There are times when episiotomies are needed (I still believe I needed one due mainly to the fact we weren't getting anywhere after 2 hours of active pushing and I was not tearing on my own) but it does seem better to simply allow tearing to occur. It is probably more likely to tear around the weakest areas anyway, rather than potentially cutting otherwise strong muscles, therefore weakening new areas.
Frankly, even the whole "slice vs tear" thing is looking like junk science these days. Tears actually heal better than epi cuts, from what I've read, because doctors can more easily tell what goes with what when they're stitching things back together afterwards. Epi cuts also seem to structurally weaken the vagina, which causes secondary tearing.
Tears that go all the way through the anus, for example, are virtually unheard of in countries which avoid episiotomies. In countries which commonly use the procedure, however, they happen in a good ten percent or more of all births.
Things do seem to have gotten a lot better in recent decades. However, you're right, it pays to be careful in any eventuality. There are still plenty of "old school" OBGYNs out there.
Interesting. I'll have to look that up at some point when the time rolls around for me to be a proxy.
Re: tears going through the anus, are we talking developed countries that avoid it, or countries without proper birth care? Because one of the risks that happens in the third world, but almost never in the developed world, is fistulas from labors that go for too long. Even though using forceps and episiotomies have risks, this is one of the complications they can help avoid. Fistulas can lead to sepsis and death.
Interesting. I'll have to look that up at some point when the time rolls around for me to be a proxy.
Re: tears going through the anus, are we talking developed countries that avoid it, or countries without proper birth care? Because one of the risks that happens in the third world, but almost never in the developed world, is fistulas from labors that go for too long. Even though using forceps and episiotomies have risks, this is one of the complications they can help avoid. Fistulas can lead to sepsis and death.
Developed countries. I think the Scandinavian countries in particular. I absolutely agree that there is a time and a place for the procedure. I simply think it's traditionally been overused.
It's interesting to note, however, that hunter-gatherer women - who forego hospitals entirely, and basically just crawl off into the bushes to birth on their own - actually have way lower maternal mortality rates than third world women who live in more developed societies (though infant mortality is about the same).
There are also more and more procedures in the developed world in place to prevent tearing entirely. "Assisted stretching" is apparently a big deal these days, for example.
Developed countries. I think the Scandinavian countries in particular. I absolutely agree that there is a time and a place for the procedure. I simply think it's traditionally been overused.
It's interesting to note, however, that hunter-gatherer women - who forego hospitals entirely, and basically just crawl off into the bushes to birth on their own - actually have way lower maternal mortality rates than third world women who live in more developed societies (though infant mortality is about the same).
There are also more and more procedures in the developed world in place to prevent tearing entirely. "Assisted stretching" is apparently a big deal these days, for example.
Yup, this is true, Phys. Believe it not, things have actually improved in the last couple decades.
It's still not good enough, but from what women have told me, giving birth in the 80's was absolute hell. That would be when Gath's mother had her experience, and also the women I mentioned in my post who recommends all women have a third party there.
Still not good enough. But the festival or horrors from the 80's beggars belief.
Interesting. I'll have a look.
Certainly. I'm sure we could get episiotomy use down to a fraction of what it is if we were actually taking proper care of women during birth.
Three is that a lot of third world countries have their own variation of abusive practices, in the way they demand women deliver.
The vagina is muscular in nature, and even a nulliparous women can handle a hell of a lot if she learns how to relax and constrict those muscles on demand. And of course, they can handle much more when you introduce the plasticity-inducing hormones of late pregnancy. But many Western women tend to have chronically constricted pelvic muscles, even if they don't meet the bar for an actual disorder, like vaginismus. Learning how to relax them probably helps a lot.
Interestingly, this seems to vary a lot by region, at least in the US. In the North East, for example, from what I've read, epi cuts are still very, very common. In New Jersey in particular, the rate is still well above 50% at a lot of facilities.
Charleston, for whatever reason, actually appears to be fairly progressive in this regard.
Leapfrog Hospital Survey
The worst in town is the Catholic hospital (probably simply because it has a high number of older doctors), and even that's only at 14%. It's also paired with a C-section rate that's only a little over 20%.
The community hospital has a 4% epi rate, and the medical university has a whopping 0.2%. Though... Unfortunately, they're a bit worse with C-sections. The one has a 36% rate, and the other is sitting around 28%.
True. Mindset and environment has a lot to do with that as well.
I've watched a couple of hospital births online, and I've watched a few water births. The difference is generally pretty remarkable.
The former tend to look and sound like horror movies half the time. The latter is often calm enough that it could be mistaken for nothing more than an unpleasant bowel movement. Lol
As you and Rogue mentioned before, there are always going to be women with complications who won't be able to achieve that. However, I certainly think that some things could be done here, both psychologically and procedurally, to make the process a lot more pleasant for the average mother to be.
Ehhh... On the other hand, however, you've got crap like what happened to my mother, where a lazy, curmudgeonly doctor went straight for the surgical scissors "just 'cuz" in spite of their being absolutely no pressing medical emergency requiring it, wound up causing some fairly traumatic bloodloss in the process (basically sending her into shock), and then stitched her up without using painkiller afterwards, telling her to "just shut up and do your breathing" when she complained. She wound up with "lady issues" that lasted for months afterwards (both of my parents have also said that their sex life was never quite the same), and to this day - almost thirty years later at this point - she still gets emotional talking about the experience.
If it's life or death, that's one thing. However, historically, and even today to a certain extent, I think a lot of doctors jump the gun, and wind up causing unnecessary damage. They often give their patients little choice in the matter when they do.
That's very interesting. Out of curiosity, what's the rate like for more rural places in the Carolinas, or further to the south?
Yes, I am turning over a theory in my mind.[emoji38]
Cities are inherently more progressive places, but culture is dependent on location like anything.
Places like the Northeast tend to have the lowest fertility rate in the country. A lot of childfree women, and a lot of women whose experience of parenthood is more of a side concern than their main focus in life.
Less so in a place like Charleston. That doesn't mean the progressives went away. It's a city, after all. But I wonder if, due to the cultural differences, the gender progressiveness and feminism in a place like Charleston focuses more on mothers, than it does in a place like New York.
Not to get weird here (whatev's, you already did that with the birth video thing :lol
but yes, it makes a huge difference, even in all the other things vaginas, uh, encounter.
I notice a difference in my tension, and how much at-will command I have over relaxing, based on where I physically am, and who I'm with. And it's not even really obvious things. Obviously I don't have sex with men I think are unsafe to be around. It's something more subtle than that, whatever it is -- perhaps just *how much* I like them, or *how used* to being in their space I am, versus my own.
Tension is often automatic. It doesn't feel like you're tensing, and you may not have any control over it at all. You only know you're tense by comparing it to when you relax, and being able to do that actually takes some practice.
Snip length
I really don't deny the existence of these doctors, but that's called medical malpractice.
Which is the point of this thread. Yes such practices need to be brought to the light and stopped, but trying to throw the "rape" stigma on top of it is the overdoing it part.If it's "malpractice," it would appear to be a form which has been rather endemic to the birthing practices of the Western World for some time, and which also seems to go unpunished, and unrecognised, at a rate which should be viewed as being nothing less than alarming. Stories like my mother's are hardly uncommon, after all.
I do think there is a valid point to be made in drawing attention to that. Though, I would agree that some people probably overdo it.
Which is the point of this thread. Yes such practices need to be brought to the light and stopped, but trying to throw the "rape" stigma on top of it is the overdoing it part.
Only if she has admitting privileges at the nearest hospital and the home has 8 ft wide hallways.Get a mid-wife and have it at home.
That's very interesting. Out of curiosity, what's the rate like for more rural places in the Carolinas, or further to the south?
Yes, I am turning over a theory in my mind. :lol:
Cities are inherently more progressive places, but culture is dependent on location like anything.
Places like the Northeast tend to have the lowest fertility rate in the country. A lot of childfree women, and a lot of women whose experience of parenthood is more of a side concern than their main focus in life.
Less so in a place like Charleston. That doesn't mean the progressives went away. It's a city, after all. But I wonder if, due to the cultural differences, the gender progressiveness and feminism in a place like Charleston focuses more on mothers, than it does in a place like New York.
There could be some merit to your theory. However, there are some other potential explanations as well.
I've read, for example, that private practices are much more likely to snip than public institutions, that white women are far more likely to have these operations than minority women, and even that wealthy women are more likely to have them than poorer women (I think, anyway). Given that the NE tends to be fairly well monied, it could very well be a "getting your money's worth" kind of thing. That they demand the "works" even when the "works" isn't necessarily what's best, and that doctors are both more than happy to oblige, as well as lead women in that direction in the first place.
It could also simply be a cultural thing. Tres, ChrisL, and Lursa are all NE girls born and raised (again, I think) and all of them have pretty firmly expressed "the doctor must be right" attitudes on these kinds of issues.
In New Jersey, the state Department of Health has urged hospitals to take a closer look at every elective early delivery. Nearly all instituted what's called a "hard stop," in which the decision to have an early delivery has to be reviewed by the head of obstetrics, and has to have a medical reason.
"It can't be, 'I want the baby's birthday to be my mother's birthday.' And yes, people do that," said Navin. "It can't be, 'I'm in a wedding and I want my bridesmaid's dress to fit.'"
Physicians were initially leery of turning down such requests, concerned that if they refused a patient's request, she'd simply find another doctor who would accommodate her, she said. That worry hasn't proved to be valid; few women switch doctors late in their pregnancies.
Hmmm... Doctors in New Jersey itself basically seem to blame the problem on an over-reliance on (often elective) induced labors in the past.
N.J. hospitals reduce early delivery of babies - with one exception
Induced labors tend to have a substantially higher rate of complication than the full-term variety, so that would explain the higher incidence of surgical intervention (particularly back before doctors were being trained to be more conservative in its application).
Interpretation of that state of affairs could really go either way with regard to our respective theories.
On the one hand, this would seem to indicate that a desire for greater control over the process of childbirth, and the willingness to throw around money to make that a reality (as well as the desire of doctors to pander to the demands of their clientele), played a large role in creating this status quo. That would be line with what I suggested.
On the other hand, however, the NE having somewhat less traditional attitudes towards femininity might very well play a role in explaining why so many women in that region of the country tend to take a "I don't care, just get it out of me because I've got better things to do" approach to childbirth in the first place. That would be in line with what you suggested - even more so if one considers that a lot of women there are having children later in life, which tends to increase the likelihood of complication requiring intervention even more.
An interesting subject to speculate on either way, I suppose. :shrug:
Interesting. Although, I wonder if this might be a distinct phenomenon than the one discussed the OP of women having certain birth procedures forced on them.
I'm sure there's some kind of feedback loop; a given doctor is used to impatient women and projects that onto other patients, etc. But there's also a unique element of women perhaps not being fully educated on the health consequences of certain pregnancy decisions themselves.
An unwillingness to slow down -- which is both a product of Northeastern culture, and the American tendency for fathers to be relatively uninvolved -- drives a desire to make pregnancy "fit" into a strict time frame that a lot of busy women have to work within, especially in the Northeast.
So, would that opinion change if the average woman were better educated about her pregnancy, and the average couple were more cooperative about parenthood responsibilities? It might very well.
But it's interesting that gender progression looks so different in different parts of the country. In Charleston, it looks like protecting the well-being of mothers and babies in a system that is often inadequate in helping women make educated medical decisions. And in New Jersey, it looks more like minimizing the impediment on women's lives that can occur due to unhelpful partners or hectic schedules.
Neither is necessarily wrong, at least in its entirely. But I think each represents an incomplete view of women's concerns in family building, and displays how much work we have to do at getting to the bottom of supporting motherhood in an honest way.
There's a part of me that isn't entirely cool with doctors refusing to perform certain procedures on women. But, that part of me comes from the fact that society is often very punishing towards women who are trying to do the best by their infants, and that refusal of these services may impede their lives in the long-term. I see the merit of Charelston's approach, and New Jersey's. Neither is complete, but both have reasoning.
Ultimately, it's a better solution for society to be more accommodating of families, beyond even just pregnancy and infants. I certainly know from experience that employers in particular are excruciatingly unforgiving of family emergencies.
What Is "Birth Rape"?
I can only just shake my head. Now I am not trying to say that there are not doctors who are just bad at their jobs, because there are. However, I find this to be going a little too far. The doctor in the birthing room has two patients; the mother and the baby. Things can happen where there simply isn't time to explain things or even ask permission, especially if the baby's life/safety is at stake, and sometimes even the mother's. This is what every mother should know when she goes in to give birth. Yes ideally, there will be time for the doctor to let the woman know what is happening and needs to happen, maybe even get permission. But things don't always go ideally and the doctor has to make the split second decisions. Now looking at the Skol example, I will say that the doctor should have had been hit with a malpractice suit and fined a lot more than he was. Skol and her baby should have been the focus. But I really can't see how the term "birth rape" can really come into play here.
Unnecessary episiotomies and C-sections that are pushed on women are rampant, largely because they bring in more money. But these can leave lasting damage for the woman.
http://www.nytimes.com/2004/01/31/u...r-trial-work-edwards-left-trademark.html?_r=0
In 1985, a 31-year-old North Carolina lawyer named John Edwards stood before a jury and channeled the words of an unborn baby girl.
Referring to an hour-by-hour record of a fetal heartbeat monitor, Mr. Edwards told the jury: ''She said at 3, 'I'm fine.' She said at 4, 'I'm having a little trouble, but I'm doing O.K.' Five, she said, 'I'm having problems.' At 5:30, she said, 'I need out.' ''
But the obstetrician, he argued in an artful blend of science and passion, failed to heed the call. By waiting 90 more minutes to perform a breech delivery, rather than immediately performing a Caesarean section, Mr. Edwards said, the doctor permanently damaged the girl's brain.
''She speaks to you through me,'' the lawyer went on in his closing argument. ''And I have to tell you right now -- I didn't plan to talk about this -- right now I feel her. I feel her presence. She's inside me, and she's talking to you.''
The jury came back with a $6.5 million verdict in the cerebral palsy case, and Mr. Edwards established his reputation as the state's most feared plaintiff's lawyer.
In the decade that followed, Mr. Edwards filed at least 20 similar lawsuits against doctors and hospitals in deliveries gone wrong, winning verdicts and settlements of more than $60 million, typically keeping about a third. As a politician he has spoken of these lawsuits with pride.
''I was more than just their lawyer,'' Mr. Edwards said of his clients in a recent essay in Newsweek. ''I cared about them. Their cause was my cause.''
The effect of his work has reached beyond those cases, and beyond his own income. Other lawyers have filed countless similar cases; just this week, a jury on Long Island returned a $112 million award. And doctors have responded by changing the way they deliver babies, often seeing a relatively minor anomaly on a fetal heart monitor as justification for an immediate Caesarean.
On the other side, insurance companies, business groups that support what they call tort reform and conservative commentators have accused Mr. Edwards of relying on questionable science in his trial work. Indeed, there is a growing medical debate over whether the changes have done more harm than good. Studies have found that the electronic fetal monitors now widely used during delivery often incorrectly signal distress, prompting many needless Caesarean deliveries, which carry the risks of major surgery.
The rise in such deliveries, to about 26 percent today from 6 percent in 1970, has failed to decrease the rate of cerebral palsy, scientists say. Studies indicate that in most cases, the disorder is caused by fetal brain injury long before labor begins.
Edwards and C-sections | MothertalkersOur Cesarean rate is currently 30%, and it’s rising at an astonishing rate. Basically three times more women are being operated on in the US today (far more than in any other country) for no real benefit and resulting in much higher risks for mother and child. It’s astonishing that 2/3rds of C-sections are unnecessary in our country today. As a country, we now have a rising maternal mortality rate, we have an appallingly high infant mortality rate. Research supports that trial lawyers (malpractice lawsuits) have very little to do with our increased healthcare costs, but, there is no such research regarding the effects of Doctors practicing ‘preventative’ medicine (preventative against lawsuits) on the rising C-section rate. And the number of lawsuits related to untimely Cesarean’s has increased dramatically.
And what are the benefits? Lawsuits with huge punitive rewards are supposed to be ‘doing’ something, teaching some sort of lesson to doctors or insurance companies. I ask you, what is the lesson? This increase of C-sections (from 7% only a few decades ago) has not resulted in a decrease in cerebral palsy rates. The have not decreased the rates of stillbirth or postneonatal death. More women are being cut open unnecessarily, and their infants generally fair worse than infant born vaginally.
That's not why C-Sections are so prevalent... where the **** do you come up with this ****? Oh, that's right didn't Obama blather about such once in one of his stupid strawman lack of information stupidity fests he calls speeches... I think he did.
The reason there are so many C-Sections, is because of lawyers like John Edwards.
Edwards and C-sections | Mothertalkers
BTW, I have been told that men would probably only give birth once! :2razz:
What Is "Birth Rape"?
I can only just shake my head. Now I am not trying to say that there are not doctors who are just bad at their jobs, because there are. However, I find this to be going a little too far. The doctor in the birthing room has two patients; the mother and the baby. Things can happen where there simply isn't time to explain things or even ask permission, especially if the baby's life/safety is at stake, and sometimes even the mother's. This is what every mother should know when she goes in to give birth. Yes ideally, there will be time for the doctor to let the woman know what is happening and needs to happen, maybe even get permission. But things don't always go ideally and the doctor has to make the split second decisions. Now looking at the Skol example, I will say that the doctor should have had been hit with a malpractice suit and fined a lot more than he was. Skol and her baby should have been the focus. But I really can't see how the term "birth rape" can really come into play here.
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