australian hospitals? Paivi
RE: [ozmidwifery] when to cut an episiotomy
I have never cut an episiotomy since I have been registered as a midwife. I did as a student midwife in 1988. Sally Westbury Homebirth Midwife Learn from mothers and babies; every one of them has a unique story to tell. Look for wisdom in the humblest places - that's usually where you'll find it. Lois Wilson
Re: [ozmidwifery] when to cut an episiotomy
I think many midwives can claim very good episiotomy rates. Mine over twenty years in 0. My virginal scissors get taken to each birth but have never been out of the packet except to be put in a new packet and re sterilised. Who else would like to celebrate their lack of desire or interest in cutting a woman's perineum. Andrea Quanchi On 21/08/2005, at 6:57 PM, Janet Fraser wrote: I'm not one of the professionals in here, Paivi but hi anyway. : ) I've read in a few places about how episiotomy rates suddenly drop when studies into them begin. A hb MW I know does less than one a year so I figure that's a good guide. Mostly in hospitals they're performed for no reason at all but the damage they do to women's bodies and psyches horrifies me. It's sanctioned genital mutilation. In birth planning meetings I run I suggest to women that they never put their bodies in a position that can be easily reached by someone with scissors. Our rates are very high in Australia. Well IMO, any rate of episiotomy is too high unless it's negligible. Just my 2c ; ) Janet x-tad-bigger- Original Message -/x-tad-bigger x-tad-biggerFrom:/x-tad-biggerx-tad-bigger /x-tad-biggerx-tad-biggerPäivi/x-tad-biggerx-tad-bigger /x-tad-bigger x-tad-biggerTo:/x-tad-biggerx-tad-bigger /x-tad-biggerx-tad-bigger[EMAIL PROTECTED]/x-tad-biggerx-tad-bigger /x-tad-bigger x-tad-biggerSent:/x-tad-biggerx-tad-bigger Sunday, August 21, 2005 6:31 PM/x-tad-bigger x-tad-biggerSubject:/x-tad-biggerx-tad-bigger [ozmidwifery] when to cut an episiotomy/x-tad-bigger A mom asked me when is episiotomy really needed. She had asked from many professionals, and all just gave her the answer, that They will try to avoid episiotomy, but will cut just in case, if not sure. In Finland the episiotomy rates are from 4% to 50%, and for firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will know best. (That is a medicalaized hospital midwife in most cases). I already know, that you have a different opinion on when it is needed, but it would be interesting to know from you, who work as midwifes, how often have you performed episiotomies? Does anyone know, what is the national average in the Australian hospitals? Paivi
RE: [ozmidwifery] when to cut an episiotomy
Also to consider, a sentence in Episiotomy and the Second Stage of Labor edited by Sheila Kitzinger that has always stood out for me as it makes so much sense. Whenever you put the scissors in and cut you ALWAYS have second degree perineal trauma. If you work to birth the baby with an intact peri then more than half of the time you will have it. Why do we cause so much pain to women unnecessarily?? In the last few years I have done a first degree nick for a tight peri and another time for a tight hymenal ring but neither needed sutures. Where I work we only have the cord scissors on our tray. Cheers Judy --- Lieve Huybrechts [EMAIL PROTECTED] wrote: Hoi Païvi, This was on the list a while ago. greetings Lieve 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 Lieve Huybrechts vroedvrouw 0477/740853 -Oorspronkelijk bericht- Van: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Namens Päivi Verzonden: zondag 21 augustus 2005 10:31 Aan: [EMAIL PROTECTED] Onderwerp: [ozmidwifery] when to cut an episiotomy A mom asked me when is episiotomy really needed. She had asked from many professionals, and all just gave her the answer, that They will try to avoid episiotomy, but will cut just in case, if not sure. In Finland the episiotomy rates are from 4% to 50%, and for firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will know best. (That is a medicalaized hospital midwife in most cases). I already know, that you have a different opinion on when it is needed, but it would be interesting to know from you, who work as midwifes, how often have you performed episiotomies? Does anyone know, what is the national average in the Australian hospitals? Paivi -- No virus found in this incoming message. Checked by AVG Anti-Virus. Version: 7.0.338 / Virus Database: 267.10.13/78 - Release Date: 19/08/2005 -- No virus found in this outgoing message. Checked by AVG Anti-Virus. Version: 7.0.338 / Virus Database: 267.10.13/78 - Release Date: 19/08/2005 Do you Yahoo!? Try Yahoo! Photomail Beta: Send up to 300 photos in one email! http://au.photomail.mail.yahoo.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] when to cut an episiotomy
Because you asked: I have cut 3 in 22 yrs as a homebirth midwife. 1 for foetal distress, 1 for buttonholing the other I cant remember. It was all so long ago. Working with a group of 7 other midwives, I have never heard of them cutting episiotomies either. MM Who else would like to celebrate their lack of desire or interest in cutting a woman's perineum.
Re: [ozmidwifery] when to cut an episiotomy
In more than 25 years and over 1200 births, I am ashamed to tell you I've cut 3. One for an unyielding primip perineum which would not budge after hour of crowning. Next birth, it stretched nicely and didn't need an epis. Two, as a last ditch effort in a fatal shoulder dystocia--didn't help anything. Third for a distressed babe with bad scalp colour, born with a non pulsing cord and am glad I did it because I think there was a real problem there that MAY have compromised the baby. Gloria Lemay, Vancouver BC - Original Message - From: Andrea Quanchi To: [EMAIL PROTECTED] Sent: Sunday, August 21, 2005 3:06 PM Subject: Re: [ozmidwifery] when to cut an episiotomy I think many midwives can claim very good episiotomy rates. Mine over twenty years in "0". My virginal scissors get taken to each birth but have never been out of the packet except to be put in a new packet and re sterilised. Who else would like to celebrate their lack of desire or interest in cutting a woman's perineum.Andrea QuanchiOn 21/08/2005, at 6:57 PM, Janet Fraser wrote: I'm not one of the professionals in here, Paivi but hi anyway. : )I've read in a few places about how episiotomy rates suddenly drop when studies into them begin. A hb MW I know does less than one a year so I figure that's a good guide.Mostly in hospitals they're performed for no reason at all but the damage they do to women's bodies and psyches horrifies me. It's sanctioned genital mutilation. In birth planning meetings I run I suggest to women that they never put their bodies in a position that can be easily reached by someone with scissors. Our rates are very high in Australia. Well IMO, any rate of episiotomy is too high unless it's negligible.Just my 2c ; )Janet - Original Message -From: Päivi To: [EMAIL PROTECTED] Sent: Sunday, August 21, 2005 6:31 PMSubject: [ozmidwifery] when to cut an episiotomyA mom asked me when is episiotomy really needed. She had asked from many professionals, and all just gave her the answer, that "They will try to avoid episiotomy, but will cut just in case, if not sure". In Finland the episiotomyrates arefrom 4% to 50%, and for firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will know best. (That is a medicalaized hospital midwife in most cases).I already know, that you have a different opinion on when it is needed, but it would be interesting to know from you, who work as midwifes, how oftenhave you performed episiotomies? Does anyone know, what is the national average in the Australian hospitals?Paivi
RE: [ozmidwifery] when to cut an episiotomy
Here is a quick story about my personal experience. When I was birthing my beautiful 4560 gram baby (now 16 months old) my midwife was concerned that my peri had stretched as far as it was going to (i.e. not far enough) and was about to perform an episiotomy. She was only able to make a very slight nic as the scissors were blunt and I had one almighty contraction at just the right time! Bubs head was out and she was then very quickly born with my peri basically intact except for some slight grazing. How lucky was I? I am just so thankful for this outcome. So I tell everyone who is remotely interested in birth that I was saved by a pair of blunt scissor and one contraction. Of course I KNEW (after giving birth to 2 other babies 4440 and 4320 grams without episiotomy) that I did NOT NEED one of these things anyway! Cheers, Julia V. (Aspiring Midwife) -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Nicole Carver Sent: Sunday, 21 August 2005 7:56 PM To: [EMAIL PROTECTED] Subject: RE: [ozmidwifery] when to cut an episiotomy I will only do an episiotomy if I am really concerned about getting the baby out quickly. I have done one on a peri that was really tight, and didn't stretch up. I think I have done three in my career, Nicole C.
RE: [ozmidwifery] when to cut an episiotomy
Hi I am usually quite a silent participant but felt an urge to comment on this topic. I have been a midwife for 15years and still am working in hospital settings with high risk women and women that choose to birth in a hospital. The rate of episiotomy can be high in hospital settings but I have had to perform 8 in all this time and all for severe fetal distress and I feel that if all of my pregnant women that I cared for were low risk pregnancy and natural healthy labour then this would yield a different result. Sometimes I keep a closer eye on previous history of 3rd 4th degree tears who have done no perineal massageantenatally. hope this helps Jenni *** This email, including any attachments sent with it, is confidential and for the sole use of the intended recipient(s). This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is transmitted/received in error. Any unauthorised use, alteration, disclosure, distribution or review of this email is prohibited. It may be subject to a statutory duty of confidentiality if it relates to health service matters. If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone or by return email. You should also delete this email and destroy any hard copies produced. ***
