PREGNANCY-BIRTH Messages for September, 1999: Re: Different ways to enlarge the outlet *to Dr.McIntosh

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Re: Different ways to enlarge the outlet *to Dr.McIntosh

From: Lauren (anonymous@obgyn.net)
Thu, 9 Sep 1999 19:26:30 -0500 (CDT)

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Reply: William D. McIntosh, MD: "Re: Different ways to enlarge the outlet *to Dr.McIntosh"

At Thu, 9 Sep 1999, William D. McIntosh, MD wrote: >
>At Wed, 8 Sep 1999, Lauren wrote:
>>
>>I have read about different episiotomies. A friend of mine needed to
>>have a 3rd degree midline episiotomy. This was done b/c more room was
>>needed for a speedy delivery. To my knowledge, mediolateral can give
>>more room than a 2nd degree midline without involving the anal
>>sphincter. There is such a high rate of the inadequacy of primary
>>repair of the sphincter muscle(around 40%). I wonder why 3rd degree
>>midline would be preferred. I'm not trying to question her doctor, just
>>curious about the different schools of thought.
>
>I will start off by saying that I am not a big fan of episiotomies,
>though there are rare instances that they can be a big help. Also, I am
>not sure where you get the figure of 40% for inadequate repair of the
>anal sphincter, but that is way to high in my opinion. Even so, it is
>true that median episiotomies are much more likely to extend into the
>anal sphincter and the rectum than either natural tears, or mediolateral
>episiotomies. The problem with mediolateral epsiotomies is the
>postoperative pain. My department chairperson when I was a resident was
>a woman who had had a mediolateral episiotomy with one of her delveries.
>It was an expulsion offence for any of us residents to make one. The
>pain is supposedly severe, almost crippling for many, and supposedly
>very long lasting (months). I have never made one, so perhaps another
>could speak from more personal experience.
>
>--
>William D. McIntosh, MD, FACOG
>Clarksville, TN
>
>This is for educational purposes only. It is not intended
> to replace consultation and examination by your physician
> or other health care provider.
>

Dr. McIntosh, Reading your response is *very* upsetting to me. My OB cut a RML epis last year during the birth of my son. Yes, it was a very long and painful recovery. There was an extension as well, plus I had severe constipation directly after delivery. I feel even worse now knowing it is so much more painful than the other option and that a resident could have been expelled for performing it in your program. Should I find another doctor? I want another child. I feel very confused and afraid about what is the correct thing here. (The "around 40%" came from a medline search I did).

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