Re: [ozmidwifery] when to cut an episiotomy

[Päivi]

Thank you so much for your answers regarding the 
episiotomy. I have been reading about it, and always knew how unneccessary it 
is, but I guess I didn't realise how little it is needed, when the birth is 
cared in a correct way. I must say I was supprised about your epis rates, and it 
gave me even more courage to fight against it over here...
Thank you for sharing your experience.
 
Paivi

Re: [ozmidwifery] when to cut an episiotomy

[birth]

Congratulations, Andrea, way to go!  What's that old quotation? ? "A good ob has
a big broad behind and knows how to put his hands under it and sit on them!"  We
could apply that to mws, too.  Love Gloria

Quoting Andrea Quanchi <[EMAIL PROTECTED]>:

> Threads like this come back to haunt you. Last night I cared for a 
> primip who I took over on night duty as she was about to enter second 
> stage after having laboured all day and having had no sleep the night 
> before.  Given lots of time she progressed very slowly to having the 
> head distending the peri and there it sat through several contractions 
> with no further progress despite maternal effort ( and yes I did think 
> oh no hear goes I'm going to have to eat my words and cut an epis. I 
> looked at the scissors and decided to leave them where they were and 
> listen to the FH instead which was strong. Then her body decided that 
> it needed a rest and we sat for about 15 min with no contractions and 
> listening to the FH while she slept. Then she woke up had one 
> contraction where she birthed the head over an intact peri and a second 
> soon after which birthed the body before she lay back and said that all 
> I had to give!  What more did she need. I had a student with me who was 
> completely baffled and we spent quite some time afterwards discussing 
> what had just happened because that had never been in anything she had 
> heard or read.
> 
> One very happy mum and one midwife with her stats intact!!!
> 
> Andrea Quanchi
> On 22/08/2005, at 11:35 PM, Katrina Flora wrote:
> 
> > Not entirely sure I want to know, but Mary what is "buttonholing"?
> >  
> > Katrina
> >> - Original Message -
> >> From: Mary Murphy
> >> To: ozmidwifery@acegraphics.com.au
> >> Sent: Monday, August 22, 2005 10:03 AM
> >> Subject: RE: [ozmidwifery] when to cut an episiotomy
> >>
> >> Because you asked:  I have cut 3 in 22 yrs as a homebirth midwife.  1 
> >> for foetal distress, 1 for “buttonholing’ & the other I can’t 
> >> remember.  It was all so long ago.  Working with a group of 7 other 
> >> midwives, I have never heard of them cutting episiotomies either. MM
> >>  
> >>
> >>
> >>  Who else would like to celebrate their lack of desire or interest in 
> >> cutting a woman's perineum.
> >>
> >>
> 


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Re: [ozmidwifery] when to cut an episiotomy

[Andrea Quanchi]

Threads like this come back to haunt you. Last night I cared for a primip who I took over on night duty as she was about to enter second stage after having laboured all day and having had no sleep the night before.  Given lots of time she progressed very slowly to having the head distending the peri and there it sat through several contractions with no further progress despite maternal effort ( and yes I did think oh no hear goes I'm going to have to eat my words and cut an epis. I looked at the scissors and decided to leave them where they were and listen to the FH instead which was strong. Then her body decided that it needed a rest and we sat for about 15 min with no contractions and listening to the FH while she slept. Then she woke up had one contraction where she birthed the head over an intact peri and a second soon after which birthed the body before she lay back and said that all I had to give!  What more did she need. I had a student with me who was completely baffled and we spent quite some time afterwards discussing what had just happened because that had never been in anything she had heard or read. 

One very happy mum and one midwife with her stats intact!!!

Andrea Quanchi
On 22/08/2005, at 11:35 PM, Katrina Flora wrote:

Not entirely sure I want to know, but Mary what is "buttonholing"?
 
Katrina
- Original Message -
From: Mary Murphy 
To: ozmidwifery@acegraphics.com.au 
Sent: Monday, August 22, 2005 10:03 AM
Subject: RE: [ozmidwifery] when to cut an episiotomy

Because you asked:  I have cut 3 in 22 yrs as a homebirth midwife.  1 for foetal distress, 1 for “buttonholing’ & the other I can’t remember.  It was all so long ago.  Working with a group of 7 other midwives, I have never heard of them cutting episiotomies either. MM
 


 Who else would like to celebrate their lack of desire or interest in cutting a woman's perineum.

RE: [ozmidwifery] when to cut an episiotomy

[Mary Murphy]

Buttonholing  is when the baby’s
head stretches the perineum to the point of splitting before it tears at the
vaginal opening.  Ie closed at the vagina, closed at the rectal end and
split in the middle, like a buttonhole.  It can (and did) cause delayed
healing because of the “blanching” of the skin. (no
circulation)  It can also extend to 3rd and 4th degree
tears because the vaginal opening holds firm.  That is a simple
explanation.  Others might have a more concise one.  Sue, it would be
good to learn to suture the tears yourselves. It is an essential midwifery
skill. Get Chris White from KEMH to do a professional development day. 
She does our updates every year.  Otherwise it is obvious that Obs find
episiotomies easier to stitch than tears because they are so used to the
straight edge.  It stretches their skills a bit to do tears.  Surely
there should be less repairs all round?  MM

 











 



Not entirely sure I want to know, but Mary what is
"buttonholing"?





 

Re: [ozmidwifery] when to cut an episiotomy

[Judy Chapman]

This reminds me of a time when I had a primi with an intact peri
in Saudi. I got called over to see her in the ward many hours
later as she was in great pain. Inspection showed a HUGE
haematoma starting high in the vagina, needed emergency draining
and haemostasis as well as blood transfusion. I was chastised by
the OB for not doing an epis. I am sure the damage was done ages
before the head was on the peri and an epis 'cuttable'. They
just don't think, just trot out their over used comments.
Needless to say, it hasn't changed my practice. 
Cheers
Judy
--- Susan Cudlipp <[EMAIL PROTECTED]> wrote:

> In my training, in UK in '79, the episiotomy rate was very
> high. Of my 30 obligatory deliveries, 29 had epis, the 30th
> being a multip who delivered too quickly for anyone to push
> scissors into my hands.  I was only taught how to deliver with
> one, no effort was made to teach how to protect the perineum.
> Mind you, we were excellent at infiltration and cutting!
> The obs at the time's view was " all primips need one and all
> multips who have previously had one!"
> Over the years my incidence of performing them reduced, and of
> the past 250 births I have performed epis on 7 occasions,
> almost without exception for fetal compromise.
> Sadly, we once again seem to be coming up against the
> (medical) viewpoint that we are not doing enough!  None of my
> colleaugues perform routine epis, and our rate is low, and
> lately we have had several 'remarks' from doctors who have
> been asked to suture tears, that we should have done an epis.
> I have even heard the physio telling women that they are a
> good idea!
> Interestingly, I have seen far fewer 3' tears since seeing a
> huge reduction in epis rates, used to see them on a regular
> basis.
> Sue
> "The only thing necessary for the triumph of evil is for good
> men to do nothing"
> Edmund Burke
>   ----- Original Message ----- 
>   From: Andrea Quanchi 
>   To: ozmidwifery@acegraphics.com.au 
>   Sent: Monday, August 22, 2005 6:06 AM
>   Subject: Re: [ozmidwifery] when to cut an episiotomy
> 
> 
>   I think many midwives can claim very good episiotomy rates.
> Mine over twenty years in "0". My virginal scissors get taken
> to each birth but have never been out of the packet except to
> be put in a new packet and re sterilised. Who else would like
> to celebrate their lack of desire or interest in cutting a
> woman's perineum.
> 
>   Andrea Quanchi
> 
>   On 21/08/2005, at 6:57 PM, Janet Fraser wrote:
> 
> 
> 
> I'm not one of the professionals in here, Paivi but hi
> anyway. : ) I've read in a few places about how episiotomy
> rates suddenly drop when studies into them begin. A hb MW I
> know does less than one a year so I figure that's a good
> guide.  Mostly in hospitals they're performed for no reason at
> all but the damage they do to women's bodies and psyches
> horrifies me. It's sanctioned genital mutilation. In birth
> planning meetings I run I suggest to women that they never put
> their bodies in a position that can be easily reached by
> someone with scissors. Our rates are very high in Australia.
> Well IMO, any rate of episiotomy is too high unless it's
> negligible.
> Just my 2c ; )
> Janet
> 
>   - Original Message -
>   From: Päivi 
>   To: ozmidwifery@acegraphics.com.au 
>   Sent: Sunday, August 21, 2005 6:31 PM
>   Subject: [ozmidwifery] when to cut an episiotomy
> 
>   A mom asked me when is episiotomy really needed. She had
> asked from many professionals, and all just gave her the
> answer, that "They will try to avoid episiotomy, but will cut
> just in case, if not sure". In Finland the episiotomy rates
> are from 4% to 50%, and for firsttime moms from 9% to 88%!. It
> is usually beleived, that the midwife will know best. (That is
> a medicalaized hospital midwife in most cases). I already
> know, that you have a different opinion on  when it is needed,
> but it would be interesting to know from you, who work as
> midwifes, how often have you performed episiotomies? Does
> anyone know, what is the national average in the Australian
> hospitals?
>
>   Paivi
> 
> 
>
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> 
> 
>   No virus found in this incoming message.
>   Checked by AVG Anti-Virus.
>   Version: 7.0.338 / Virus Database: 267.10.13/78 - Release
> Date: 19/08/2005
> 







 
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Re: [ozmidwifery] when to cut an episiotomy

[Sonja]

Maybe the midwives could suture the tears 
themselves?
Sonja

  - Original Message - 
  From: 
  Susan 
  Cudlipp 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Monday, August 22, 2005 11:51 
  PM
  Subject: Re: [ozmidwifery] when to cut an 
  episiotomy
  
  In my training, in UK in '79, the episiotomy rate 
  was very high. Of my 30 obligatory deliveries, 29 had epis, the 30th being a 
  multip who delivered too quickly for anyone to push scissors into my 
  hands.  I was only taught how to deliver with one, no effort was made to 
  teach how to protect the perineum. Mind you, we were excellent at 
  infiltration and cutting!
  The obs at the time's view was " all primips need 
  one and all multips who have previously had one!"
  Over the years my incidence of performing them 
  reduced, and of the past 250 births I have performed epis on 7 occasions, 
  almost without exception for fetal compromise.
  Sadly, we once again seem to be coming up against 
  the (medical) viewpoint that we are not doing enough!  None of my 
  colleaugues perform routine epis, and our rate is low, and lately we have had 
  several 'remarks' from doctors who have been asked to suture tears, that we 
  should have done an epis.
  I have even heard the physio telling women that 
  they are a good idea!
  Interestingly, I have seen far fewer 3' tears 
  since seeing a huge reduction in epis rates, used to see them on a regular 
  basis.
  Sue
  "The only thing necessary for the triumph of evil is for good men to do 
  nothing"Edmund Burke
  
- Original Message - 
From: 
Andrea Quanchi 
To: ozmidwifery@acegraphics.com.au 

Sent: Monday, August 22, 2005 6:06 
    AM
    Subject: Re: [ozmidwifery] when to cut 
an episiotomy
I think many midwives can claim very good episiotomy rates. 
Mine over twenty years in "0". My virginal scissors get taken to each birth 
but have never been out of the packet except to be put in a new packet and 
re sterilised. Who else would like to celebrate their lack of desire or 
interest in cutting a woman's perineum.Andrea QuanchiOn 
21/08/2005, at 6:57 PM, Janet Fraser wrote:
I'm not one of 
  the professionals in here, Paivi but hi anyway. : ) I've read in a 
  few places about how episiotomy rates suddenly drop when studies into them 
  begin. A hb MW I know does less than one a year so I figure that's a good 
  guide.  Mostly in hospitals they're performed for no reason at 
  all but the damage they do to women's bodies and psyches horrifies me. 
  It's sanctioned genital mutilation. In birth planning meetings I run I 
  suggest to women that they never put their bodies in a position that can 
  be easily reached by someone with scissors. Our rates are very high in 
  Australia. Well IMO, any rate of episiotomy is too high unless it's 
  negligible.Just 
  my 2c ; 
  )Janet
  - Original 
Message -From: 
Päivi 
To: 
ozmidwifery@acegraphics.com.au 
Sent: 
Sunday, August 21, 2005 6:31 PMSubject: 
[ozmidwifery] when to cut an 
episiotomyA 
mom asked me when is episiotomy really needed. She had asked from many 
professionals, and all just gave her the answer, that "They will try to 
avoid episiotomy, but will cut just in case, if not sure". In Finland 
the episiotomy rates are from 4% to 50%, and for firsttime 
moms from 9% to 88%!. It is usually beleived, that the midwife will know 
best. (That is a medicalaized hospital midwife in most cases). I 
already know, that you have a different opinion on  when it is 
needed, but it would be interesting to know from you, who work as 
midwifes, how often have you performed episiotomies? Does anyone 
know, what is the national average in the Australian hospitals? Paivi



No virus found in this incoming message.Checked by AVG 
Anti-Virus.Version: 7.0.338 / Virus Database: 267.10.13/78 - Release 
Date: 19/08/2005

Re: [ozmidwifery] when to cut an episiotomy

[Susan Cudlipp]

In my training, in UK in '79, the episiotomy rate 
was very high. Of my 30 obligatory deliveries, 29 had epis, the 30th being a 
multip who delivered too quickly for anyone to push scissors into my 
hands.  I was only taught how to deliver with one, no effort was made to 
teach how to protect the perineum. Mind you, we were excellent at 
infiltration and cutting!
The obs at the time's view was " all primips need 
one and all multips who have previously had one!"
Over the years my incidence of performing them 
reduced, and of the past 250 births I have performed epis on 7 occasions, almost 
without exception for fetal compromise.
Sadly, we once again seem to be coming up against 
the (medical) viewpoint that we are not doing enough!  None of my 
colleaugues perform routine epis, and our rate is low, and lately we have had 
several 'remarks' from doctors who have been asked to suture tears, that we 
should have done an epis.
I have even heard the physio telling women that 
they are a good idea!
Interestingly, I have seen far fewer 3' tears since 
seeing a huge reduction in epis rates, used to see them on a regular 
basis.
Sue
"The only thing necessary for the triumph of evil is for good men to do 
nothing"Edmund Burke

  - Original Message - 
  From: 
  Andrea 
  Quanchi 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Monday, August 22, 2005 6:06 
  AM
  Subject: Re: [ozmidwifery] when to cut an 
  episiotomy
  I think many midwives can claim very good episiotomy rates. 
  Mine over twenty years in "0". My virginal scissors get taken to each birth 
  but have never been out of the packet except to be put in a new packet and re 
  sterilised. Who else would like to celebrate their lack of desire or interest 
  in cutting a woman's perineum.Andrea QuanchiOn 21/08/2005, at 
  6:57 PM, Janet Fraser wrote:
  I'm not one of the 
professionals in here, Paivi but hi anyway. : ) I've read in a few 
places about how episiotomy rates suddenly drop when studies into them 
begin. A hb MW I know does less than one a year so I figure that's a good 
guide.  Mostly in hospitals they're performed for no reason at all 
but the damage they do to women's bodies and psyches horrifies me. It's 
sanctioned genital mutilation. In birth planning meetings I run I suggest to 
women that they never put their bodies in a position that can be easily 
reached by someone with scissors. Our rates are very high in Australia. Well 
IMO, any rate of episiotomy is too high unless it's negligible.Just 
my 2c ; 
)Janet
- Original 
  Message -From: 
Päivi 
To: 
ozmidwifery@acegraphics.com.au 
Sent: 
  Sunday, August 21, 2005 6:31 PMSubject: 
  [ozmidwifery] when to cut an 
  episiotomyA 
  mom asked me when is episiotomy really needed. She had asked from many 
  professionals, and all just gave her the answer, that "They will try to 
  avoid episiotomy, but will cut just in case, if not sure". In Finland the 
  episiotomy rates are from 4% to 50%, and for firsttime moms from 
  9% to 88%!. It is usually beleived, that the midwife will know best. (That 
  is a medicalaized hospital midwife in most cases). I already know, 
  that you have a different opinion on  when it is needed, but it would 
  be interesting to know from you, who work as midwifes, how often have 
  you performed episiotomies? Does anyone know, what is the national average 
  in the Australian hospitals? Paivi
  
  

  No virus found in this incoming message.Checked by AVG 
  Anti-Virus.Version: 7.0.338 / Virus Database: 267.10.13/78 - Release Date: 
  19/08/2005

Re: [ozmidwifery] when to cut an episiotomy

[Katrina Flora]

Not entirely sure I want to know, but Mary what is 
"buttonholing"?
 
Katrina

  - Original Message - 
  From: 
  Mary 
  Murphy 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Monday, August 22, 2005 10:03 
  AM
  Subject: RE: [ozmidwifery] when to cut an 
  episiotomy
  
  
  Because you 
  asked:  I have cut 3 in 22 yrs as a homebirth midwife.  1 for foetal 
  distress, 1 for “buttonholing’ & the other I can’t remember.  It was 
  all so long ago.  Working with a group of 7 other midwives, I have never 
  heard of them cutting episiotomies either. MM
   
  
  
  
  
   Who else would like to celebrate 
  their lack of desire or interest in cutting a woman's 
  perineum.

Re: [ozmidwifery] when to cut an episiotomy

[Catherine Pearson]

Hi All
Just my 2 cents worth on when to do an epis. I 
remember some advice given at a conference some years ago, however I cannot 
remember if it was Andrea Robertson or Caroline Flint. But I have never 
forgotten the advice - If you think an epis is needed, just wait a little while 
then wait a little while longer. Once you have waited a while, just wait a 
little longer  and after waiting a little longer you will find that an epis 
was never necessary at all ! 
Catherine Pearson

  - Original Message - 
  From: 
  Andrea 
  Quanchi 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Monday, August 22, 2005 8:06 
  AM
  Subject: Re: [ozmidwifery] when to cut an 
  episiotomy
  I think many midwives can claim very good episiotomy rates. 
  Mine over twenty years in "0". My virginal scissors get taken to each birth 
  but have never been out of the packet except to be put in a new packet and re 
  sterilised. Who else would like to celebrate their lack of desire or interest 
  in cutting a woman's perineum.Andrea QuanchiOn 21/08/2005, at 
  6:57 PM, Janet Fraser wrote:
  I'm not one of the 
professionals in here, Paivi but hi anyway. : ) I've read in a few 
places about how episiotomy rates suddenly drop when studies into them 
begin. A hb MW I know does less than one a year so I figure that's a good 
guide.  Mostly in hospitals they're performed for no reason at all 
but the damage they do to women's bodies and psyches horrifies me. It's 
sanctioned genital mutilation. In birth planning meetings I run I suggest to 
women that they never put their bodies in a position that can be easily 
reached by someone with scissors. Our rates are very high in Australia. Well 
IMO, any rate of episiotomy is too high unless it's negligible.Just 
my 2c ; 
)Janet
- Original 
  Message -From: 
Päivi 
To: 
ozmidwifery@acegraphics.com.au 
Sent: 
  Sunday, August 21, 2005 6:31 PMSubject: 
  [ozmidwifery] when to cut an 
  episiotomyA 
  mom asked me when is episiotomy really needed. She had asked from many 
  professionals, and all just gave her the answer, that "They will try to 
  avoid episiotomy, but will cut just in case, if not sure". In Finland the 
  episiotomy rates are from 4% to 50%, and for firsttime moms from 
  9% to 88%!. It is usually beleived, that the midwife will know best. (That 
  is a medicalaized hospital midwife in most cases). I already know, 
  that you have a different opinion on  when it is needed, but it would 
  be interesting to know from you, who work as midwifes, how often have 
  you performed episiotomies? Does anyone know, what is the national average 
  in the Australian hospitals? Paivi

RE: [ozmidwifery] when to cut an episiotomy

[Jennifer Price]

Hi I am usually quite a silent participant but felt an urge to comment on 
this topic.  I have been a midwife for 15years and still am working in hospital settings with high risk women and women that choose to birth in a hospital.  The rate of episiotomy can be high in hospital settings but I 
have had to perform 8 in all this time and all for severe fetal distress and I 
feel that if all of my pregnant women that I cared for were low risk pregnancy 
and natural healthy labour then this would yield a different result.  Sometimes I keep a closer eye on previous history of 3rd & 4th degree tears 
who have done no perineal massage antenatally. hope this helps 
Jenni

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RE: [ozmidwifery] when to cut an episiotomy

[Julia Vaughan]

Here is a quick story about my personal
experience.  When I was birthing my beautiful 4560 gram baby (now 16
months old) my midwife was concerned that my peri had stretched as far as it
was going to  (i.e. not far enough) and was about to perform an episiotomy. 
She was only able to make “a very slight nic” as the scissors were
blunt and I had one almighty contraction at just the right time!   Bub’s
head was out and she was then very quickly born with my peri basically intact
except for some slight grazing.  How lucky was I?  I am just so
thankful for this outcome.  So I tell everyone who is remotely interested
in birth that I was saved by a pair of blunt scissor and one contraction. 
Of course I KNEW (after giving birth to 2 other babies 4440 and 4320 grams
without episiotomy) that I did NOT NEED one of these things anyway!

 

Cheers,

 

Julia V. (Aspiring Midwife)

 

 

 

-Original Message-
From:
[EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On
Behalf Of Nicole Carver
Sent: Sunday, 21 August 2005 7:56
 PM
To: [EMAIL PROTECTED]
Subject: RE: [ozmidwifery] when to
cut an episiotomy

 



I will only do an episiotomy if I am really concerned about getting
the baby out quickly. I have done one on a peri that was really tight, and
didn't stretch  up. I think I have done three in my career,





 

 

Nicole C.

 

RE: [ozmidwifery] when to cut an episiotomy

[Alan Rooney]

Hi 
paivi
I have 
never taken scissors to to a woman's peri. I believe that a tear is far better 
that cutting. An episiotomy will only open up the soft tissue. this is not 
usually the cause of any problem. However I suppose that there nay be some rare 
occasions that require an episiotomy but I am unable to think of one at this 
time.
 
Alan

  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED]On Behalf Of 
  PäiviSent: Sunday, 21 August 2005 6:31 PMTo: 
  [EMAIL PROTECTED]Subject: [ozmidwifery] when to cut an 
  episiotomy
  A mom asked me when is episiotomy really needed. 
  She had asked from many professionals, and all just gave her the answer, that 
  "They will try to avoid episiotomy, but will cut just in case, if not sure". 
  In Finland the episiotomy rates are from 4% to 50%, and for 
  firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will 
  know best. (That is a medicalaized hospital midwife in most cases). I 
  already know, that you have a different opinion on  when it is needed, 
  but it would be interesting to know from you, who work as midwifes, how 
  often have you performed episiotomies? Does anyone know, what is the 
  national average in the Australian hospitals?
   
  Paivi

Re: [ozmidwifery] when to cut an episiotomy

[Gloria Lemay]

In more than 25 years and over 1200 births, I am 
ashamed to tell you I've cut 3.  One for an unyielding primip perineum 
which would not budge after hour of crowning.  Next birth, it stretched 
nicely and didn't need an epis.  Two, as a last ditch effort in a fatal 
shoulder dystocia--didn't help anything.  Third for a distressed babe with 
bad scalp colour, born with a non pulsing cord and am glad I did it because I 
think there was a real problem there that MAY have compromised the 
baby.
Gloria Lemay, Vancouver  BC

  - Original Message - 
  From: 
  Andrea 
  Quanchi 
  To: [EMAIL PROTECTED] 
  
  Sent: Sunday, August 21, 2005 3:06 
  PM
  Subject: Re: [ozmidwifery] when to cut an 
  episiotomy
  I think many midwives can claim very good episiotomy rates. 
  Mine over twenty years in "0". My virginal scissors get taken to each birth 
  but have never been out of the packet except to be put in a new packet and re 
  sterilised. Who else would like to celebrate their lack of desire or interest 
  in cutting a woman's perineum.Andrea QuanchiOn 21/08/2005, at 
  6:57 PM, Janet Fraser wrote:
  I'm not one of the 
professionals in here, Paivi but hi anyway. : ) I've read in a few 
places about how episiotomy rates suddenly drop when studies into them 
begin. A hb MW I know does less than one a year so I figure that's a good 
guide.  Mostly in hospitals they're performed for no reason at all 
but the damage they do to women's bodies and psyches horrifies me. It's 
sanctioned genital mutilation. In birth planning meetings I run I suggest to 
women that they never put their bodies in a position that can be easily 
reached by someone with scissors. Our rates are very high in Australia. Well 
IMO, any rate of episiotomy is too high unless it's negligible.Just 
my 2c ; 
)Janet
- Original 
  Message -From: 
Päivi 
To: 
[EMAIL PROTECTED] 
Sent: 
  Sunday, August 21, 2005 6:31 PMSubject: 
  [ozmidwifery] when to cut an 
  episiotomyA 
  mom asked me when is episiotomy really needed. She had asked from many 
  professionals, and all just gave her the answer, that "They will try to 
  avoid episiotomy, but will cut just in case, if not sure". In Finland the 
  episiotomy rates are from 4% to 50%, and for firsttime moms from 
  9% to 88%!. It is usually beleived, that the midwife will know best. (That 
  is a medicalaized hospital midwife in most cases). I already know, 
  that you have a different opinion on  when it is needed, but it would 
  be interesting to know from you, who work as midwifes, how often have 
  you performed episiotomies? Does anyone know, what is the national average 
  in the Australian hospitals? Paivi

RE: [ozmidwifery] when to cut an episiotomy

[Mary Murphy]

Because you asked:  I have cut 3 in 22 yrs
as a homebirth midwife.  1 for foetal distress, 1 for “buttonholing’
& the other I can’t remember.  It was all so long ago.  Working with
a group of 7 other midwives, I have never heard of them cutting episiotomies
either. MM

 











 Who else would like to
celebrate their lack of desire or interest in cutting a woman's perineum.

RE: [ozmidwifery] when to cut an episiotomy

[Judy Chapman]

Also to consider, a sentence in "Episiotomy and the Second Stage
of Labor" edited by Sheila Kitzinger that has always stood out
for me as it makes so much sense. Whenever you put the scissors
in and cut you ALWAYS have second degree perineal trauma. If you
work to birth the baby with an intact peri then more than half
of the time you will have it. Why do we cause so much pain to
women unnecessarily?? 
In the last few years I have done a first degree nick for a
tight peri and another time for a tight hymenal ring but neither
needed sutures. Where I work we only have the cord scissors on
our tray. 
Cheers
Judy

--- Lieve Huybrechts <[EMAIL PROTECTED]> wrote:

>  
> 
> Hoi Païvi,
> 
>  
> 
> This was on  the list a while ago.
> 
>  
> 
> greetings
> 
> Lieve
> 
>  
> 
>  
> 
> Routine episiotomy shows no benefits, only harm
> Source: Journal of the American Medical Association 2005; 293:
> 2141-8
> 
> Comparing maternal outcomes with routine versus restrictive
> use of
> episiotomy in a systematic review of the literature. 
> 
> Routine episiotomy does not appear to provide the benefits
> traditionally
> credited to it, and, in some cases, is more damaging than a
> spontaneous
> tear, say researchers. 
> 
> Episiotomy was initially introduced on the assumption that a
> deliberate
> incision would heal more quickly and with fewer complications
> than a
> spontaneous tear, and that it would lead to less pelvic floor
> problems,
> such as fecal or urinary incontinence or impaired sexual
> function, later
> on. 
> 
> To determine whether this is actually the case, researchers
> led by
> Katherine Hartmann, from the University of North Carolina at
> Chapel Hill
> in the USA, conducted a systematic review of the best quality
> trials
> available comparing routine with restrictive use of the
> procedure. 
> 
> The 26 articles selected for detailed study were consistent in
> finding
> that routine episiotomy did not reduce the severity of
> laceration, pain,
> or pain medication use, compared with restricted surgery.
> There was also
> no evidence to support the longer-term outcomes ascribed to
> episiotomy,
> including prevention of fecal or urinary incontinence or
> reduced
> impaired sexual function. In fact, pain during intercourse was
> more
> common in women who underwent the procedure. 
> 
> Study co-author John Thorp Jr. summarized: "In most cases,
> episiotomy
> doesn't do any good, and it can harm women. Why would one want
> a
> surgical procedure that's worthless
> 
>  
>  
> Lieve Huybrechts
> vroedvrouw
> 0477/740853
> 
> -Oorspronkelijk bericht-
> Van: [EMAIL PROTECTED]
> [mailto:[EMAIL PROTECTED] Namens Päivi
> Verzonden: zondag 21 augustus 2005 10:31
> Aan: [EMAIL PROTECTED]
> Onderwerp: [ozmidwifery] when to cut an episiotomy
> 
> 
> A mom asked me when is episiotomy really needed. She had asked
> from many
> professionals, and all just gave her the answer, that "They
> will try to
> avoid episiotomy, but will cut just in case, if not sure". In
> Finland
> the episiotomy rates are from 4% to 50%, and for firsttime
> moms from 9%
> to 88%!. It is usually beleived, that the midwife will know
> best. (That
> is a medicalaized hospital midwife in most cases). I already
> know, that
> you have a different opinion on  when it is needed, but it
> would be
> interesting to know from you, who work as midwifes, how often
> have you
> performed episiotomies? Does anyone know, what is the national
> average
> in the Australian hospitals?
>  
> Paivi
> 
> 
> --
> No virus found in this incoming message.
> Checked by AVG Anti-Virus.
> Version: 7.0.338 / Virus Database: 267.10.13/78 - Release
> Date:
> 19/08/2005
> 
> 
> 
> -- 
> No virus found in this outgoing message.
> Checked by AVG Anti-Virus.
> Version: 7.0.338 / Virus Database: 267.10.13/78 - Release
> Date:
> 19/08/2005
>  
> 







 
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Re: [ozmidwifery] when to cut an episiotomy

[Andrea Quanchi]

I think many midwives can claim very good episiotomy rates. Mine over twenty years in "0". My virginal scissors get taken to each birth but have never been out of the packet except to be put in a new packet and re sterilised.  Who else would like to celebrate their lack of desire or interest in cutting a woman's perineum.

Andrea Quanchi

On 21/08/2005, at 6:57 PM, Janet Fraser wrote:

I'm not one of the professionals in here, Paivi but hi anyway. : ) I've read in a few places about how episiotomy rates suddenly drop when studies into them begin. A hb MW I know does less than one a year so I figure that's a good guide.  Mostly in hospitals they're performed for no reason at all but the damage they do to women's bodies and psyches horrifies me. It's sanctioned genital mutilation. In birth planning meetings I run I suggest to women that they never put their bodies in a position that can be easily reached by someone with scissors. Our rates are very high in Australia. Well IMO, any rate of episiotomy is too high unless it's negligible.
Just my 2c ; )
Janet
- Original Message -
From: Päivi 
To: [EMAIL PROTECTED] 
Sent: Sunday, August 21, 2005 6:31 PM
Subject: [ozmidwifery] when to cut an episiotomy

A mom asked me when is episiotomy really needed. She had asked from many professionals, and all just gave her the answer, that "They will try to avoid episiotomy, but will cut just in case, if not sure". In Finland the episiotomy rates are from 4% to 50%, and for firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will know best. (That is a medicalaized hospital midwife in most cases). I already know, that you have a different opinion on  when it is needed, but it would be interesting to know from you, who work as midwifes, how often have you performed episiotomies? Does anyone know, what is the national average in the Australian hospitals?
 
Paivi

RE: [ozmidwifery] when to cut an episiotomy

[Sally Westbury]

I have never cut an episiotomy since I have
been registered as a midwife. I did as a student midwife in 1988. 

 

Sally Westbury

Homebirth Midwife

"Learn from
mothers and babies; every one of them has a unique story to tell. Look for
wisdom in the humblest places - that's usually where you'll find it."

— Lois Wilson

 

RE: [ozmidwifery] when to cut an episiotomy

[Nicole Carver]

Hi 
Paivi,
Not as 
many births as some of my colleagues. However, I have been to a Dennis Walsh 
workshop called something like Evidence Based Care in Normal Labour. He stated 
that the ONLY evidence based reason for episiotomy is in severe fetal distress. 
They are sometimes required for manoevres to get a baby out with severe shoulder 
dystocia, but in most cases not.
Certainly, I have had a couple of tears personally, and I didn't find 
them a problem. However, the thought of someone taking scissors to my perineum 
fills me with terror!
Kind 
regards,
Nicole.

  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED]On Behalf Of 
  PäiviSent: Sunday, August 21, 2005 9:53 PMTo: 
  ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] when to 
  cut an episiotomy
  Hi Nicole,
   
  That is so awasome, how many births have you done 
  in your career?  I read about a midwife, who had performed 6 episiotomies 
  in 650 births. Two of these were when she was taught how to make them as a 
  student.
   
  Paivi
  
- Original Message - 
From: 
Nicole Carver 
To: ozmidwifery@acegraphics.com.au 

Sent: Sunday, August 21, 2005 12:55 
PM
Subject: RE: [ozmidwifery] when to cut 
    an episiotomy

I 
will only do an episiotomy if I am really concerned about getting the baby 
out quickly. I have done one on a peri that was really tight, and didn't 
stretch  up. I think I have done three in my 
career,
Nicole C.

  -Original Message-From: [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED]On Behalf Of Janet 
  FraserSent: Sunday, August 21, 2005 6:57 PMTo: 
  ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] when 
      to cut an episiotomy
  I'm not one of the 
  professionals in here, Paivi but hi anyway. : ) I've read in a few 
  places about how episiotomy rates suddenly drop when studies into them 
  begin. A hb MW I know does less than one a year so I figure that's a good 
  guide.  Mostly in hospitals they're performed for no reason at 
  all but the damage they do to women's bodies and psyches horrifies me. 
  It's sanctioned genital mutilation. In birth planning meetings I run I 
  suggest to women that they never put their bodies in a position that can 
  be easily reached by someone with scissors. Our rates are very high in 
  Australia. Well IMO, any rate of episiotomy is too high unless it's 
  negligible.
  Just my 2c ; 
  )
  Janet
  
- Original Message - 
From: 
Päivi 
To: ozmidwifery@acegraphics.com.au 

Sent: Sunday, August 21, 2005 6:31 
PM
Subject: [ozmidwifery] when to cut 
an episiotomy

A mom asked me when is episiotomy really 
needed. She had asked from many professionals, and all just gave her the 
answer, that "They will try to avoid episiotomy, but will cut just in 
case, if not sure". In Finland the episiotomy rates are from 
4% to 50%, and for firsttime moms from 9% to 88%!. It is usually 
beleived, that the midwife will know best. (That is a medicalaized 
hospital midwife in most cases). I already know, that you have a 
different opinion on  when it is needed, but it would be 
interesting to know from you, who work as midwifes, how often have 
you performed episiotomies? Does anyone know, what is the national 
average in the Australian hospitals?
 
Paivi

Re: [ozmidwifery] when to cut an episiotomy

[Päivi]

Hi Nicole,
 
That is so awasome, how many births have you done 
in your career?  I read about a midwife, who had performed 6 episiotomies 
in 650 births. Two of these were when she was taught how to make them as a 
student.
 
Paivi

  - Original Message - 
  From: 
  Nicole 
  Carver 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Sunday, August 21, 2005 12:55 
  PM
  Subject: RE: [ozmidwifery] when to cut an 
  episiotomy
  
  I 
  will only do an episiotomy if I am really concerned about getting the baby out 
  quickly. I have done one on a peri that was really tight, and didn't 
  stretch  up. I think I have done three in my career,
  Nicole C.
  
-Original Message-From: [EMAIL PROTECTED] 
[mailto:[EMAIL PROTECTED]On Behalf Of Janet 
FraserSent: Sunday, August 21, 2005 6:57 PMTo: 
ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] when to 
    cut an episiotomy
I'm not one of the 
professionals in here, Paivi but hi anyway. : ) I've read in a few 
places about how episiotomy rates suddenly drop when studies into them 
begin. A hb MW I know does less than one a year so I figure that's a good 
guide.  Mostly in hospitals they're performed for no reason at all 
but the damage they do to women's bodies and psyches horrifies me. It's 
sanctioned genital mutilation. In birth planning meetings I run I suggest to 
women that they never put their bodies in a position that can be easily 
reached by someone with scissors. Our rates are very high in Australia. Well 
IMO, any rate of episiotomy is too high unless it's negligible.
Just my 2c ; 
)
Janet

  - Original Message - 
  From: 
  Päivi 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Sunday, August 21, 2005 6:31 
  PM
  Subject: [ozmidwifery] when to cut an 
  episiotomy
  
  A mom asked me when is episiotomy really 
  needed. She had asked from many professionals, and all just gave her the 
  answer, that "They will try to avoid episiotomy, but will cut just in 
  case, if not sure". In Finland the episiotomy rates are from 4% 
  to 50%, and for firsttime moms from 9% to 88%!. It is usually beleived, 
  that the midwife will know best. (That is a medicalaized hospital midwife 
  in most cases). I already know, that you have a different opinion 
  on  when it is needed, but it would be interesting to know from you, 
  who work as midwifes, how often have you performed episiotomies? Does 
  anyone know, what is the national average in the Australian 
  hospitals?
   
  Paivi

RE: [ozmidwifery] when to cut an episiotomy

[Nicole Carver]

I will 
only do an episiotomy if I am really concerned about getting the baby out 
quickly. I have done one on a peri that was really tight, and didn't 
stretch  up. I think I have done three in my career,
Nicole 
C.

  -Original Message-From: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED]On Behalf Of Janet 
  FraserSent: Sunday, August 21, 2005 6:57 PMTo: 
  ozmidwifery@acegraphics.com.auSubject: Re: [ozmidwifery] when to 
  cut an episiotomy
  I'm not one of the 
  professionals in here, Paivi but hi anyway. : ) I've read in a few places 
  about how episiotomy rates suddenly drop when studies into them begin. A hb MW 
  I know does less than one a year so I figure that's a good 
  guide.  Mostly in hospitals they're performed for no reason at all 
  but the damage they do to women's bodies and psyches horrifies me. It's 
  sanctioned genital mutilation. In birth planning meetings I run I suggest to 
  women that they never put their bodies in a position that can be easily 
  reached by someone with scissors. Our rates are very high in Australia. Well 
  IMO, any rate of episiotomy is too high unless it's negligible.
  Just my 2c ; )
  Janet
  
- Original Message - 
From: 
Päivi 
To: ozmidwifery@acegraphics.com.au 

Sent: Sunday, August 21, 2005 6:31 
PM
Subject: [ozmidwifery] when to cut an 
episiotomy

A mom asked me when is episiotomy really 
needed. She had asked from many professionals, and all just gave her the 
answer, that "They will try to avoid episiotomy, but will cut just in case, 
if not sure". In Finland the episiotomy rates are from 4% to 50%, 
and for firsttime moms from 9% to 88%!. It is usually beleived, that the 
midwife will know best. (That is a medicalaized hospital midwife in most 
cases). I already know, that you have a different opinion on  when 
it is needed, but it would be interesting to know from you, who work as 
midwifes, how often have you performed episiotomies? Does anyone know, 
what is the national average in the Australian hospitals?
 
Paivi

RE: [ozmidwifery] when to cut an episiotomy

[Lieve Huybrechts]

Title: Bericht




 
Hoi 
Païvi,
 
This was on  the 
list a while ago.
 
greetings
Lieve
 
 
Routine episiotomy shows no 
benefits, only harmSource: Journal 
of the American Medical Association 2005; 293: 2141-8
Comparing maternal 
outcomes with routine versus restrictive use of episiotomy in a systematic 
review of the literature. 

Routine episiotomy 
does not appear to provide the benefits traditionally credited to it, and, in 
some cases, is more damaging than a spontaneous tear, say researchers. 

Episiotomy was 
initially introduced on the assumption that a deliberate incision would heal 
more quickly and with fewer complications than a spontaneous tear, and that it 
would lead to less pelvic floor problems, such as fecal or urinary incontinence 
or impaired sexual function, later on. 
To determine 
whether this is actually the case, researchers led by Katherine Hartmann, from 
the University of North Carolina at Chapel Hill in the 
USA, conducted a systematic review of 
the best quality trials available comparing routine with restrictive use of the 
procedure. 
The 26 articles 
selected for detailed study were consistent in finding that routine episiotomy 
did not reduce the severity of laceration, pain, or pain medication use, 
compared with restricted surgery. There was also no evidence to support the 
longer-term outcomes ascribed to episiotomy, including prevention of fecal or 
urinary incontinence or reduced impaired sexual function. In fact, pain during 
intercourse was more common in women who underwent the procedure. 

Study co-author 
John Thorp Jr. summarized: "In most cases, episiotomy doesn't do any good, and 
it can harm women. Why would one want a surgical procedure that's 
worthless
 
 
Lieve Huybrechts
vroedvrouw
0477/740853

  
  -Oorspronkelijk bericht-Van: 
  [EMAIL PROTECTED] 
  [mailto:[EMAIL PROTECTED] Namens 
  PäiviVerzonden: zondag 21 augustus 2005 10:31Aan: 
  ozmidwifery@acegraphics.com.auOnderwerp: [ozmidwifery] when to cut 
  an episiotomy
  A mom asked me when is episiotomy really needed. 
  She had asked from many professionals, and all just gave her the answer, that 
  "They will try to avoid episiotomy, but will cut just in case, if not sure". 
  In Finland the episiotomy rates are from 4% to 50%, and for 
  firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will 
  know best. (That is a medicalaized hospital midwife in most cases). I 
  already know, that you have a different opinion on  when it is needed, 
  but it would be interesting to know from you, who work as midwifes, how 
  often have you performed episiotomies? Does anyone know, what is the 
  national average in the Australian hospitals?
   
  Paivi
  --No virus found in this incoming message.Checked by 
  AVG Anti-Virus.Version: 7.0.338 / Virus Database: 267.10.13/78 - Release 
  Date: 19/08/2005


--
No virus found in this outgoing message.
Checked by AVG Anti-Virus.
Version: 7.0.338 / Virus Database: 267.10.13/78 - Release Date: 19/08/2005
 

Re: [ozmidwifery] when to cut an episiotomy

[Janet Fraser]

I'm not one of the 
professionals in here, Paivi but hi anyway. : ) I've read in a few places 
about how episiotomy rates suddenly drop when studies into them begin. A hb MW I 
know does less than one a year so I figure that's a good 
guide.  Mostly in hospitals they're performed for no reason at all but 
the damage they do to women's bodies and psyches horrifies me. It's sanctioned 
genital mutilation. In birth planning meetings I run I suggest to women that 
they never put their bodies in a position that can be easily reached by someone 
with scissors. Our rates are very high in Australia. Well IMO, any rate of 
episiotomy is too high unless it's negligible.
Just my 2c ; )
Janet

  - Original Message - 
  From: 
  Päivi 
  To: ozmidwifery@acegraphics.com.au 
  
  Sent: Sunday, August 21, 2005 6:31 
  PM
  Subject: [ozmidwifery] when to cut an 
  episiotomy
  
  A mom asked me when is episiotomy really needed. 
  She had asked from many professionals, and all just gave her the answer, that 
  "They will try to avoid episiotomy, but will cut just in case, if not sure". 
  In Finland the episiotomy rates are from 4% to 50%, and for 
  firsttime moms from 9% to 88%!. It is usually beleived, that the midwife will 
  know best. (That is a medicalaized hospital midwife in most cases). I 
  already know, that you have a different opinion on  when it is needed, 
  but it would be interesting to know from you, who work as midwifes, how 
  often have you performed episiotomies? Does anyone know, what is the 
  national average in the Australian hospitals?
   
  Paivi