Dear Rasheedah,

I would encourage you to do whatever you can to avoid an episiotomy.
Not only does the use of episiotomy often result in an additional 200cc
of blood loss, but it also can cause unnecessary pain which makes
sexual activity more difficult for many months after the birth.

Also, contrary to what you may be told by those there in the Turkish
medical system who support the use of episiotomy, a natural 1st to 2nd
degree tear heals much faster and hurts much less than an episiotomy
does.

Also contrary to beliefs by those who believe in using episiotomies,
3rd and 4th degree tears are NOT prevented by the use of episiotomies.
In fact, those kinds of tears are much MORE likely when an episiotomy
has been used.

The issue of episiotomy is not a minor one, in my opinion. I suggest
that you have one person there, hopefully an experienced doula, whose
job it is to watch for the doctor's hands and scissors at all times,
but especially at that point in labor, so that no episiotomy is done.
Otherwise, it can be done SO quickly that it will be done before anyone
has a chance to object. If they see that one is about to be done, they
can gently hold the doctor's hand by the wrist (behind the sterile
glove, so as to not break his sterile field), and say to you, "The
doctor is about to do an episiotomy. Do you want an episiotomy?" When
you say "No", and the father can re-iterate "No, we definitely do not
want an episiotomy", and the doula can turn to the doctor and say "The
mother and her husband do not want an episiotomy." Then the mother and
father can even suggest that they sign whatever the doctor might like
for them to sign as a legal waiver so that he is not liable in any way
if he does not do an episiotomy.

Here are some resources which might be useful for you as you try to
negotiate for your preferences with your care-givers.

http://www.mothering.com/saying-no-episiotomy-getting-through-labor-
and-delivery-one-piece-0

http://www.sheilakitzinger.com/Research.htm#Episiotomy%20Research

http://www.naturalchildbirth.org/natural/resources/labor/labor07.htm

http://www.naturalchildbirth.org/natural/resources/labor/labor05.htm

http://www.naturalchildbirth.org/natural/resources/labor/labor03.htm

http://www.midwiferytoday.com/enews/enews1005.asp#main

http://www.midwiferytoday.com/enews/enews0125.asp

http://www.midwiferytoday.com/search/
default.asp?query=episiotomy&x=21&y=8

May you have much success in having a natural childbirth and a healthy
labor and baby in this context.

Best wishes,
Joy
(a nurse/midwife's assistant/former doula/former childbirth educator)
http://home.mindspring.com/~djsnjones/

On Wednesday, June 24, 2009, at 03:25 PM, Tamahine Alemdar wrote:

>
>
> Dear Rasheedah,
> i,m sure we are all wishing you good luck for your birth! Please let
> us know how things go.
>  
> Much encouragement
> Tamahine
>  
>
<image.tiff>
>
> To: naturalbirthturkey@yahoogroups.com
> From: hakancoker@...
> Date: Tue, 23 Jun 2009 17:19:34 +0300
> Subject: Re: [naturalbirthturkey] Re: living in Mugla - wanting
> natural birth, no circ, etc...Help! :-)
>
>
>
> I think you might leave the rest of the talk to that day. ASs Serbnem
> wrote to you, If you are polite and determined about your preferences,
> I am sure they will try to help you.
>  
> The most important think will be emotional and pysical support during
> the labor. Who will be there to support you for these? Will she be
> enough  experienced to do the negotiation between the health care
> providers?
>  
> These are all important issues waiting for you.
>  
> Best wishes in your labor. A healty nice babay will arrive, dont
> worry...
>  
> Hakan
>  
>  
>
> ----- Original Message -----
> From: Rasheedah
> To: naturalbirthturkey@yahoogroups.com
> Sent: Tuesday, June 23, 2009 1:43 PM
> Subject: [naturalbirthturkey] Re: living in Mugla - wanting natural
> birth, no circ, etc...Help! :-)
>
> Dr. Hakan Bey,
>
> Thank you so much for your words of advice. You actually cleared up
> some confusion we were having about our doctor who has both a private
> and public practice. We were seeing him at the public hospital and
> wondering why he wouldn't be attending our birth.
>
> I have to say that my husband and I were disappointed to learn that it
> will be so difficult to avoid the episiotomy but from hearing the way
> my GYN and sister-in-law (who was trained as a nurse) spoke about it,
> I was beginning to get that feeling. We met with the nurse midwives
> once before and they seemed very sweet and helpful - which was
> comforting to me. We are wondering if it might be worth it to meet
> with them once more to ask more questions or if it is better to simply
> talk with them when we arrive.
>
> Thank you again for your thoughts and advice. Should we begin this
> process again, we would know where to look!
>
> Thanks so much,
> Rasheedah
>
> --- In naturalbirthturkey@yahoogroups.com, Op.Dr.Hakan Çoker
> <hakancoker@...> wrote:
> >
> > Dear Rasheedah,
> > In Mugla state Hospital your cesarean rate will be approximately
> 50-60%. This was the rate in most of the state hospitals. (Getting
> down recently)
> > I can quarantee that you will not be offered to have any painkillers
> or epidural anestezia because it is never used in that state hospital.
> But I can not guarantee some interventions. Your labour might be
> fastened with induction, you might be forced to not to eat anything
> and have drops.
> > You epiziotomy rate will also be nearly 100%.
> >
> > But if you dont have any private doctor agreement for the state
> hospital, you will be cared by the midwifes. If you have a nice
> correspondence than you will probably have a very nice labor. If you
> trust and respect them, they will respect you more. And definately
> they will try to help you a lot.
> >
> > So good luck to you in your labor.
> >
> > Dr.Hakan Coker
> > www.dogaldogum.com
> >
> > ----- Original Message -----
> > From: Rasheedah
> > To: naturalbirthturkey@yahoogroups.com
> > Sent: Monday, June 22, 2009 3:28 PM
> > Subject: [naturalbirthturkey] living in Mu&#287;la - wanting natural
> birth, no circ, etc...Help! :-)
> >
> >
> >
> >
> >
> > Hello All,
> >
> > I am new to this group and stumbled upon it because my mother was
> reading an article in Today's Zaman that mentions this group and
> midwifery today (which mentions Dr. Hakan). I am an American citizen
> and my husband is Turkish. We are at 40 weeks right now and are
> expecting the baby any day now. We are big on natural birth but this
> is our first baby and we have both recently relocated to Turkey (so,
> we have been used to the American medical system and resources there).
> >
> > So far, all is normal in our pregnancy and the due date is June
> 25th. I am wondering if there are any tips and suggestions you might
> be willing to share to help us prepare and advocate for a natural
> birth at the state hospital here (Mu&#287;la Davlet Hastanesi). I
> would like to deliver vaginally without the use of any painkillers and
> hopefully without an induction or any other interventions if possible.
> >
> > I really wish I had seen these resources sooner because I swear I
> had been seeking out advice wherever I could find it. We wanted to go
> the slightly inexpensive route so, because we have state insurance, we
> see a private hospital doctor occasionally because she is my Gyn but
> have been mostly meeting with a recommended Ob/Gyn at the state
> hospital and making occasional visits to the Sa&#287;l&#305;k
> Oca&#287;&#305; as requested by them. We personally supplement this
> with prenatal yoga, lots of online research, and an Our Bodies,
> Ourselves and Dr. Sears pregnancy books. If I had known of midwife and
> home birthing options and doulas here in Mu&#287;la, I would have
> jumped at that opportunity.
> >
> > Again, any tips you can share about how to go about a natural birth
> (we are about 10 minutes from the hospital) from how long we should
> stay at home during labor to once we get to the hospital are very much
> welcomed. Also, after delivery, what do we HAVE to do? I was told the
> baby will be given to us and they will try to do tests (blood and
> shots and so on). The sa&#287;l&#305;k oca&#287;&#305; says to insist
> they wait on those and come visit them a couple of days later for that
> kind of stuff. We are a bit confused on what to do.
> >
> > Also, we are big on not doing unnecessary surgeries. Neither of us
> are practicing Muslims or Jews so we feel no cultural pull to have a
> circumcision but we know that is practice here. Anyone else who
> decided not to do this have any thoughts or suggestions/tips?
> >
> > Thank you so much,
> >
> > Rasheedah
> >
>
>
>
>
>
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