A Rant on Episiotomy - Page 5

[MegBoz]

Originally Posted by AlaaJ 

So is it true that once an episiotomy, always an episiotomy? (And if not an epi, then definitely a tear?) I've been hearing that a lot when asking ppl about their birth experiences.

In the JAMA article mentioned above, they wrote:

"In seeking to establish an evidence base to support or refute the use of episiotomy, randomized clinical trials in the mid and late 1980s found that routine episiotomy compared with restrictive use was associated with higher risk of anal sphincter and rectal injuries and precluded a woman from giving birth with an intact or minimally damaged perineum."

Is my struggle to avoid an episiotomy all in vain? Any IPAEs (in-tact perineums after episiotomy) out there?

The part you bolded to me just means "routine epis prevents a woman from giving birth over an intact or minimally damaged perineum." Which makes sense - I believe epis is always at least 2nd degree, so if you define "minimally damaged perineum" as 1st degree tear or less, then yes, it's impossible to do routine epis and have any women with minimally damaged perineum.

I do believe there is some truth that scar tissue is less 'stretchy' but I DON"T think that means you must always have an epis or tear if you've had past epis (or past 2nd degree tear or greater.) as a matter of fact, I'm fairly certain my MW told me she had a 4th degree tear with one of her children & thanks to perineal massage, subsequently gave birth over an in-tact perineum.

[Smokering]

According to Ina May Gaskin, scar tissue is stretchy and a previous epi doesn't mean a woman will always tear or need to be cut. My mother had a biggish, routine epi with her first child, and went on to have five more (four vaginally). I'm pretty sure she didn't have any more epis, and I know she didn't tear at the last birth (I was there) - not sure about the others. So it's definitely possible. 

[Lady Lilya]

My friend had an epi with her first child because her OB did them routine.  When she met the OB for her second birth, he asked her what she thought of her previous birth, and she said the worst part was the healing from the epi.  That OB said "well, you don't have to have one."  She was so excited "really!?!?!?"  And she didn't have one with any of her later babies.  Poor thing didn't know it wasn't always a part of birth!

[SGVaughn]

I had a horrific epi with my first...but in fairness I had been pushing for literally hours by that point and was completely exhausted..to the point of passing out between contractions

but you know what? the OB rolled her %^&*($ eyes right before she did it, so I really question its need....I was so exhausted I passed out before I was stitched up..and was rather alarmed to find stitches about four days later

my oldest was also sunny side up though, so who knows

it took 3 months to heal..I hate that dr to this day,,,14 years later

my other two..one much smaller baby and one about the same size..not a single mark that Im aware of...felt great afterwards

and they were both epidural babies...so figure that out!

[zuzunel09]

With my first birth, I was completely unprepared and woefully naive, and just didn't question anything the doctor did because I had very strong painful contractions, and he also just surprised me with some of the interventions.  He did a pressure episiotomy that was preemptive, but I believe he does it routinely in any case.  He never talked about it or told me he was going to do it, then he didn't numb the site to stitch me up.  I took a long time to heal.

I don't like episiotomies, either.

:(