Episiotomy vs. tearing « Back to Group Discussions

[TallToriV]

First-time mama question here! My mom is concerned about my not wanting an episiotomy. She's pretty old-school, and firmly believes that if I don't get one, I'll tear, and that's a billion times worse to her. (It's so funny - her distrust of doctors is how I learned to question EVERYTHING, and yet when push comes to shove, she's still very much a baby boomer wanting to do what the doc says.)

Has anyone been through both? Or do you have a good article or something you've found that I can send her? My own belief of "Well, I think my body can handle this, and if I do tear, it's really not that much different from having someone cut me in the long run..." does NOT seem reassuring to her!  I'm not changing my plans to make her feel better, but I would like to reassure her if I can. I'm her baby, after all, and I'm starting to "get" what that might mean, emotionally speaking.

[Chloe'sMama]

I know when I had DD1 I was very against epi to the point that the doc said, 'one little cut and your baby will be here', and I still said 'NO'.  I did have a second degree tear with that birth, but I believe it was because I had an epidural and couldn't feel when I needed to push or to rest.  The doctor was also very rough with her manual stretching after I said no.  I didn't have any bad tearing with DD2 as I could feel when I needed to push and not (had a wonderful homebirth).

I have heard that people that have had both think that natural tearing heals easier and hurts less. There is also the idea that once the skin is compromised, it is more likely to tear more than it has been cut.... I was given the visual of fabric.... have you ever seen at a fabric store where they make a small cut, then rip the rest of the fabric... kind of like that.  Anyway, once the skin has been cut, it would be more likely to tear more significantly.  

I say, if I am going to need stitches, lets make sure it was completely needed, not an elective procedure.

No great info to send her though.

[HouseofPeace]

my mom is exactly the same!  last time i was home, she was commenting to my sister (a labor and delivery nurse) how my midwives were less wise since they don't do episiotomies, and my sister replied "Actually, mom, they're finding the tears easier to repair and less severe, so we almost never do episiotomies anymore."  So, I don't have the evidence, but a couple of encouraging stories.

I had one friend who pushed and got a 4th degree tear, and another 2 or 3 who had episiotomies and also had 4th degree tears.  I have had 4 babies, and no perineal tearing at any births.  I didn't do any perineal stretching, or anything but kegel's during pregnancy, but i believe natural pushing, and especially having the urge to push and pushing at your own body's pace is key to keeping from tearing.

And my son, my first, was overdue, 7lbs 15oz, and came out OP (facing the wrong way) and only had some labial tearing from that.  In all of my births, I pushed with full feeling (the epidural didn't work very well in my first, and totally wore off before i started pushing).  I remember pushing for 1 hour 40 minutes with him (though my sister remembers 3 hours, husband is with 1 1/2 hours, ???  it was a ridiculously long and painful birth)- and he came out finally in one big shot.  I didn't have any coaching, just the midwife saying 'push with each contraction' then i was pushing, and lots of encouragement until i lost it and said 'if i were doing such a good job the baby would be here.  just shut up.'  Ah, labor.  

I think a supportive caregiver who is expecting to help support you and not cut will make a huge difference as well.  having a caregiver you trust and that you can also use as a reinforcement for your decisions helps a lot in discussions w/ family.

[TallToriV]

Oh, this is helpful stuff! Thank you both.

[loveandgarbage]

I can't post any links to articles that I know of, but from what I've heard from other moms who have had epis they tear worse. Mamas who have haven't but still tore healed up faster. I had a natural tear with DS2 (3rd degree) and I healed up completely and you can't tell/I have no issues with incontinence, etc. I only pushed when I felt the urge, but I wasn't in the best pushing position (was on my back)-- it's a long story but I had a natural birth at a hospital that was great for the most part, except for my OB wanting me to be on my back during pushing. I should've pushed in a different position but at that point I just wanted the baby out and listened to her/didn't have the energy to argue even though I knew better. Some women are more prone to tear, but if you make sure you only push when ready and push in a good position (standing up, on your side, etc) you'll fare better. DS2 also had a gigantic head so that didn't help! This time around I'm going to push in a better position to minimize tearing because I am prone to tearing, plus this baby will most likely have a large head too (both of mine had 15-16" heads).

[odinsmama]

I had 2nd degree tears with both of mine and healing was minor.  Sorry, so experience with an epi.

The first time (hospital birth) they gave me this spray that was supposed to numb the area to deal with any pain.  It wasn't particularly painful (maybe a little when urinating but if you lean forward then urine doesn't get on the wound) but it was SUPER itchy.  The spray stuff helped only a little bit.

The second time (home birth) my midwife gave me this huge bag of mixed herbs to make a tea with (not for drinking) that I used in a peri bottle and sprayed the area after each trip to the bathroom.  Could also be used in a sitz bath.  I kept my peri bottle in the fridge and then treated myself to this cool wash in the bathroom.  It helped completely with itchiness and it healed much faster than my first.  She came to check on us on day 2 I think and checked the stitches and said "wow, it looks great!"

I have a friend who is 5"1' and very petite and she swears by evening primrose oil rubbed on daily for weeks before birth.  She had a really hard labor with a baby over 9lbs and only tore in the front, where she hadn't applied any oil.

I'm sure you could also find actual research on the subject, with a google search, rather than anecdotal.

[loveandgarbage]

Ah, love the evening primrose oil suggestion! I love using that on my skin so I already have some in the fridge.

I would also suggest doing kegels like mad throughout your pregnancy. It helps condition your area for labor and can help with controlling pushing.

[Brambleberry]

I had an unplanned episiotomy - and tore as well, past the cut.  I still have to cross my legs every time I sneeze, and it's been 2.5 years.  

DD's head was cocked to the side when I started pushing, and I didn't make progress for a LONG time.  We tried every position imaginable.  I pushed for 6 hours and ended up having to get some vacuum assist on four of the pushes at the end.  I think the episiotomy was cut after the vacuum, I don't quite remember, although maybe it was to help get the vacuum thing in there?  At any rate, I felt like it was totally necessary.  We needed to do anything we could to get the baby out asap by that point, and I'm just glad I didn't end up with an emergency c-section.  Any other doctor would have had me in the operating room long before.  

My doctor was totally on board with the no-episiotomy thing when we made out my birth plan.  She also feels like it does more harm than good in most situations.  But there are times when it's helpful. 

[JessNP]

Has anyone ever heard of the Epi-no? It's a device used toward the end of pregnancy to train your vagina and perineum to stretch. You can read about it here. I've been reading a lot about it and think I may save up some money to buy one (there about $200). If you google it you will find a lot of information about it (other than the company's claims). It's not sold in the U.S. but can be purchased and shipped to the U.S. here. Here is a pic:

[HouseofPeace]

Jess- thanks for the link!!!  i just had way to much fun and involuntary kegels reading about pushing out a 10cm balloon!!!  but having something for exercising seems like it would be useful.  i've considered getting something a few times in the past, but just haven't buckled down to figure out what to get.  so i keep kegeling and then kegel some more....  

[LadyCatherine185]

I think if you have a midwife supporting your perinium, and pushing when you feel you need to without coaching,  you most likely will not tear and definitely won't need an episiotomy. With both of my births, I had a midwife using hot compresses on my perinium while I was pushing, and during my first my MW rubbed olive oil on the area. I am 5'1" and 120 lbs, had two 9+ lb babies (no epidural/drugs) without any tearing. My first son's head circumferance was 15".. my midwife says that is the biggest she ever sees. Just my experience! My mom said the same things yours is saying. ;)

[odinsmama]

http://www.pregnantpossibilities.com/2011/pelvic-floor-exercises-squatting/


I ran across this a long time ago and was glad I could find it again. I try to squat when I'm doing stuff on the floor (Legos, coloring, etc) with my kids.

[shazrael]

Assuming you aren't going to UC, have you talked to your OB or midwife about episiotomies? I had my son in spring 2011 in a hospital with a CNM group. I asked about their episiotomy practice during my pregnancy. I was told that the different midwives each had episiotomy rates between 2-5% of vaginal labors. They did not cut them as standard practice, but believed that during certain labors cutting a 2nd degree episiotomy could stop a 3 or 4th degree tear or be used as a last resort to avoid forceps. I really appreciated that explanation, and was comfortable knowing that we had the same beliefs and goals for my son's birth.

During my actual labor everything went well until I reached 10 centimeters. Just as I felt ready to push his heart rate disappeared from the monitor, he had rotated and gone OP. His hand was also on his forehead, so pushing was really difficult. After a bit over an hour of pushing he was about to crown, but I stopped making progress. He stayed in the same spot, and at times went backwards, for at least 15 minutes. I was unmedicated because my pain had been manageable until pushing began, but I was beginning to lose strength. When my CNM asked if I would consent to an episiotomy because she thought his presentation was very difficult and I was almost out of energy, I didn't hesitate at all and said yes. She said she would administer a topical anesthetic following my next contraction, and then cut following the one after that. I must have changed my pushing after she said that, because he shot out to the shoulders during the very next contraction. 

I ended up having three 1st degree tears and developing a rectocele that I hope to have repaired following my second and final labor. Perhaps if I had had a small episiotomy early on when he seemed stuck I could have avoided the rectocele, but there is no way of knowing that for sure. I think every labor and mother is different, and you can never know with 100% certainty whether a tear or episiotomy would have been less damaging, small, or have healed faster.

Talk with your OB or midwife about their standard practice. Likely they will have information and wording that will be a great comfort to your mother, but if they do normally do a episiotomy for every first time mom you should know that now while there is still plenty of time to hire someone else. I think a birth plan saying you do not want an episiotomy is worth little if you have a provider who does them every time, and if you provider doesn't do them regularly then their exact words and explanation will make your mother feel better than any anecdote or study.

[etsdtm99]

I have torn and had episiotomies.. it is still hard to compare and here is why.. 

1st - i had an epidural and a huge episiotomy - the ob did the episitomy and she flew out in one push, causing me to tear past the cut - borderline 3rd/4th degree tear - my OB said 3rd, my Midwife said i have scar tissue indicating a 4th degree, and also symptoms and healing indicating 4th.  my recovery was horrible. 3-4 weeks before i could do anything normal - like sit up straight.

2nd - had a non-working epidural and a  'tiny' last second episiotomy to "direct the tear" - i was skeptical but it worked - i had just a few stitches on my old scar tissue - recover was a breeze, i was completely healed by 5-7 days. 

3rd baby - homebirth, had a bit of an emergency while pushing, baby got stuck and her cord was compressed so my midwife had to reach way in and pull her out (her head was out to the ears, and my midwife reached in to baby's shoulder/arm), i tore a tiny bit on my old scar tissue and had pretty bad tearing on the side where my midwife went in.. if that hadn't happened my midwife said i likely would not have torn at all .. healing time was about 2 weeks - the location of the tear made it hard to walk comfortably..
 

Ranking healing time, #2 was the best/easiest, #3 next, and #1 was the worst .. 

All of my long term problems (none of which are really bad, i can just tell things are different, no pain) are from the first/big episiotomy .. if i had to do it again, i would have tried harder to avoid the 1st episiotomy .. (which i'm sure was done to speed things up because it was after 4:30pm and the doctor wanted to go home..)

[JessNP]

Wow - you guys are troopers! These stories are incredible. The variety of different experiences is amazing! LadyCatherine 1985 - 5'1" 120lb and with two 9lb+ babies and no tearing vs. etsdtm99 - a 4th degree tear on baby #1 - yeeeooow! As a first timer, I have to just say - I was not fearing the pain of labor up until now. This may sound dumb, but I always assumed that the majority of pain experienced in labor came from the intense contractions. Is the majority of pain from actually pushing the baby out through a relatively tiny opening and tearing? Uuhhhh...I am feeling some major panic right now...what if I can't do this?

[MaybeJ]

Originally Posted by JessNP 

Wow - you guys are troopers! These stories are incredible. The variety of different experiences is amazing! LadyCatherine 1985 - 5'1" 120lb and with two 9lb+ babies and no tearing vs. etsdtm99 - a 4th degree tear on baby #1 - yeeeooow! As a first timer, I have to just say - I was not fearing the pain of labor up until now. This may sound dumb, but I always assumed that the majority of pain experienced in labor came from the intense contractions. Is the majority of pain from actually pushing the baby out through a relatively tiny opening and tearing? Uuhhhh...I am feeling some major panic right now...what if I can't do this?

Well for ME, the contractions sucked incredibly but once my water was broken and I started pushing, I felt nothing at all.  No pain at all throughout the pushing stage.  I was quite tired though, since I pushed for 1 hour and 45 minutes but there was no pain during that stage for me.  I did feel the "ring of fire" as DD crowned but that was over in the blink of an eye.  I had 2 tiny tears.  My midwife did constant pressure, massage and stretching with olive oil.

[MaybeJ]

Oh and JessNP, you CAN do this!!
 

[LadyCatherine185]

For me the contractions were definitely more painful than the actual pushing out... I never got the "ring of fire" with #1, but I think that's because the pushing was so long and gradual (2.5 hours) but it definitely HURT with my second, but was over very quickly.. He was completely out in 3 contractions. ;)

For me personally, I was more scared of the possible repercussions from and epidural (stuck in the bed, not feeling when need to push, more possibility of tearing due to position and not feeling, etc) than I was of the pain of labor. I am very blessed to have had 2 relatively "easy" labor/births (no complications, etc). I feel though, that if I would have had an epidural I probably would have ended up with C-sections.. for how small I am and how big those babies were, I really needed to move around and work WITH gravity during labor to get them out.

[LadyCatherine185]

and i highly recommend reading "Ina May's Guide to Childbirth"... she goes over all of that pushing/stretching etc and shows you how your body was MADE TO DO THIS. :) :)

[Brambleberry]

Yes, for most people it's painful, but you know it's going to be over at some point and there will be a pretty nice reward at the end .  I found that if I just let go and accepted the pain rather than fought against it, I could get through it.  It was manageable.  I labored in the jacuzzi until I started pushing and it really helped.  During pushing the most painful thing for me was when I couldn't push: when I was being checked by the nurses or when my OB was trying to get the vacuum in.  Yes, it hurt when the baby crowned, but it seemed like a shorter, more surface sort of pain, and really it's just so overshadowed in my memory by the baby arriving.  You can do it.  Billions of women have and do every day.  Without medication.  You just go though the pain and it's done.