This is what NICE guideline has to say on episiotomy
Carry out episiotomy only when there is:
● clinical need such as instrumental birth
● suspected fetal compromise
Do not offer routinely following previous third- or fourthdegree
Use mediolateral technique (between 45° and 60° to
right side, originating at vaginal fourchette)
Use tested effective analgesia
This is what Nice Guideline has to say on Induction of labour
Offer membrane sweep (check for low-lying placental site first).
Formal induction with vaginal PGE2
Inform women about the risks of uterine hyperstimulation.
Induce in the morning.
Check for low-lying placental site before induction.
Offer vaginal PGE2 as tablet, gel or controlled-release pessary:
– tablet or gel: one dose, followed by a second dose after 6 hours if labour does not
start (maximum two doses)
– pessary: one dose over 24 hours.
Reassess Bishop score 6 hours after each tablet or gel, or 24 hours after controlled-release pessary.
If woman goes home after tablet or gel, ask her to contact her obstetrician/midwife:
– when contractions begin
– if she has had no contractions after 6 hours.
If labour does not start
Normal fetal heart rate
Confirm fetal wellbeing with continuous electronic fetal monitoring.
Intermittent auscultation should then be used unless there are indications for continuous monitoring3.
If fetal heart rate is abnormal, refer to ‘Intrapartum care’3.
When labour is established, monitor according to ‘Intrapartum care’3.
For pain relief, see box 1.
Assess Bishop score and confirm normal fetal heart rate pattern with electronic fetal monitoring.
Provide information and support, invite questions, and allow women time for
discussion with partners and for making decisions. See also key priorities on
page 3 and guidelines on intrapartum and antenatal care3,4.
NICE clinical guideline 70 Quick reference guide
I have mentioned these two guidelines( just the relevant bit of it) because I wish to show how today's patient misinterpret these beautiful guidelines and make their management dangerous and taking patients care difficult for the concerned doctor.
like a precipitate labour and had to be given episiotomy to prevent a bad tear.Her husband questions the need for a cut as google says episiotomy should be avoided.They have coolly forgotten to read clinical need.Not that doctor has any benefit in giving a cut and repairing. It just adds on to the doctors time.Why would a doctor wish to unnecessarily add on to one's effort.The answer comes from the husband , to have a easy delivery.God easy delivery for whom?For your wife only.Why do you wish it to be difficult and traumatic?
2nd patient.....primigravida at 39 weeks goes in spontaneous labour.High risk factors----pregnancy induced hypertension controlled since 32 weeks on Methyldopa but not willing for an induction of labour as induction is associated with higher risk of caesarean section not willing to understand the risk of raised blood pressure.That lady had big blisters all over due to pregnancy hormones ,could hardly walk but the husband her gaurdian was not allowing a Induction of labour to prevent caesarean section not realizing that chronic placental insufficiency due to PIH puts one at increased risk of caesarean section.Anyways at admission she was getting mild contractions.A simple sweep for augmenting the labour was also questioned by the husband of the patient as artifical intervention and it was too Premature to sweep her.And what was the outcome.There were type 2 dips and Lady ended with a caesarean section.
DO READ THESE BOOKS/GUIDELINES/PATIENT INFORMATION LEAFLETS BUT READ AND UNDERSTAND IT COMPLETELY.BOTH THE SIDES OF THE MANAGEMENT NOT JUST THE SIDE WHICH YOU WANT TO APPLY TO YOURSELF.