 |
 |
 |
|
|
|||
|
|
||||
|
||||
Re: EpisiotomyFrom: K.Tice (anonymous@obgyn.net)Tue, 20 May 1997 22:13:43 -0500 (CDT)
At Tue, 20 May 1997, D. Ashley Hill, M.D. wrote: > >At Mon, 19 May 1997, K.Tice wrote: > >>I received the following reply in relation to episiotomies: > >>* I forgot to warn you about episiotomy. Your md might sugar coat it but many women who have had them complain of painful sex for years after the birth. Some authors have gone as far as to call it genital mutilation. > >>I would tend to take personal advice like this seriously, especially as it is noted that some women this person knows have experienced bad outcomes as a result of episiotomies. > >Karen- > >I don't routinely cut episiotomies (less than 5% of my deliveries). >However, while anecdotes like you received are important, they will >never replace well-controlled scientific studies in the medical >literature, where hundreds, and sometimes thousands, of patients are >examined and their symptoms are documented and analyzed systematically. >The medical literature is pretty straightforward on episiotomies: under >*most* circumstances, they lead to worse tears and more damage. However, >in some cases an episiotomy is necessary (for example, when the baby's >heart rate is drastically low and a rapid delivery is critical). And, >while in some cases an episiotomy is more painful than a c/section, I >would guess the reverse is true 9/10 times. I have seen patients with >problems after an episiotomy, the most common being painful intercourse. >A simple steroid injection is almost always curative. Other possible >problems include anal incontinence (with a very deep episiotomy), >infection (quite rare), or a blood clot (also rare). Common problems >with a c/section include infection (up to 50% in some areas), bleeding, >scar tissue formation, cutting through the bladder or intestines, >anemia, and post-operative wound breakdown. > >An episiotomy is an approximately 2-3 inch cut through the muscles and >tissue between the vagina and anus (usually), called the perineum. A >c/section is 5-6 inch cut through the skin of the abdomen, the tough >fascia, the peritoneum, the elastic tissue above the bladder, the thick >muscle of the uterus, and the water bag. There is a dramatically >increased chance of serious infection with a c/section (infections of an >episiotomy are exceedingly rare). In addition, the blood loss during a >c/section averages between 500-1000cc (1 liter) whereas it's between >200-500cc with a vaginal delivery (usually about 1/3 the amount of a >c/section). Finally, the chance of damage to the bladder or intestines >is almost nil with a vaginal delivery, while they are certainly possible >with a c/section. > >Whether or not you choose to have a try at a vaginal delivery or a >repeat c/section is a very personal choice. It seems that a major >component of that is your concern about an episiotomy. Surely you can >talk this important concern over with your doctor and let he or she know >that you absolutely do *not* want an episiotomy. I can't imagine that a >doctor would go against such a straightforward and reasonable wish. > >Best of luck to you, > >-- >Ashley Hill >D. Ashley Hill, M.D. >Assistant Director, Department of Ob/Gyn >Florida Hospital Family Practice Residency >Orlando, FL >dahmd@gate.net > Ashley, Thank you for your reply. I do not dispute the fact that anecdotes like I received cannot replace well-controlled scientific studies and medical literature. However first hand experience is vitally important to hear about when you are trying to weigh up the choice between VBAC and c-section. You mentioned a steriod injection can almost always cure pain with sex as a result of an episiotomy or tear during labor. What are the side effects of this injection and what is its medical name? As for the most common problems resulting from a c-section that you outlined, in relation to infection being 50% in some areas - what is exactly meant by this? Do you mean that it depends on hospital hygiene standards, and the practices of your paticular doctor? If so I would seriously would doubt in a country such as Australia paticularly in the private sector that the risk of infection would be as high as 50%? An episiotomy may be a smaller scar in comparison to a c-section scar (mine is a horizontal bikini line scar measuring 7cm), it is in a place of the female anatomy where it is more likely to cause on going pain, and this is my worry in general. For what reasons should I expect to have a high chance of damage to my bladder or intestines with a c-section delivery? As I mentioned I am a private patient with a very experienced OB and I live in Australia. I know this may mean very little, as anything can happen either with VBAC, VB or c-section, but surely it hould be taken into account? My only concern about VBAC (which deep down I would like to try for if my fears can be put at rest) is episiotomy. If I knew I would have to have one, I would definately choose a c-section over VBAC. I will discuss this at length with my OB at my next visit, however if I tell him I do not under any circumstances want an episiotomy, what options does that leave me with when delivery VBAC if I start to tear or the doctor tells me I will have to consider changing my mind about episiotomy? Did you not say that some times they are necessary? I have asked my OB about this briefly, and his personal practice is not to give episiotomies but to allow the patient to tear and see how things go from there, but in general he is not discussing the option of VBAC with me because he wants to give me a c-section (even though I do not need one). He wants full fees for the delivery by the 34th week of gestation, I am now 25 weeks and my next visit is June 10th (28 weeks). In this situation I guess I will try and talk to him at my next visit (he has told me he will not make a decision with me until 38 weeks, so it will be too late), do you think I would just be best to try a new doctor one last time? So far your medical advice/opinions have been very valuable. regards, Kelly Tice
|
|
Return to ![[ Women's Health Forum ]](http://www.obgyn.net/images_women/wh-forum.gif)
Report TECHNICAL Problems ONLY to: webmaster@obgyn.net
Last Updated: Mon Nov 2 07:05:10 2009
Women's Insurance Checklist from Auto Insurance Quote
home | medical professionals | women | industry | forums | international