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Re: episiotomy and shoulder dystocia wasits effects on perineal body/external anal sphinctor From: TPCanavan (tpcanavan@redrose.net) Sun Apr 27 20:46:33 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: tstork2: "Re: 63 years old and pregnant" Previous message: paul297@juno.com: "Old parents" I've been following the thread on episiotomies for shoulder dystocia. I'm sure many of us (like myself) were trained to do an episiotomy when SD is encountered. Of course this doesn't make any sense anatomically for SD but there is no good literature to provide any help either way. Of interest I know of a case where there was a lawsuit and the case rested on the OB decision NOT to do an epis. You couldn't believe how many of our low life colleagues were willing to testify under oath (and for a hefty fee) that it is malpractice not to do an epis. That OB lost the case. The main points that came up were 1. ACOG tech bull #196 states "Some have advocated performing a generous episiotomy to increase space for manipulations" 2. the same is said in Williams and is repeated in the new 20th ed (on page 452). The lawyer twisted this statement to indicate if your procedures don't go well to release the SD an epis is needed. I don't know if you can argue with that. Just to really get you going I was just served on a case where a midwife delivered the baby and I was the backup. The baby did well -- no SD but she cut an epis. Patient is suing because she states she didn't want an epis and it (the epis) caused her a rectocele and now sex is painful. Sounds ridiculous right. Well they have an expert opinion by a FACOG that this is the case. Remember for any case to begin there has to be an expert opinion that malpractice exists. Until we get rid of our colleagues who will say anything for buck -- garbage like this will continue. On a happy note the new Gabbe is out and the chapter on malpresentation discusses SD and says nothing about episiotomy (sounds like Steve Gabbe is on the right track). Timothy Canavan, MD, FACOG Dir. Ob/Gyn Dept Family & Community Medicine Lancaster General Hospital Next message: tstork2: "Re: 63 years old and pregnant" Previous message: paul297@juno.com: "Old parents"

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