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.