Is an episiotomy assault and battery?

Posted July 16

Is an unwanted episiotomy assault and battery? One California mother thinks so, and she is suing her former obstetrician for performing the procedure in 2013 even as she begged him to stop.

As NPR reported, the case has brought to light the number of episiotomies performed in the U.S. a decade after the American College of Obstetricians and Gynecologists urged its doctors to curtail the practice.

An episiotomy is a surgical cut doctors make to widen the vaginal opening during childbirth, ostensibly to prevent tearing. But research has shown that the benefits don't justify routine use of the practice, and episiotomies can cause blood loss, infection, incontinence and pain that continues months after delivery.

In the California case, the birth was videotaped, and more than 400,000 people have watched on YouTube as Dr. Alex Abbassi made multiple cuts after the mother, Kimberly Turbin, repeatedly asked him not to.

In court filings, Turbin accuses the doctor of an "egregious act of obstetrical violence" and said the doctor began the procedure just two minutes after entering the surgical suite, Yahoo! News reported last year. Turbin has said she had significant pain after delivery and is afraid of getting pregnant again. The case is scheduled for trial in the fall.

When the American College of Obstetricians and Gynecologists urged doctors to curb the practice in 2006, episiotomies were performed in more than one-third of vaginal hospital births, according to the journal American Family Physician. In the 1970s, it was even higher: more than 60 percent.

But although rates have fallen dramatically since then, to about 12 percent nationwide, they remain troublingly high at some hospitals. NPR said two hospitals in Los Angeles report episiotomies in 60 percent of deliveries; four others have rates close to 30 percent.

Dr. Emiliano Chavira, a maternal and fetal medicine specialist at Dignity Health's California Hospital Medical Center in Los Angeles, told NPR that some doctors contributing to the inflated rates are likely trying to speed up deliveries. Others may just be unwilling to change longstanding habits, or lack information, Chavira said.

"Certain segments of the obstetric community are very slow to modernize the practice," Chavira told journalist Jocelyn Wiener, reporting for NPR.

Episiotomies are sometimes necessary and should be performed with the mother's consent if the baby is unusually large or in distress, or the mother is exhausted from a protracted labor. But there are things a pregnant woman can do to make it less likely that she will have an episiotomy that isn't needed, Parents magazine said.

Dr. Hartmann said in Parents magazine that pregnant women should talk with their doctor before their due date, and ask what his or her episiotomy rate is. (Ideally, it should be less than 15 percent.) Make clear your wishes, not only to your doctor, but also the nurses at the hospital. Women can also perform perineal massage in the final months of pregnancy to make a cut or tearing less likely, and should talk to their doctors about about how and when to do it, according to the article.


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