Episiotomy vs tearing - Page 2

[moonglowmama]

The first time I was ever at a birth my friend was given an episiotomy, which I had the unfortunate experience of witnessing. I decided at that point I would never let someone get close to me with scissors near my perineum. And then I started researching it, which confirmed that I think it is totally unnecessary.

What most of us aren't saying is that an episiotomy is most easily avoided by not being tethered to the bed, not having an epidural and most importantly, being able to move how YOU need to during birth. If you want a birth that means not feeling anything, you might "need" to be cut because you will have given up all your own instinct as a birthing woman.

My midwife has cut fewer than 5 episiotomies in over 1200 births, and she said that in hindsight even those probably were not necessary, though they seemed so at the time.

[BrittneyMarie]

i would never have an episiotomy unless my baby was at risk. the reason being, i didnt have one with dd, and i tore. but not there. i definitely wouldnt have wanted an extra set of stitches in addition to the 10 i had to have

[MegBoz]

Originally Posted by nikirj

Wrt support: I know "the studies" say that perineal support etc doesn't make a difference, but I think in this case "the studies" are wrong.
<snip>
The problem with all those official studies is that they compare no support to some unknown standard of support provided by an OB who may or may not have any good idea of what s/he is doing anyway;

yes, true, good point! Not only that, but in a study of how to reduce/minimize tearing, I would think it would only make sense to include only births with 1. no epidural or other drugs, 2. no directed pushing, 3. no lithotomy position or any other position but what mama herself wanted. Since we know all 3 of those things individually increase the rate of tearing, if we're going to study what reduces the rate of tearing, it makes the most sense to eliminate those factors in order to examine a controlled variable.

Originally Posted by nikirj

ETA - research definitively supports tearing over episiotomy. Episiotomies are more likely to result in more significant extension tearing, and are almost guaranteed to create a greater degree wound than a tear would.

Ah, yes, true. The research definitely supports tearing over epis, so I guess that would mean that the question of anterior tear is moot... tears are preferable to epis, period. (Except the severe fetal distress issue, as noted.)

[Pirogi]

Originally Posted by MegBoz

A friend of mine told me her OB says he'll make a cut sometimes if it looks like the mama is about to tear upwards since he's seen that before & it's bad & he wants to spare women that.

(bolding mine)

I had an upwards tear into the clitoral tissues (I have heard the idea that all vaginal/vulval tissue could be more accurately described as clitoral tissue, but that's a different post). I had never heard of a clitoral tear before the birth, and it took me by surprise. It was mad painful, probably caused me to bleed more than if I had not torn, and wasn't visible, so the midwife thought I might be hemorrhaging from a placental implantation site. Luckily the herbs slowed the bleeding way down, but the recovery from that tear took me about 7 weeks before it was not painful during movement. I don't think I trusted anyone near my clitoris for about 10-12 weeks. The other tear (downward toward my anus) took the same amount of time to heal, and I did not have any stitches, although I probably needed some. Still, I would have chosen this over an episiotomy any day. Maybe it's my feminist side shining through, but the paternalistic tones of OBs like the one referenced above make me batty. It's my vulva, thankyouverymuch, and I don't need anyone to make decisions about when and where it's ok to cut it. But that's just me.

ETA: and I was free to move how I wanted, had no drugs, and was in the water. I think in my case, my previously broken tailbone may have reduced the space available for the baby to come through. In any rate, my body took the position of H&K for pushing, then kneeling for the birth. In hindsight, this put lots of pressure on my front tissues, but allowed baby to drop down and slip under the crooked-in tailbone.

[MyBoysBlue]

During my first birth in hospital, while I was pushing my doc said your getting a bit tight I'm going to make a cut. I said, in the middle of pushing "no I'd rather tear". After DS was born and he checked me over no stitches were needed. I had no more than a "skid mark" as he put it. If I had let him cut when he had wanted I would have been guaranteed some stitches.

Here are a few links:
http://www.ahrq.gov/clinic/epcsums/epissum.htm
http://www.medicalnewstoday.com/articles/23837.php
http://www.medicalnewstoday.com/articles/23880.php
http://www.medicalnewstoday.com/articles/14472.php
http://www.medicalnewstoday.com/articles/40865.php
http://www.childbirthconnection.org/...e.asp?ck=10004

[Serenyd]

They don't always tell you they are going to cut. Esp. if you sign a blanket consent for things like c-section/episiotomy. Just fyi.
Cutting is a bad idea. I'd rather tear.

[MyBoysBlue]

I know I was lucky my doc listened. I've heard stories where they just cut and don't even tell you.

[Mawood]

I think you probably have enough answers by now. I know that in Europe even the hospitals don't do an episiotomy routinely anymore. Maybe it's because every hospital has midwifes and the doctor and the midwife work hand in hand at every birth and share their knowledge. They only cut when the baby needs to get out quickly. It is recommended to bring some black coffee and do compressions with it. That the midwife will do to help avoiding a tear. Also they believe that a tear heals better than a cut. I put it in my birth plan and also mentioned it to my OB specifically 'cause I think he does it routinely.

[MyBoysBlue]

Coffee? Really?

[etsdtm99]

I've had 2 episiotomies .. the 1st, was a long labor,baby's heart rate was not recovering between ctx the way they wanted and baby was not coming down.. the doctor said a 'little cut' would get her out, but there was nothing little aout it, it was huge.. enough that a baby who was still behind my pubic bone just fell out in the next ctx after the epi. awesome, huh? recovery was pretty horrible. baby was small, but had a big head.. (almost 15in) i would have preferred to tear in this case, i also would have preferred to push the baby out on my own..

2nd baby - i was pushing, baby was crowning and the ob starts talking about another epi - i said no - she backed her chair up and crossed her arms and got all pissy with me so there i was pushing and having this 'talk' with her about it.. she said if she didn't cut i would tear in every direction, i just asked her to wait a min, at the time i didn't feel like i would tear.. a few seconds?mins? later i felt i was going to tear to the front and told her a TINY cut on my scar tissue would be ok.. she cut just the tiniest snip and it took away that feeling of tearing toward the front and DS came just after that.. i needed just a few stitches, it only hurt for a couple days .. i remember by day 4 i felt almost normal and by 1 week i could walk to the park etc. without pain.. if i hadn't told her no at first, i fear she would have cut a lot more.. i had my DH watch her to make sure she didn't cut too much and afterwards she thanked me basically telling me i saved her from not being able to give me any stitches because she thought i would have tore 'in every direction' .. i just don't know if that would have happened or not or if it would have been better or worse but i am very glad to not have a tear to the front.. and a small cut on my scar wasn't bad at all compared to the 'normal' epi. i had with my first.. most of my trauma from the birth was due to swelling and bruising unrelated to the episiotomy ..

i was wondering though, if you are more likely to tear or not tear on scar tissue?

[purplepaperclip]

I am really scared for baby #2's birth. (not preggo now, but in the future) I had 4th degree tearing and upward tearing with dd. It took over an hour to stitch me up. I keep hearing about how scar tissue will tear much more easily the second time around and that scares the dickens out of me!!!

[JorgieGirl]

Originally Posted by suebee79

I am really scared for baby #2's birth. (not preggo now, but in the future) I had 4th degree tearing and upward tearing with dd. It took over an hour to stitch me up. I keep hearing about how scar tissue will tear much more easily the second time around and that scares the dickens out of me!!!

My sister had very similar with her DS1's birth. Horrible tearing after 2 episiotomies were cut, right into her anus.

She had no episiotomy with her DD's birth 13 months later, and did tear but only to the 1st degree and she said the healing was completely different.

She didn't tear with DS2's birth at all. So, her scar tissue certainly didn't tear easier. It got better each time.

Keep the faith.

[katelove]

Originally Posted by etsdtm99

i was wondering though, if you are more likely to tear or not tear on scar tissue?

You are more *likely* to tear through scar tissue as it is always weaker and less elastic than the surrounding tissue.

However, more likely is not definitely. Some people who have scar tissue do not tear at all the next time. Others tear in a different place, leaving the scar tissue intact.

[Sk8ermaiden]

Originally Posted by Lauren31

In your opinion which is better/easier for recovery etc? Tearing, maybe deeply, or an episiotomy? I have heard both and I can't seem to find a decisive answer either way. I want to put on my birth plan, please do not give me an episiotomy without my consent but WHEN would I actually consent to that!?

My midwife says she has done two (in almost 800 births). Both times baby's heartrate was taking during the pushing. They were both first time moms and she didn't believe mom was going to get baby out fast enough.

And everything (with any scientific backing) that I have read says that cutting leads to a higher likelihood of tearing even further (which is common sense if you really think about it) and that tears tend to heal much better/more completely.

[Serenyd]

Originally Posted by katelove

You are more *likely* to tear through scar tissue as it is always weaker and less elastic than the surrounding tissue.

However, more likely is not definitely. Some people who have scar tissue do not tear at all the next time. Others tear in a different place, leaving the scar tissue intact.

Me. I tore on the opposite side of my perineum from my episiotomy scar. Both during my 2nd and 3rd birth. I wonder if I would have torn at all, though, if not for the inelasticity of the scar tissue?

[Mawood]

What about the massage of the perineum to stretch and prepare it? Is anyone doing that? is there a certain oil you can recommend? The German midwifes recommend it to all pregnant women and believe strongly in it but here I have heard that it wouldn't be worth it and even doulas or midwifes say it is not proven to help.

[sostinkinhappy]

Originally Posted by MyBoysBlue

I know I was lucky my doc listened. I've heard stories where they just cut and don't even tell you.

This happened with my first. The doctor that delivered her was old school and on top of that, I think he was a lot more aggressive with me because I was a single mother. (He was also a member of the same church I belonged to and part of the lay-leadership and had very, very strong views about single women who chose to parent instead of adopt but that is another post fo another time...)

[Litcrit]

Originally Posted by katelove

You are more *likely* to tear through scar tissue as it is always weaker and less elastic than the surrounding tissue.

If the episiotomy scar is mediolateral, is that scar tissue then weaker than perineal tissue?