WOMENS-HEALTH Messages for October, 1998: Re: ATTN DR. DAVID ASHLEY HILL from: CONNIE controversy regarding episiotomies

Re: ATTN DR. DAVID ASHLEY HILL from: CONNIE controversy regarding episiotomies

From: D. Ashley Hill, M.D. (anonymous@obgyn.net)
Sat, 24 Oct 1998 17:14:45 -0500 (CDT)

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Reply: Connie: "ATTN DR. DAVID ASHLEY HILL from CONNIE -- episiotomy -- answers to your questions"

As a matter of fact, I wish you >could tell me what on earth is wrong with my episiotomy site 2 1/2 years
>after the

First, thank you for your clarification of your earlier post, and your very nice compliments. If your episiotomy site is very tender, you should really have a thorough exam, looking for a fistula (hole between the rectum and vagina), scar tissue, or trigger points. Sometimes tiny nerves get jumbled up in scar tissue. Either injecting this area with a steroid solution, or (sometimes) surgical revision, will correct the problem. Without looking at the area (let's try *that* over the Internet!) it's impossible to say, but many gynecologists are experienced in evaluating painful episiotomy sites. I hope you can track down a gyn with experience in this and that everything works out well.

>In such a situation as the one you mention above -- if the head is RIGHT
>there but the mom is too tired to continue pushing and the baby's heart
>rate is going down -- wouldn't a vacuum suction help get the head out
>without the episiotomy.

Absolutely. I do not routinely cut an episiotomy for vacuum deliveries, but sometimes it's hard to get the baby out without one. It depends on the size, shape, and consistency of the patient's perineum. However, many patients prefer an episiotomy to a vacuum. That's part of the informed consent process. I've had many ladies tell me "please try an episiotomy first, and if that doesn't work, try the vacuum." Others prefer a vacuum delivery first. When there is no medical reason to choose one versus the other, I like to give the patient the choice. It involves her in her own health care, which makes it a team approach. Except in cases of a life or death emergency ("ma'am, would you like your heart shocked, or just CPR?!") I have found it's always better to make such decisions together.

Thanks again, and good luck.

-- Ashley Hill David Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, FL http://home.mpinet.net/dahmd

The above is intended for general medical education, and is not for specific medical advice. I apologize, but I am unable to answer personal e-mail due to time constraints.

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