Episiotomy - Yay or Nay?

Nay on the episiotomy.

Large-scale tears are most likely to happen when there's been an episiotomy. One person explained it to me this way: if you try to tear a piece of fabric, it can be hard to get it started. But if you make a tiny snip in the edge of the fabric, you can usually tear it easily. Getting the episiotomy is that tiny snip, and it can end up making it easier for you to have a 3rd or 4th degree tear. 4th degree tears are very rare unless there is an episiotomy first.

Yay for the episiotomy! I've experienced both because one of my births came so fast, there wasn't time to do one. I could feel him trying to hold the tissue together but it ripped anyway. I now agree with my OB, a rip is harder to stitch back together and it takes longer to heal.

J. in Minneapolis

Thoughts on this topic have changed a lot over the years. It use to be that an epistiotomy was highly favored, they figured if it is going to tear anyway that it is better to have a straight surgical cut. However, over time they have learned that the womans body was designed in amazing ways to adapt to delivery. They have found that if they allow the skin to tear, it tends to tear more naturally and thus heals more cleanly and the tissue is stronger then if it is forced to heal where it would not naturally have torn. I personally had 3 small tears ( one vaginal , two cervical) when my son was born and did not have an epistiotomy. They have healed well and i have no lasting effects from it. There's my 2 cents.

Nay-studies have shown that it is harder to heal from episiotomy than a tear. the other moms gave great advice but I just wanted to throw out there, that I didn't tear at all, not one stitch, and I am very petite-size 0, 5 feet tall. Not one stitch, Good luck!

I just decided to trust my midwife & let her decide what was best. I did end up with one in the end & all was OK. Once it happened I felt a rush of relief & he came right out. It wasn't painful like I thought it would be. It was pure relief! I really trust my midwife & I know she would make the right decision. Otherwise, I think that the unknown makes it more intimidating, but it really was no big deal.

Good luck!

NAY. I haven't had time to read all the responses so I apologize if this is a repeat. But most current research says the cons outweigh the pros of an episiotomy in most cases. One example my OB gave me was to take a whole piece of paper, grab each side and try to pull it apart by pulling your hands away from each other. It doesn't rip. Now put a small tear in the middle of the top and try the same thing. It usually tears easily. Same with you. Also, just because it's easier for the doc to stitch up a straight cut doesn't mean it's better for YOU.

As for personal experience, I had quite a bit of tearing with my first. With the second I had a tiny tear that didn't even need stitches. And with the third and biggest, no tearing at all. In my experience, the actual giving birth part was the same, I literally couldn't tell if there was tearing or not (and even asked my doctor if she was sure there wasn't with the third since he was so big!). The only difference was with the recovery time. Stitches definitely made me feel more sore afterwards but that would be true with an episiotomy too.

Do your kegels, and if you have a chance, I would highly recommend taking a prenatal yoga class. It was soooo helpful for me!

NAY! Although I think there's a time and place for some medical intervention, there is no need to plan to have an epis. My friend and I gave birth a day apart and I healed quickly even though I had a more complicated tear to stitch. She had an episiotomy, and it took a long long time to heal. In her case the doctor didn't discuss it with her and went ahead and did the cut. Just make sure that whatever you decide, your doctor, nurses, etc. know what your thoughts are. Otherwise, they might assume that you don't care and do what makes their job easier. Also, we used a doula and it worked out great. All the best!

P.S. My mother and sister (who is over 10 years older than I) both thought that I was nuts for not wanting an episiotomy. Times have changed a lot. Women are taking charge of their medical care like never before.

With my 1st child my doctor streched the vaginal wall as much as possible to avoid the episiotomy. Unfortunatly her head was a 13 so she had to make a small cut to avoid tearing in the wrong place. With my 2nd child I also had one but felt the doctor didn't work with me as much (HMO - you get whos on call). 1st baby I had the same doctor the whole pregnancy. Talk to your doctor if possible and find out if he/she always does one or only when necessary. They all do things differently. Some doctors will work with you. It sounds like you have an extra voice and support with the doula. Episiotomy is to prevent tearing out sideways, which is harder to repair and recover, but should only be done if you are already stretched to the limit before tearing. In the end just make sure if you need stiches that they do them properly. Stiches can break when just sitting if propper attention is not given to that process. Trust your instinct and go with what feels right to you. Everyones body is different and you know your body better than anyone else.

i had a small episiotomy with my first (unsure what will happen with #2 - we'll see in a few months!), and i had no issue with it. i had very few stitches, i had no problems with aftercare & everything healed quickly. since then i've had no problems with excessive tightness or anything like that. personally my labor went so fast, i think tearing would have been more traumatic for me.

i think it's definitely a conversation to have with your ob/midwife to see what they do routinely & what other measures they are comfortable & willing to take (perineal massage, etc.). then you have a little more information to make your own decision about what's right for you.

congratulations & good luck!
J.
mom to chase (4) & paige (due 6.2.08)

Starting out let me say that my mother of nine children told me that with every single one she had an episiotomy, the doctors didnt really ask they just did it, wow things are different.
I have two children and had no medical intervention with either, both births were different but I trusted my body and my doula. just decide what you would prefer and be ready to have things changed. With my last child I spent a long time pushing( big head and shoulders like his dad), but when the head crowned my sister(doula) made me stop pushing and just let things stretch. No stiches or tearing with this baby. I had one stitch with my first child and I didnt slow down when I was pushing.
I can highly recomend a water birth I had one with both my children and it is incredible the difference I felt getting into the water as I entered transition.
Just remember to be flexible and trust your body. relax and know that you can do this.
kegels, kegels, kegels!!!!!

I have experienced both. I would go with the Episiotomy. reason for this is it is easier to repair a straight cut incision then a jagged tear. Stitches tend to heal better also. That is just my take. Best wishes to you

Let me begin by saying that no matter what your birth plan most likely things will go a little differently than planned and that's O.K. The most important thing is delivering a wonderful little girl. There are exercises you are able to do to help your body prepare for birth and hopefully neither tear nor need an episiotomy. I would talk to your Dr./Midwife about those.

As for a personal experience I had one after 2 hours of pushing. About 2 minutes after I had it my son was born- yea!- a c-section was looming for me if he wasn't born. It was painless and healed quickly. I am so thankful I didn't have a tear or a c-section. My Dr. worked really hard to avoid it per my request, but it just didn't happen the way I planned. and you know what?- it didn't matter one way or another because I got my beautiful child and that's all that matters.

I suppose am more accepting of an episiotomy than some because I had a fine experience and personally I would rather have a nice clean incision that healed quickly than a tear (that could tear in any direction). I have heard stories of good tears, horrible tears, good episiotomies, and bad ones. Just leave enough wiggle room in your birth plan for the unexpected.

I'm with the nays. Everything I read (and boy did I read a LOT on pregnancy and childbirth) suggested that episiotomies in general take longer to heal and are more painful. I understand that is b/c most tears are relatively minor. While I think the term is a little misleading, my husband and I created a *Birth Plan* (maybe it should be called Birth Suggestion). On it we included the following point: "During labor and birth, we would prefer: ... To preserve mom’s perineum; prefer no episiotomy unless required for baby’s safety or if tearing badly, and then would like to be notified first." For what it's worth, my #1 piece of advice is, If you have a preference on episiotomy or any other birth stuff, consider making a birth plan for yourself. Be sure to go over a draft with your caregivers beforehand. On the Big Day, bring a copy to the birthplace, too. And yes by all means check out www.childbirthcollective.org. Best wishes! My birthday is June 17th: it's a great month to have a birthday! --L., mom to 6 month old boy

Nay, to the extent you can plan it -- sometimes it can't be avoided if your pushing stage is long and your baby needs to get out quickly. It used to be thought that an episiotomy was easier to heal from (and probably easier for doctors to stitch up -- lots of routine procedures have a lot to do with making birth easier on the staff) and would reduce tearing, which is probably why your mother-in-law recommends it, but many newer studies have found that tears, IF they even happen, are easier on the body. Also, what starts out as a "little episiotomy" can sometimes lead to much larger tearing. You might want to look into having a doula, as well as some out-of-hospital childbirth education classes -- check out both at www.childbirthcollective.org. I think it's best to go into your birth knowing that your body is built to give birth, and that humans give birth better than almost any other species, and complications happen very rarely.

Have a blessed and peaceful birth!

First of all, don't stress out at all about your labor. It will go great, regardless of an episiotomy or tear. Recent studies have shown that an episiotomy doesn't help with incontinence over tearing. I think the other moms are right, in that OBs regularly now do not do an episiotomy now. With my first, my OB felt that way. BUT, that kid was not coming out without a cut first. So, I had an episiotomy because I didn't have any other choice. I've had no problems since. With my second, he came out so fast that I just tore in the same place. No problems since either. I'm sure your fine either way, and just don't get your mind set on one or the other because you ultimately can't control what happens! Congratulations and good luck.
E.

E.-
I've had two, one with each of my pregnancies. First of all, it is one of those things you don't plan on having, and something that is a bit difficult to plan for. Sometimes you need one, sometimes you don't. I had doctors and OB nurses deliver both of my children, and both times the episiotomy was presented as an option. My first one was to expedite the delivery (I was exhausted and my son had a big head!) and the second was done to prevent tearing my original scar tissue from the original episiotomy. I think the procedure is better than tearing, simply because it is easier to repair and confined, whereas tearing can occur over a larger area and take longer to stitch up. The recovery from an episiotomy is rough--I won't lie--especially the first one. But I've had no lasting issues with either. So, if you do need to have one, I would opt for the episiotomy over tearing. Good luck and congrats on the baby!

NAY! I don't think most OB's or Midwives even do them routinely anymore! If in labor they need to, they will, but as far as putting it on the birth plan, forget it! I was unsure for the 1st, just like you, but decided I wouldn't have any idea before labor what I wanted or needed, but would make the decisions with my dr. and DH in labor. That has worked great through both kids! One suggestions, don't eat anything too heavy in labor, I had a horrible experience with vomiting pasta in labor. Not recommended!! Good luck!!!

Hi E.,

NAY NAY NAY NAY NAY! ;) My sister in law had an with episiotomy with her first, and had to have one with her second and third (because of the risk of tearing along the scar). She said it was horrible, and if she could have done it over again, she would have let herself tear. It took her alot longer to recover than it did me, I tore both times, required a few stitches, but it wasn't too bad.

Talk more to your doula about natural vs. medical when it comes to birth. I my opinion it is always best to let your body do it than to intervene (unless medically necessary). I had a Dr. directed birth with my first and a 100% natural water birth with the second and I highly recommend going natural.

Good luck!
J.

My son is 6 years old, and I was 25 when he was born. He was 10lb 2oz and I had a natural child birth-no drugs. My Doctor suggested that I tear instead of an episiotomy because it sutures easier and heals and more naturally. I can't say for certain because I've never experienced an episiotomy, however I can say the natural tear left no scarring, healed just fine and looks normal.

Well you could look at it like this...you can either tear naturally or have someone cut you...or you could be like me and not tear at all, I didn't require any stitches afterwards, so it does happen, I had two babies and no tearing with either......I guess I would prefer to not be cut by the knife...

you can listen to your doula, do the little exercises and the vaginal massages by either yourself or your partner to soften the tissues to better prepare for labor....

my mother in law is a nurse too and I got a lot of 'you should's' or 'you have to's'...
and really you should do it your way...