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02-20-2013 at 7:44 PM
RussianMom...
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tearing vs. episiotomy

I've read some ppl are putting in their birth plans that they would rather tear naturally than have an episiotomy - obviously having neither would be ideal, but wondering why the reason for this would be? you would have to get stitches either way, right?

do midwives have a lower rate of tearing/epis births? is it possible to avoid tearing altogether? 

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02-20-2013 at 7:52 PM
mabenner1
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Tearing is natural, and easier to heal. An epi can lead to more severe tearing, and is a mostly useless procedure.
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02-20-2013 at 7:56 PM
MrsWindyCi...
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mabenner1:
Tearing is natural, and easier to heal. An epi can lead to more severe tearing, and is a mostly useless procedure.

This. Epis are pretty outdated, too. My OB practice doesn't do them any more.

 
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02-20-2013 at 7:59 PM
SevenThree...
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I agree most OBs let you tear naturally. It depends on how your baby presents, your pelvis, etc.  Some people recommend 'perineal massage'....I did it a couple times pre first birth, but honestly, I doubt it would have helped me.   I had a 3rd degree with first and a repeat tear with the second baby. I just assume my body will tear :(
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02-20-2013 at 8:14 PM
RussianMom...
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oh ok, thanks!

 

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02-20-2013 at 8:19 PM
ShawMich
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My doc would have given me an episiotomy if he thought I needed it. I never did...my skin stretched enough.
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02-20-2013 at 8:28 PM
elainelbuc...
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My OB only does episiotomies with forceps deliveries.  DD got stuck and we needed the forceps.  With a small episiotomy I also had 4 small tears.  I hate to think how badly I would've torn without it.
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02-20-2013 at 8:42 PM
Anne Mommy
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elainelbuck:
My OB only does episiotomies with forceps deliveries. nbsp;DD got stuck and we needed the forceps. nbsp;With a small episiotomy I also had 4 small tears. nbsp;I hate to think how badly I would've torn without it.

Same for me. I discussed it with my doctor since I would like to avoid it this time. He said it is rarely needed but it's better than a huge tear.
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02-20-2013 at 8:58 PM
laurakaz13
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Anne Mommy:
elainelbuck:
My OB only does episiotomies with forceps deliveries. nbsp;DD got stuck and we needed the forceps. nbsp;With a small episiotomy I also had 4 small tears. nbsp;I hate to think how badly I would've torn without it.
Same for me. I discussed it with my doctor since I would like to avoid it this time. He said it is rarely needed but it's better than a huge tear.

 This is me too.  I have extremely narrow hips.  They had to suction DD out and I did have an episiotomy.  I healed up in a very short time.  I was running again 2 weeks post-delivery, so clearly it was a good experience for me. 

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02-20-2013 at 9:11 PM
InkedMegs
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I had a friend get a Staph Infection while she was still in the hospital after her delivery with an Epi.  After a long recovery, they realized the doctor had nicked her bowel while doing the Epi.  He also had four other cases where this happened to women.

She said this past summer (four years later) she finally feels like everything is healed (she had to get a few surgeries) and she is actually finally thinking about having #2, but will most likely request a C-section if she can.

I keep forgetting to ask my doctors their opinion on Epi's, but if I do have to get one, I said I will lay there with my eyes closed and say, "Please don't nick my bowel, please don't nick my bowel" repeatedly.




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02-20-2013 at 9:18 PM
JollyWife
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They used to be used routinely because people thought it was better to have a "clean" cut, but now we know it actually doesn't heal as well as when your body separates on its own.  So now they are only indicated in cases of fetal distress or, rarely, if you have something going on anatomically that is preventing baby from coming out (like a super thick band of tissue in your perineum that isn't stretching, and you've been pushing for a long time, etc.).

I would run- fast- from any provider who gives you a choice about this. 
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02-20-2013 at 9:25 PM
PrimRoseMa...
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mabenner1:
Tearing is natural, and easier to heal. An epi can lead to more severe tearing, and is a mostly useless procedure.


Agree. This.
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02-20-2013 at 9:51 PM
Luckey4
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I was wondering this too! thanks for the info!
 
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02-20-2013 at 10:43 PM
rach10782
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I told me doctor I did not want to be cut under any circumstances.  What the nurse did to me to try and loosen me up to prevent tearing was to try and strech everything out with circular motions using two fingers in between my contractions after I got to 10.  I wouldn't have known but they turned off my epidural so I felt everything for those last 2.5 hours.
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02-21-2013 at 1:26 AM
AFBTB
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I had an episiotomy when DS was born, after having asked my Dr if she does them and she told me VERY rarely. During pushing she told me she had to do an episiotomy because DS's head was stuck on my pelvis. But I had already begun to tear internally.

My recovery was no longer than anyone else's, and it was only difficult for the first few days because of the stitches.

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02-21-2013 at 3:53 AM
Kimbus22
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JollyWife:

They used to be used routinely because people thought it was better to have a "clean" cut, but now we know it actually doesn't heal as well as when your body separates on its own.  So now they are only indicated in cases of fetal distress or, rarely, if you have something going on anatomically that is preventing baby from coming out (like a super thick band of tissue in your perineum that isn't stretching, and you've been pushing for a long time, etc.).

I would run- fast- from any provider who gives you a choice about this. 

This. And FWIW my 3rd/4th degree tear from my vaccuum delivery healed up fine but my best friend had a patrial episiotomy and has yet to have sex without pain since her 6 year old was born.
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02-21-2013 at 4:19 AM
KateRN08
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JollyWife:

They used to be used routinely because people thought it was better to have a "clean" cut, but now we know it actually doesn't heal as well as when your body separates on its own.  So now they are only indicated in cases of fetal distress or, rarely, if you have something going on anatomically that is preventing baby from coming out (like a super thick band of tissue in your perineum that isn't stretching, and you've been pushing for a long time, etc.).

I would run- fast- from any provider who gives you a choice about this. 

This. Also FWIW, the worst tears I have seen were midwife patients. I think it just depends on the patients, care provider and their patience.  
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02-21-2013 at 5:18 AM
Lolalipsy
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In terms of healing a tear may heal better but for me personally I would rather a nice clean surgical cut than risk and uncontrolled tear.  With Uncontrolled tears there may be an increased risk of a more serious injury. Personally I would leave it up to the medical team to decide.
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02-21-2013 at 7:38 AM
KrisM86
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Routine episiotomies aren't being done by most OBs or MWs up to date with current research. Many MW practices (especially birth center practices) have lower rates of tearing simply because women are more often going med-free and better able to feel how to push and/or are helped figure out how best to push slowly. This is certainly not always the case.

Tearing naturally is generally better. The tear tends to heal more quickly and easily than an episiotomy. Also, often when women get episiotomies they end up tearing more on top of it. Unless there is some real reason to do one, they are unnecessary and don't have much benefit (if any).
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02-21-2013 at 8:07 AM
tokenhoser
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If they cut you, you often tear farther. So it's not one or the other, it's both or just a tear. Tears heal stronger and better, as well.

It's rare that a doctor does an episiotomy other than for a surgical delivery (forceps/vacuum). 

I had a third degree tear and no complications. My baby was OP, so really I was lucky to escape the vacuum and further damage.

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02-21-2013 at 8:24 AM
526SadieSa...
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I tore and had a 3rd degree epi (I know, I'm such an over achiever).  I was pushing for three straight hours and almost needed an emergency c-sec (thanks for the narrow birth canal, Mom!)

DD had to be delivered with use of the vacuum but when that didn't work, my OB cut me open and yanked her out. 

I didn't experience a whole lot of pain once I was stitched up, never needed anything more than ibuprofen.  I will say that going down a bumpy road in the car on the way home from the hospital was not a fun experience.  Everything healed up just fine and DH says everything feels the same when we have sex.

I'd much rather have a repeat of the tear/epi than to have a c-sec next time around.
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02-21-2013 at 8:30 AM
dalzien
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mabenner1:
Tearing is natural, and easier to heal. An epi can lead to more severe tearing, and is a mostly useless procedure.

This. You are also more likely to tear or rerip yourself along an episiotomy. As far as avoiding a tear altogether... if you're incredibly lucky maybe... but from what most women say it is virtually impossible to avoid a tear. 
 
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02-21-2013 at 8:31 AM
mainerocks
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JollyWife:

They used to be used routinely because people thought it was better to have a "clean" cut, but now we know it actually doesn't heal as well as when your body separates on its own.  So now they are only indicated in cases of fetal distress or, rarely, if you have something going on anatomically that is preventing baby from coming out (like a super thick band of tissue in your perineum that isn't stretching, and you've been pushing for a long time, etc.).

I would run- fast- from any provider who gives you a choice about this. 

This was basically me. The practice I go to rarely does them, but even with lots of perineal massage from the nurse, and lots of pushing, he was totally stuck so she gave me the episiotomy. I hadn't planned on it, but given the situation I was in, I trusted her judgement and went with it. I healed quickly and all was fine for me.
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02-21-2013 at 12:59 PM
skyllingst...
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dalzien:

mabenner1:
Tearing is natural, and easier to heal. An epi can lead to more severe tearing, and is a mostly useless procedure.

This. You are also more likely to tear or rerip yourself along an episiotomy. As far as avoiding a tear altogether... if you're incredibly lucky maybe... but from what most women say it is virtually impossible to avoid a tear. 

This but I will say that its not virtually impossible to avoid a tear. I didn't tear at all with my 2nd and with my 1st I tore so minimally that I literally only needed 1 stitch. In my Bradley classes when we discussed episiotomy vs tearing the instructor gave a great example as to why tearing naturally is generally preferred. She said to think of a t-shirt- if you pull and pull and pull on an opening (the neck hole or something) it will eventually tear but its going to stretch a TON before that happens vs. if you pull on the neck hole of a t-shirt that already has a tiny cut slit into it. If you pull at the tiny cut it will rip all the way down very easily. Same principle goes with episiotomies. Obviously in some circumstances they are needed but in most normal vaginal deliveries your body will stretch and only tear the bear minimum needed if at all. I definitely attribute not tearing to my midwives and their expertise. They do a TON of massage while the baby is crowning and I can remember them forcing me to slow down with my pushing. Its really hard at that stage of labor to not just want to push and push until the baby comes but if you do slower, smoother, small pushes while the baby is crowning it gives your body time to accommodate and stretch as it goes. When a baby comes too fast is when your body is more apt to tear b/c it can't keep up with the fast pressure and pushing your body is doing. 
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02-21-2013 at 1:10 PM
Monsieur_e...
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I've heard both camps and honestly wouldn't be able to tell you which one is best. My Dr prefers to do an episiotomy rather than letting me tear. I have no objection. With both girls, I only needed a handful of stitches and it really didn't make recovery any harder.
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02-21-2013 at 2:12 PM
BelhurstBr...
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My OB rarely does them and compares it to ripping a tee shirt. If you start to cut a shirt it's easy to rip with minimal effort. She said an epi is the same, once you make the cut it's so much easier to continue to tear and more often than not there's much less damage if you let the tear happen naturally. 

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02-21-2013 at 2:44 PM
alilovesma...
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I had an epi with DS. They were in a rush to get him out though, using the vacuum. It was a pretty painful recovery but they did what they needed to do. I completely trust my doctor.
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02-21-2013 at 7:20 PM
wendalsue
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I had an epi 13 yrs ago and thought it was fine at first, but over the years I've noticed that the scar tissue gets irritated still from time to time.  It's always been raised up and kind of funny looking, but it gets sore from sex occasionally, and sometimes just starts hurting on its own.  Actually, it's been irritated the past 2 days for no apparent reason.  I'm planning on discussing the issue with my OB at the next appt. and find out what her position is on this matter.  I'd obviously rather avoid another one, but I might be equally as irritated by a tear.  I don't know.  The first one probably wasn't necessary, it was just done immediately when I started pushing.  I definitely don't want that to happen again, but I'm not opposed to one that is medically necessary.
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