WOMENS-HEALTH Messages for May, 1997: Re: Episiotomy

Re: Episiotomy

From: D. Ashley Hill, M.D. (anonymous@obgyn.net)
Tue, 20 May 1997 23:18:25 -0500 (CDT)

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In reply to: K.Tice: "Re: Episiotomy"

At Tue, 20 May 1997, K.Tice wrote:

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?

Karen- I'm leaving town for 5 days tomorrow, but wanted to "get this in" before I left. This injection is similar to the "trigger point" injections used for fibromyalgia, and in my experience is without side effects.

>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?

The main infection seen after a c/section is endometritis, also called endomyometritis, which is an infection of the uterus and surrounding tissues. Treatment usually consists of IV antibiotics, although in unusual cases a blood thinner or abscess drainage is necessary. The next most common infection is a bladder or kidney infection. Infections are less common with c/sections that occur when the patient is not already in labor (as, I assume, would be the case in your situation), and in "private" patients. However, there is no question the rate of infection with c/section even with private, scheduled c/sections is many multiples of the rate of infection with episiotomy, which is actually quite rare.

>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

Karen, I would disagree with this. This has not at all been my experience, and I would suggest that the pain from a c/section, due the fact it's a larger incision and it goes through many different tissue layers into the abdominal cavity, is considerably more painful than an episiotomy. Episiotomy pain is usually (although not always) an acute pain that diminishes over a few weeks to a month, whereas a c/section scar can cause pain forever. I have done laparoscopies and even hysterectomies on a number of women whose uteri were literally glued to the abdominal wall and other organs after a c/section. In fact, I've done 2 hysterectomies for intractable pelvic pain due to post c/section adhesions in the last few months. It is not rare, and in my experience is much more common than long-term pain after an episiotomy.

>For what reasons should I expect to have a high chance of >damage to my bladder or intestines with a c-section >delivery?

Quite simply, because you have had one previously. The chance is never "high" but increases with each prior c/section.

>As I mentioned I am a private patient with a very
>experienced OB

Unfortunately, this really does not matter. A well-trained Ob/Gyn should be able to do a c/section. Each patient has a different predisposition to scarring, and the skill of the surgeon, while important, is not the primary factor that determines whether or not you will have postoperative scar tissue formation after a c/section.

> 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

Again, I am having a hard time with the relationship between you and your doctor. I can't advocate changing doctors over the Internet, but I can sure suggest that you look at the reasons why he or she is so against you having a trial of labor. I know an Ob/Gyn who refuses to give his patients an epidural. He's a *very* lonely Ob/Gyn, who delivers very few babies. Most patients, when counseled about the risk:benefit ratio of epidurals, might very well choose to try labor without one. But, they want the choice, as is their right. The safest, most efficient, and most productive patient/doctor relationship is one of good communication, trust and mutual respect. If this is lacking in your own relationship with your doctor, then by all means I would strongly consider looking into a new doctor.

Best wishes, and good luck with everything.

Ashley

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

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In reply to: K.Tice: "Re: Episiotomy"

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