WOMENS-HEALTH Messages for May, 1997: Re: Getting a baby out

Re: Getting a baby out

From: D. Ashley Hill, M.D. (anonymous@obgyn.net)
Mon, 12 May 1997 22:57:53 -0500 (CDT)

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In reply to: Shawn: "Getting a baby out"

At Mon, 12 May 1997, Shawn wrote:

>
>My question is this...why don't doctors in hospitals use oil to
>lubricate the vaginal opening?

Shawn-

I routinely use sterile KY-type gel during the last part of labor, but am not convinced it's necessary. There's a lot of mucous produced by the cervix, and the baby comes equipped with it's own "cold cream," called the vernix (the white stuff all over the baby's skin), both of which lubricate the vagina. Some doctors use a gel imbedded with novocaine, which, actually, has been shown to be a little helpful in some medical studies.

>My OB says almost everyone tears (so they do an episiotomy). My midwife
>says most of her clients don't tear.

Every doctor and midwife has his or her own experience with tears during delivery, but I can tell you that both my experience and, more importantly, the experience of many medical studies, support *not* cutting an episiotomy unless absolutely necessary (i.e. the baby's heart rate has dropped and time is critical). Think of it like this: take 2 pieces of identical notebook paper. Put a little tear in the middle of one of them, but not the other. It's much easier to completely tear the one that has been already torn a little, which is the theory behind the larger tears that seem to occur, statistically, with an episiotomy. The medical literature is quite clear on this: routine use of episiotomies leads to larger overall tears, some of which can tear through to the rectum (the worst kind). I almost never cut an episiotomy and have looked at my "tear rate" statistically and it's somewhere around 20% or so. My partners have the same rate.

As you can see, there's a lot of "art" to the art of Obstetrics, and since you have valid concerns, please let your doctor know about them. I'll bet he or she agrees to try things "your way"!

Good luck with the remainder of your pregnancy and delivery.

Ashley

--
Ashley Hill
D. Ashley Hill, M.D.
Assistant Director, Department of Ob/Gyn
Florida Hospital Family Practice Residency
Orlando, FL
dahmd@gate.net

Next message: Sharon: "Ovarian cyst"
Previous message: Harvey S. Marchbein, M.D.: "Re: breast changes"
In reply to: Shawn: "Getting a baby out"

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