Episiotomy or tearing?

[its_our_family]

Neither sounds fun to me but what is the lesser of 2 evils?

I would rather have neither but I just wonder if the ob "really" waits for the right time to do an episiotomy or if they really even try, kwim?

[shelbean91]

I had an episiotomy with my dd and that was the worst part of the delivery and recovery. They gave me 6 shots to numb before the cut and I felt each one and each one hurt! When the novacaine (or whatever numbing stuff they used) wore off, it was so sore and achy. I couldn't sit normally for weeks.

With my ds, I told them I didn't want to be cut and I wasn't. Didn't tear, either. I was ready to go out dancing 2 days later. I did have some 'skid marks' from stretching, but those only hurt when I peed and stop when I used the peri bottle to rinse off. (Sorry if TMI)

I don't know if tearing would be better than a cut, but I've heard it's better and I really don't want another cut- I thought it was just horrible. I've got a new OB now and I will be discussing the issue at length at my next appt.

[pamamidwife]

Here's a thread that might help you out, if you're planning a vaginal birth:

http://mothering.com/discussions/sho...hreadid=101149


That said, no matter how many times I've heard doctors say, "oh, I never routinely cut episiotomies", it seems that I always witness those extremely rare births where they do. Your doc has to be totally on board with what you want or your support person better be ready to knock the scissors out of his/her hands.

Sharp things do not belong near our genitals - male or female!

[Artisan]

I delivered a 10 lb baby and needed two stitches. It hurt a lot for quite a while. But I still wouldn't ever want an episiotomy. (I had a hospital delivery with a midwife.)

I have a friend with a traditional, male OB, and she told him "NO EPISIOTOMY." He relented, but then did NOTHING to support her perineum, and she ended up tearing (with a 6 lb baby) in a starburst pattern that is still not completely healed 2 years later. (She tore so bad she has a problem with fecal matter leaking out a hole in that area -- she won't let them go in and repair it.)

Her example is extreme, thank God, but I used it to illustrate that even if you say you don't want an epis, you MUST have a practitioner who knows how to support the "area". Unfortunately, a lot of doctors are not trained that way!

[milk4two]

With an episiotomy it's likely you will tear even further. There's no guarantee you will tear at all, especially with perineal massage. I wouldn't choose an episiotomy.

[anothermama]

I would rather tear....

It makes a lot of sense to me that a tear will hear faster and easier than a cut.

I had a 9 1/2 lb baby and needed four stiches from the tear, and to be honest, I didn't feel myself tear, I didn't feel the stitches, and by the time I got up the nerve to look down there after I had my baby, everything was back to normal. I was sore for about...oh....four days afterwards, but I think that was also due to delivering a big baby and not just the tear.

[Spark]

I'd vote for not tearing and not getting an episiotomy. If I had to choose between the two, then I'd tear. The idea that tearing leaves tiny little edges that have more surface to glue back together VS. the smooth cut that a blade makes seems to equal faster healing time for tearing than cutting.

I do believe in perenial massage, woman in labor to decide when/how/where to push, and supporting the perenium during pushing (you can do that yourself if your provider can't). We did all of that during my last pregnancy/birth. I pushed my son out while he was posterior and had a compound presentation. He was an average 7#, 2oz, but I didn't tear at all. I might have had a minor skid mark, but I never did need the Peri bottle.

IMO, if my medical provider said that he/she did one or more episiotomies in his/her last 20 births...I would RUN.

[Greaseball]

When women are allowed to care for themselves during birth, rather than have people "manage" everything for them, they support their own bodies instinctively at the right time and most of the time they do not tear at all. Some do have a slight tear which quickly heals on its own.

If you are forced into an unnatural position and are not permitted to do any of the things that feel right to you, tearing is much more likely.

But, I delivered on my back in stirrups and with forceps, and I did not tear.

I would much rather tear than have an epis.

[lilmiss'mama]

My babes were 9.5.lbs and 9lbs and neither tearing or an episitomy occured. I have heard the perenial message works, but I didn't do it. My widwife used olive oil, a warm cloth, and gentle stretching with her hands for my second birth, which was on land. For my first, which was a water birth, there was no help. Maybe it was being in the tub so much during labor.

[lilmiss'mama]

Also, my midwife told me about a midwife friend of hers who used seaweed to heal tears. She would put a small piece on the tear and it would heal on its own. Does anyone know more about this?

[its_our_family]

Where can I find info on perineal massage??

Is this something a doula can help with?

[Boobiemama]

I'd rather tear. Who wants a knife down there???

I have given birth 4 times. I had no episiotomy, and no tear for the first 3. The last baby I had an OB who put me in stirrups, and I tore. After 3 babies!!! And she was NOT the biggest!
Anyway, needed only 3 stitches, and it healed nicely. I guess, I cant see down there! LOL

I wonder if a previous tear makes me more succeptible to tearing again and what I could do to prevent another tear.

Of course, no stirrups.....

I am planning a waterbirth in a freestanding birth center with a male OB.
I plan to discuss this at my next appt in 10 days.

[aguacates]

When you tear, only the amount that needs to tear goes, when you are cut, several layers of muscle tissue are severed, which can lead to further tears.

That said, I birthed a 9 lb 14 oz baby and had a slight tear on my labia that needed minimal stiching. If I had had an episiotomy, my perineum would had been cut, which didn't tear in the slightest.

When I was born, my mother was given an episiotomy, she tore three ways from that episiotomy, it was a third and forth degree tear, and I was only 7 lbs 6 oz.

[Spark]

Megan --
Here's one site on Perenial Massage. http://www.childbirth.org/articles/massage.html

There are quite a few threads on it over at I'm Pregnant. Just do a search if you want to hear what other MDC women say about it.

I'm sure your doula knows about it. Personally, for me, it's a rather intimate thing. I prefered my MW to show my husband how and then, have him do it weekly until birth. Or just do it myself.

[shelbean91]

I don't know if I should start a different thread for this, but it's pretty related....

I know for lots of cuts and stuff, some doctors and hospitals are using glue type stuff to close wounds instead of stitches. Does anyone know if they could use that same glue type stuff instead of stitches for a tear? (Probably not for epi b/c that cuts more layers....)

[tinyshoes]

Originally posted by Boobiemama
I'd rather tear. Who wants a knife down there???

Too bad it's not a knife (scapel) used for this unneccesary surgical procdure--it's a pair of blunt-tipped Mayo scissors. Natural birth advocate and author Shelia Kitzinger cites the frequency that these scissors are somewhat dull (vs. a sharp scapel) and tend to crush and bruise tissues as they slice perineal flesh.

An episotiomy is ALWAYS a 2nd degree injury, that is, through skin AND muscles, whereas most times if a woman tears it will be a 1st degree (skin only) injury. A 3rd degree is to the anal sphinchter, 4th degree is clear throught tha anal sphinchter. 3rd and 4th degree injuries are most often a result of an episiotomy, and any OB textbook or episiotmy-slicing OB will tell you that (it's not just the crunchy homebirthers alleging that episiotomy causes those injuries.)

I always think it is worth keeping in mind the concept that the delicate perineal tissues/labia are just like the lips on a persons face--what would hurt more? A tear/crack in the corner of your mouth or a scissors-snip through the cheeck tissue?

THAT'S what's happening with an episiotomy--gross, hunh? Each winter I know I can live through some dry lips/cracked corner of the mouth with a little TLC & lip balm...I wouldn't want to cut 'n' sew my face to prevent a naturally occuring tear. (Ok, extreme example, but hey--just trying to illustrate my point.)

OBs who perform episiotomies "only when neccessary" do them all the time. These are docs who fundementally believe birth should take place in a hospital under physician's care. Snip, snip.

[tinyshoes]

double post

[cottonwood]

Perineal massage/support are *not* necessary if the hormonal process is uninterfered with. (I'm not sure that they even help when it *is* interfered with.)

Here's one thing to think about: for most women, when anyone but their lover touches their genitals, they tense up. Is that the state you want to be in when you are trying to get a baby out? Tenseness in your tissues makes you *more* likely to tear.

It also helps to think about skin in general -- what helps with its elasticity? Well, warmth, and heat, and good nutrition. Cold dry skin cracks easily -- so it stands to reason that it would tear more easily.

Also, think about the perineum and vagina during sex. What is the state of the skin and underlying tissues when you are aroused vs. not aroused? The same hormones involved in sex are involved in birth. If those hormones are somehow not released at the right time or in the right amount (which happens if the process is interfered with in any way: bright lights, logical words, fear, inhibition, anything that takes the mother out of herself, also things like guided pushing, pushing in a reclining position, etc.,) the tissues will not be ready for the passage of the baby.

[Greaseball]

That's right about the scissors. I looked at a breech delivery site that was posted in another thread here, and there were several photos (all crotch-shots, of course) of a very managed vaginal breech delivery in a hospital. I always thought episiotomies were done with a scalpel as the baby was crowning, but in this picture, before you could even see the baby, the scissor was about an inch into the vagina and then the cut was made. One of the grossest things I have ever seen; it looked like someone was being slaughtered instead of born.

[USAmma]

I had an emergency episiotomy, 2nd degree, because dd's hb was in the 60's for several min. and falling fast. The doctor was massaging and using oil and pressure and said I wasn't going to tear. I had photos taken of the birth, and there's one that shows my loose skin and muscles open and hanging right after baby was born. It's really gross.

I did see a birth of a posterior 10 pound baby and the tear was extremely deep, way into the mucle tissue. Friend didn't even know she had torn until the midwife gave her some shots before stitching it. But I feel that while in most cases that cheek vs. lip comparison might be accurate, it's not in all cases. This woman needed several layers of stitches to heal. I think it was even worse than my episiotomy.

Darshani