Can I avoid a tear/episiotomy after a prior episiotomy?

[HiItsMeSandy]

Can this be done? Even if baby #2 is bigger? Or is scar tissue unable to stretch? I really want to avoid tearing and getting cut this time around. How do I do this?

[Ottbabies]

I have the same concerns!! Hopefully someone has some good advice.....

[grcelizabeth]

Every woman, pregnancy, baby, and delivery are different and the answer would be different for everyone. Most of the time, if the mother is able to shift positions (not on back on semi-recline), left alone to push w/o pulling and breathing, pushing when she feels the need, no epi. so mom can feel how to push and the OB will give her the time to stretch slowly and he/she doesn't do routine episiotomies then it's highly possible. The reasons for doing an episiotomy are different so there's isn't a straight forward answer but like I said above. If you stick to your guns, research different positions and best ways to stretch, no epi. ect. ect. very likely. You would most likely have a huge chance of no episiotomy if you were to do a homebirth or birth center, but I can't say for sure. Good luck mama!

[mntnmom]

I had a 3rd degree, after an episiotomy with my first. Took over an hour to repair. Got a couple stitches with #2, don't know if I actually needed them. And had no tearing at all with 3 and 4.
My advice: don't get another episiotomy!! The situations were they are necessary are very rare, and they actually increase the risk of severe tearing. Avoid OBs who do them routinely, and talk to your midwife/OB about your desire to avoid one. Many midwives take great pride in their abilities to help moms keep their perineums intact!

[lunita1]

Originally Posted by HiItsMeSandy

Can this be done? Even if baby #2 is bigger? Or is scar tissue unable to stretch? I really want to avoid tearing and getting cut this time around. How do I do this?

FWIW, i had a large tear with my first, and my next two were bigger (they went 7 lbs 11, 7 lbs 14 and then 8 lbs 15) I did tear with them, but my tears were significantly smaller and healed much more quickly. I didn't really do anything special to keep from tearing. I pushed in a semi-sitting position with #1 (and she flew out in 15 minutes, thus the tear), I pushed longer, flat on my back (actually arched/overextended... Walcher's position?) with a posterior baby for #2, and I pushed standing up with #3. Anyway, despite not doing anything and having scar tissue, the tearing was really insignificant in comparison.

As for avoiding an episiotomy? I think the most effective way to do that is to chose a caregiver who doesn't do them routinely or find them "necessary" on a regular basis. If your caregiver is used to cutting when things don't happen as quickly as he/she's prefers, you're going to find yourself "needing" another episiotomy. If your caregiver only cuts once a year or so in very extreme circumstances, you'll probably not be that one instance.

[MegBoz]

Originally Posted by lunita1

If your caregiver is used to cutting when things don't happen as quickly as he/she's prefers, you're going to find yourself "needing" another episiotomy. If your caregiver only cuts once a year or so in very extreme circumstances, you'll probably not be that one instance.

I'd ask, both, "Under what circumstances do you feel episiotomy is necessary? and
"In what % of the births you attend do you perform an epis?" Anything higher than about 5% is serious cause for concern. I might also ask, "What steps do you take to prevent tearing?" You definitely want an HCP who realizes they should aim to help you keep your perineum in tact!

& if you have any doubts, say if you have 1 OB or MW in the practice you're concerned about, I'd DEFINITELY have a doula in case they reach for scissors without warning you!! It's not a doula's job to jump in front of those scissors, but they certainly can help - and can bring it to your attention so you can refuse before it happens.

As for scar tissue stretching, well I don't think it's possible for the scar tissue itself to stretch, but bear in mind that only a small part of your vaginal opening is comprised of scar tissue! Everything else still has that same elasticity - so you should still be able to stretch without tearing, I would think. (Sorry, don't know any good stats though.)

[TanyaS]

A good friend had an episiotomy with her first, tore badly down the scar with her second (I believe it was because the nurses were asking her to wait until the doctor arrived...she is a very fast birther). Her stitches had to be done twice because of that tear. She had another VERY fast birth with her third and her midwife helped guide her so she wouldn't tear that time, and it worked!

[JorgieGirl]

Here's a link I sent to a friend the other week:

http://doulamomma.wordpress.com/2009...or-episiotomy/

[xixstar]

well from personal experience...
dd1 was 7lbs7oz and an episiotomy was automatically done - bah.
dd2 was 10lbs1oz, shoulder dystocia with mw hands helping her shoulder free, and no tearing. dd2's head was delivered slowly (15+inches) because it took a fair amount of work to get it out, perineum supported the whole time, and I think that helped a lot.

[SwanMom]

My mom had an epi with her first and said it was horribly uncomfortable for months/years to come. With her last (7th baby), she tore in the same place, but she said it healed so much better & felt great after a short period of time. What I take away from that is that tearing is still better than being cut.

(But I still hope to not tear with baby #2--I had a 2nd degree tear with baby #1 so I'll keep reading this thread)

[buttercups.nest]

Hey

My first baby, a girl, was 7lbs 4oz. I need an epi with her....was a nasty one too. Needed a lot of stitches, and had to be restitched 3x.

Baby #2, a boy, was 9lbs 2oz, 2 weeks late. No epi, very minimal tearing. I was terrified of tearing....all I could think of was the back of someone's pants splitting open. I didn't even feel it...I had no idea I tore until the doctor was doing stitches. Stitches also didn't hurt....stung a little but no pain.

[buttercups.nest]

Hey

My first baby, a girl, was 7lbs 4oz. I need an epi with her....was a nasty one too. Needed a lot of stitches, and had to be restitched 3x.

Baby #2, a boy, was 9lbs 2oz, 2 weeks late. No epi, very minimal tearing. I was terrified of tearing....all I could think of was the back of someone's pants splitting open. I didn't even feel it...I had no idea I tore until the doctor was doing stitches. Stitches also didn't hurt....stung a little but no pain.

[at_the_hip]

I had an epis with #1...and #2's birth of a bigger baby went just fine, with no stitches required. It did take much longer to crown though because the scar tissue didn't stretch as well. Going slow, although really difficult, can help. EPO or vit E might help also but I didn't use it. Since then, with #3 and #4, it was much much easier.

[MCatLvrMom2A&X]

I had an epis with my dd. Dr. cut me all the way back to my anus against my wishes dd was 7p11oz 13.5 inch head. I had ds 4yrs later with only some skid marks no issues with the epis at all. It stretched over ds's head he was 8p4oz 14.5 inch head.

I only had to push for 5 min with him.

[DeChRi]

I am unsure of the "right" answer, but I had a "standard" epis with DD1 11 years ago (8 stiches). When I had DD2 I did not, and ended up with a single stitch in a totally different area, that the Dr almost didnt think warrented a stitch, but threw one in just to be safe. DD1 was 8lb2oz and DD2 was just under 9lb.

[Katsmamajama]

I had an epis with DD1 (6 lb, 6 oz, 15 in. head) 9 years ago. This time, with the shoulder dyst. of DD2 (8 lb. 2 oz., 18 in. head I think?) I had a 2nd degree tear straight down my scar from DD1, along with road rash and a teeny nick at around the 2:00 position. One of the midwives I had seen (team of 6, can't remember which one) had told me that there was a chance that my scar would tear, because it would be a weak spot. On the plus side, it seemed to heal a hundred times better as a tear than it did as a cut.

[nia82]

I had two tears with DS, a 2nd degree perineal tear and a 2nd degree labial tear, the latter I never noticed, the other took about a week of soreness or so.
I could have prevented all of this by using a DOULA!!!!! I wasn't allowed to use upright pushing positions and was forced to use the good ole push for 10 seconds three times a contraction method.... That wouldn't have happened if a) DH would have listened to me (believe me, they do not stay cool throughout delivery) and b) a doula. I was CRYING on that bed, asking to be upright. Throughout my one contraction that lasted on hour and took me from 5 to 10cm (it was like a storm of contrax) my blood pressure reading once said 160/90, so they told me with high blood pressure like that you are not allowed to push upright, total BS! (btw, blood pressure was fine once hell contrax was over... everybody's pressure would be up if you think you're gonna die)... Anyways, morale of the lesson learned: you take a doula with you if you cannot do a homebirth...

Both my sisters had epis and felt much worse than I did, and still do (18 months and 5 months pp)... One had an epi for no reason, really, the other had a vacuum extraction for no reason either (only pushing for less than 60 minutes, no heart decels))... One was with a midwife who had to call an obgyn cause baby wasn't out after 30 minutes of pushing, the other had a perinatologist as ob to begin with...

Neither of us could use perineal massage in the weeks prior to delivery cause of preterm labor (all of us have a somewhat incompetent cervix).,, I do think that helps. My midwife did perineal stretching and massage and I do think it helped. she just wasn't allowed to lemme push upright because of laws (ob on the phone, she was bound to listen to him). DS hd a 13 inch head, born at 36 weeks and 6 days of gestation with a nuchal hand, and was posterior, turned throughout labor though.

[milansmommy]

This was my biggest concern when I was pregnant with #2. With the first one I had an episiotomy and a 4th degree tear. With #2 I only had a 1st degree tear and he was 2.5 lbs bigger. They were both huge babies. The big difference was birthing on a birthing stool rather then on my back, he also crowned really slowly so I had time to stretch out. So it can be done. Good luck!