Episiotomy or tearing? - Page 2

[Quirky]

I ended up with an episiotomy (from a medwife at a birth center ) and it SUCKED healing from it. I would much, much, MUCH rather have torn. I am STILL angry about it.

One book you might want to check out is Get Through Childbirth in One Piece! How to Prevent Episiotomies and Tearing by Elizabeth Bruce.

I don't recall if anyone above gave you the fabric analogy - grab a piece of fabric, pull on it at either side and try to make it tear. Now cut a one inch slice along the top edge and try to make it tear. The notion that episiotomies prevent tearing is totally false! Episiotomies do worse damage than tearing.

[pamamidwife]

I am fortunate to work with moms who are unmedicated and mobile, so a quick "your baby needs to be born NOW" with a look into her eyes, a change of position and some good pushing can deliver a baby faster if need be.

It's true that some women have fragile tissues and they tear deep when they do. This is rare. What is more common is the tissues and underlying fascia is weakened and split with a cut and women tear beyond that - oftentimes into their rectums. As someone who has dealt with fecal incontinence and reconstructive surgery, I can never imagine taking a pair of scissors to a woman's perineum.

As you can tell, because of my personal experience, it's a sore spot for me.

[hypno-teacher]

I teach my Hypnobabies students to push their babies out in between contractions to avoid tearing or an episiotomy, which is usually worse. It works very well for many women, and I did it myself with my last baby.

If you do push the baby out at your own speed, without the force of a contraction behind you, you have much less of a chance of tearing. If you need more of an idea on how to do this, just e-mail me at [e-mail].

[cottonwood]

Kerry, can you explain the reasoning behind pushing between contractions?

In my case I waited to push until I knew my body was absolutely ready for it -- that is, when my body was doing it itself. At that point, I couldn't help but push with the contraction, it was completely instinctive and spontaneous. And it makes sense to me that it should be so, and that trying to consciously do something other than the natural, instinctive process would only increase the risk of tears.

So I'm wondering what are your thoughts on the instinctive vs. controlled birthing? I do not know very much about hypnobirthing, I've always assumed that it could help facilitate instinctive birth, but after reading your post I am thinking that it could actually facilitate any means to birth, such as the controlled birthing you mention.

[hypno-teacher]

Hi, I'm happy to explain a bit about the pushing process that I teach.

First of all, I teach my students that pushing is entirely *mother-directed*. This means that unless there is something going on such as the babys' heart rate going down, each mother is the only one who really knows how to push in a way that is indeed moving her baby down and out. That means, with the exception of her Birth Partner or hypno-doula giving her reminders about hypnotic anesthesia for her bottom, (no Ring of Fire) no one else need to gets into the act. The mother changes positions and pushes as she sees fit, and I give a bit of direction that they may try which is called, "AAAAHHH" pushing. Keeping their mouths and throats open, which has a direct correlation to their bottoms, they "AAAHH" the baby down and out. It works well for most women and they also can try other ways and decide what works for them.

As for the pushing the baby out between pressure waves, (contractions) I suggest this so that they can be in full control of the speed the baby comes out, so as to avoid tearing or the need for an episiotomy. These are the suggestions I give for doing it:

"When you have pushed your baby down your birth canal and baby’s head is crowning, your birth attendant says - “with the next [contraction], the head will come out”. You rest for only about 60 seconds, (not waiting until the next pressure wave comes) , then take a deep breath, make sure the doc or midwife is giving you perineal support, and push your baby’s head out without the force of a pressure wave behind it. You can then control the speed at which your baby’s head comes out without any extra force from a pressure wave, and without the need for an episiotomy. Tears are much less common when women use this technique! (Never lay on your back while pushing!)

You will feel the baby's head move forward, and if there is too much pressure you'll hold back for a moment and go on when you feel like it, instead of being *forced* to push as with a pressure wave. (or told frantically *not to*) Many attendants have not seen this done, and you may just be the one to show them!"

I actually did this with my second baby because I so did not want the force of that next pressure wave to come and (sorry) "split me open", which was what it was feeling like to me at the time. (not using Hypnobabies). It worked really well - no tears, and many of my Hypnobabies students do it as well.

Hope this helped.

Kerry

[mittendrin]

i tore, had a couple of stitches and healed up w/o problems. i started doing perineal massages 8 weeks before edd 2x a day with a special oil for p. massgae that i got back home in germany. you can use olive oil for massage or vitamin e oil.
i would not let anybody cut me down there, yikes!

[Stacymom]

I had an episiotomy with my first birth- I didn't know any better. My second dd was born in the van- an extremely fast and unplanned unassisted birth- and had a second degree tear towards my rectum, and upwards through my clitoris and urethra. I had to have a catheter for two days! But- I healed faster from the tearing than I did from the episiotomy, even though the tearing was "much more serious" according to the hospital staff. That's enough evidence for me.

[shelbean91]

OBs who perform episiotomies "only when neccessary" do them all the time.

I've been thinking about this for awhile. I'm sure there that there is not a single OB who has never done an epi. Instead of getting the 'only when necessary' answer, what question should I ask and what should the reply be to be sure I won't get one?

I think I was going to ask- in what situations is an epi needed and how often to you do them- would that be sufficient? Again, what answer am I looking for?

[tinyshoes]

shelbean91, you're right--there is no OB who's never done an episiotomy. Docs must demonstrate the skill on a live woman (vs. the rules for licensed homebirth midwives in the state of Minnesota, who, in contrast, must demonstrate suturing skills on a lifelike model.)

That being said--I think the best and easiest way to get an anwer is to be direct and open-ended, asking a doc: how do you feel about episiotomy?

The answer you want to hear would echo the posts you read on this thread, things like, GOOD GOD, NO, keep scissors away from birthing women's crotches!

My cousin is planning to birth with a male OB, and his respnose to her querey was that he performs about 1 episiotomy a year. (THAT could be an OB I would let near me, should the occasion warrent.)

I think you want answers like:

"A little tear is usually a superficial wound, whereas an episiotomy will always cut the belly of the muscle, and cutting muscles is a terrible idea, surgically speaking."

"I will use warm compresses and support your perineum, allowing the skin to stretch while you push in any position and with any frequency, intensity, and duration you wish."

Some OBs, loyal to their surgical origins, probably wince at the idea of skin tearing or stretching, such that they want to 'rescue' the laboring woman and provide a quick snip.

I think many OBs tend to believe that a woman's going to need stitches anyway, so why not cut 'n' sew the way the OB has a thousand times before, preffered to wagering the possibility that a woman will tear (and when you're on your back in stirrups it's quite likely) and will need to be stitched in an UNUSUAL manner.

In my opinion, an OB will cut--a woman's perineum or her belly.

In any case, when asking a birth attendant questions, it is important to hear the answer, rather than what you WANT to hear, y'know?

[hypno-teacher]

Hi Michelle,

You wrote:

>>>Instead of getting the 'only when necessary' answer, what question should I ask and what should the reply be to be sure I won't get one?>>>

You might ask, "In what circumstances do you do an episiotomy?", however what you also need to know is that "to be sure you won't get one" is not a doctor issue, it's your reponsibility if indeed you don't want one. If you don't, just say NO. You are always in charge of every decision regarding your pregnancy, labor and birth, if you want to be. If it's important to you not to have an episiotomy, putting that specifically in your Birth Plan is necessary, as is telling the doctor flat out that you won't be having one unless thereis an emergency situation, and also having your Birth Partner remind the doctor as soon as he walks in to your birthing room that, "We have been preparing for a birth without an episiotmomy and would very much like your help in getting this". This simply reminds the doctor not to automatically cut you as so many do, and since all of those tempting sterile instruments will be right there next to him, he just needs reminders not to use them, and to provide perineal support for you.

>>>I think I was going to ask- in what situations is an epi needed and how often to you do them- would that be sufficient? Again, what answer am I looking for?>>>

There are 2 indications for having an episiotomy:

1) Fetal Distress while pushing

2) A tear that is starting to go up into the periurethral area instead of down.

A natural tear beginning as your baby crowns, if it is going down, is usually not an indication for doing an episiotomy since that will only make the wound *bigger*, (although easier for your physician to suture, which is not your concern.)



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[shelbean91]

Thanks for your replies. I'm *hoping* my ob will be the one I get to keep. I have lots to discuss with her- but I got her name from a midwife I talked to. (Opted against homebirth b/c can't afford it and both of my other kids were born at 35 weeks- midwives won't deliver that early anyway, if history repeats itself.)

This will be a different ob and hospital than I used last time. With dd, I was cut, didn't know any better, but w/ds I said I didn't want one and wasn't cut and didn't tear. I'm sure I can do it again, as long as I have a supportive ob.

[captain optimism]

My mw gave me an episiotomy. I had been pushing for about 8 hours (that's what my husband says, anyway, I can barely remember it.) I really didn't want one. When she said she was going to give me one, I yelled "Crap! Crap!" and started to push really hard. (no, I didn't yell sh*t, don't you think that's kind of weird?) I thought maybe I could finally push the baby out before she made the cut. But she was very speedy and very gentle and very accurate, so she did make the cut first.

It healed okay, I guess. I mean, it was still bleeding a little when she examined me at the six week post partum exam. It didn't particularly sting afterward. It does seem to have fully healed and everything feels normal to me now.

I don't think the baby was in distress when she did it. On the other hand, it was forty-four @##*$*^# hours of stupid pitocin and other interventions. (Water broke, labor didn't start.) I think she was getting nervous. Part of the reason I chose the midwifery was to avoid pitocin, an epidural, and an episiotomy. They almost never cut, I think they said in less than 1% of their births when I asked.

OTOH, an OB would have insisted on a c-section at the beginning of those 44 hours. I'd rather recover from an episiotomy than a c-section.

[Karry]

I had an episiotomy with my first because her heartrate had gone down for awhile (the cord was around her neck). I had the most awful recovery after her birth. I could not sit for a week. While I was still in the hospital I was extremely swollen. PP recovery was worse than the labor and I didn't have any drugs during labor.

WIth my second I ended up tearing in two spots. I had a few stitches, but my recovery was so much easier. I did not get as swollen and I could sit with very little discomfort. I would rather tear than have an episiotomy.

With this next baby I hope to not have either happen, but if the OB suggests and episiotomy I will tell them to keep the scissors away and that I don't mind tearing a little.

I'm impressed with you mamas that had big babies and did not tear, good for you! I didn't have big babies and did tear with my second

[tinyshoes]

I am first in line to complain and blame OBs, but Kerry makes a good point.

Originally posted by hypno-teacher
[W]hat you also need to know is that "to be sure you won't get one" is not a doctor issue, it's your reponsibility if indeed you don't want one.

This POV is also shared by Ina May Gaskin in her latest book, Ina Mae's Guide to Childbirth where she writes:
As long as women go on accepting episiotomies, doctors will continue to cut them.

[dotcommama]

I had a huge episiotomy with my first birth because he was a forcepts delivery. It took over a year to heal.

For my latest birth I did not want an episiotomy at all and told the midwife I would rather tear.

However, as the baby was crowing my midwife told me she wanted to do an episiotomy and I said no. She said she would respect my decision, but she warned that it looked as though I was going to tear all the way to my clitoris because I was not stretching at all. I agreed and she made a very small cut that took only a few stitches and healed very fast.

I discussed the situation fully with my midwife later and she said she had never seen a perineum so resistant to stretching. She said I had so much scar tissue from my previous episiotomy during my first birth that I was just not stretchy. She also told me that she almost never does episiotomies and tried very hard using oil and massage to help me stretch, but to no avail.

So, for me, I think it was better to be cut then to tear.