Episiotomy vs. Tearing ?! (rant) - Page 2

[velveeta]

*any* valid reason for episiotomy?

Hi Ladies!

I am pregnant with my first baby, due in the beginning of May.

If I am in excellent health, and at a good weight, and am fit, would there be any reason for the midwife to say, "okay, we have to do an episiotomy and use forceps b/c this baby has to come out *now*."

My mother will be at the birth and she is very against episiotomy, so I know that she will stand up for me in that regard.

And can you ladies provide some nice links that you like on this subject?

From what I've read of LeBoyer and others, it seems to be a very unhealthful practice, and I am scared about someone forcing it on me.

Help, Ladies!

Jean

[Quirky]

ok, this post is way long

Just to add my story:

One of my primary reasons for choosing to deliver at a local freestanding birth center under midwifery care was to avoid an episiotomy and have a drug free birth. I accomplished my goals on the latter, but not on the former.

I did everything right: I read books (Henci Goer, etc.). I took and practiced courses in hypnobirthing and prenatal yoga, and had my partner do perineal stretching/massage with oil ahead of time. I had a birth plan that stated I wanted to avoid an episiotomy at all costs and would rather tear if it came down to it. I hired a doula (another story, but she never showed...). I took evening primrose oil to ripen my cervix and soften my tissues. Etc. etc.

I labored for the most part in the hot tub and when I started pushing I pushed in any position I wanted to (mostly standing/squatting/side-lying). I also had warm compresses from the crock-pot, perineal support (not massage) from the midwife, and oil. When push came to shove (so to speak ), though, after 2.25 hours of pushing, because DS's heart was starting to show signs of decels on the doppler, I consented to an episiotomy. (And it was consent - the subject came up and we discussed it before she did it).

Let me tell you if you don't already know from painful experience, it is not fun at all getting sewn up and healing afterwards from a cut or a tear (I also had a small "skid mark" that was pretty sore for a while). I didn't have the chance to talk to my midwife about her doing an episiotomy until a week later, and I was pretty upset about it after the heat of the moment had worn off. When I saw her, though, she told me that I was one of maybe 10 women she'd done an episiotomy on in 20 years of practice and over 2000 deliveries. Essentially, my vaginal muscles/pelvic sling are so tight that they were just not opening and stretching enough to let DS's 14-inch head out. (My mother had vaginal strictures, so it runs in the family.) She was really apologetic, but she was also worried about the heart rate issue and told me she would not have recommended the episiotomy if we had any untried alternatives, which we didn't. I felt a lot better after talking to her, although I still wish I could have avoided it altogether.

Although I agree 100% that the vast majority of episiotomies in this country are totally unnecessary and invasive, I am here to tell you that in rare cases they may be necessary. Which is not to say you shouldn't do everything possible to avoid the situation (i.e. most importantly choose the right caregiver), but even in the best of circumstances sometimes it might be necessary.

Jean, I hope I haven't scared you; I have every confidence you'll be able to avoid an episotomy! Talk to your midwife about it and find out what measures she will take to help you avoid an episiotomy (esp. hot compresses, favorable labor positions) but also ask her how many she's done out of how many births and what the circumstances were so that you'll be mentally prepared *if* she suggests it while you're in labor.

[SoHappy]

9lbs, 3oz. 15in head. Just under 5 hours of pushing.
The perineal compresses, oil and huge natural tearing weren't enough, my doc had to (with apologies and regret) cut me to get him out as he was getting seriously stressed. Oh, the recovery... couldn't even sit in a car for more than a few minutes for a month, was still very sore after 4 months. The scarring (inside and out) are awful. Sigh.

But my son is awesome!

[hawleyclan]

"Just under 5 hours of pushing"



Wow!! I'm impressed that a doctor actually let you push that long without shuttling you off for a C/section!! That in itself is a miracle- let alone waiting so long to do an episiotomy!

Position when pushing seems to have more to do with it than the baby's head size. Lying positions are just not good for ladies with a history of tearing, and I can attest to that- both tears I had were while lying. (Well... the first one was a continuation of an episiotomy while in lithotomy with stirrups, the second was just a tiny tear but I was flat on my back again... ) It forces the baby to have to curve upward to get out, which puts added strain on the perineum making a tear more likely. When you are in a squat type position, whether a full squat, supported squat, or sitting squat, the exit route is wider and shorter, with less curve for the baby to need to maneuver- even standing to deliver can open you up more... These are all beneficial to avoiding perineal tears...

(You are also more likely to end up with forceps when in a back-lying position- it is just not a good way for baby to try to maneuver out of that pelvic obstacle course..., for some ladies position is the best tool that they have for helping their little ones come out...)

I know of a lady who birthed a 13+ lb baby without any tears...

There are other factors that play into it in some instances, but for the most part oiling to reduce friction, and finding a good pushing position that really moves the baby down will overcome most problems. Don't be shy about changing positions if something isn't working, and sometimes a good hula/belly dance can shift those hips around and help a baby who isn't wanting to descend... (just getting up and walking a couple steps can have amazing results in getting a slow baby to really clear that pelvis...)

Knowing how to direct your pushing can be a big help too, a trick I read about is to place your hand on your pubic bone and push toward that, often we are told to push like having a bowel movement, but that really doesn't direct the energy quite where it is needed. We want those muscles to push out, not down...

I hope that helps some!

Tears do happen sometimes, but fortunately birth is so intense that you don't really feel anything until afterward- usually during repair... and if you use dermaplast and keep the stitches rinsed, it should heal without too much trouble. Usually a natural tear will be a first or second degree tear, which heal easily and leave little scarring. Do lots of Kegels to help restore circulation and muscle tone to any areas that have torn recently, or in the past. And if you have a little tear, ask about medical superglue, some midwives carry it if you ask... it makes for effective, speedy repair and healing in little tears that might otherwise result in an annoying skintag (like the one that I ended up with after the tiny tear, my husband ended up having to help me cut it off... )

The Lord bless you all!
Zoie
http://groups.yahoo.com/group/Godsbabycatchers

[Charmie981]

Zoie, I'm pretty sure I know the board you're talking about and someone finally came in and said "did it ever occur to you that you don't have to choose between the epi and a tear?" YEA!

Jean, a lot of it depends on what kind of MW you have? Are you having a homebirth or a birth center or a hospital birth? Do you have a lay midwife or a CPM? Most lay midwives aren't even allowed to legally cut an epi so it shouldn't be a big deal. I do know of a few who have done one. The case that comes to mind is one where the baby crowned and as he crowned, the cord slipped down under his head! Not knowing if the cord was compressed and if it was, how long it had been that way, the MW said "PUSH HARD NOW" and cut a episitomy. Were I that mother, I wouldn't have been upset at all! So the first step in avoiding an epi is knowing how likely your provider is to cut one in the first place.

If your MW says, as my doctor did, that she'll let you try, but hasn't had very "good luck" with avoiding epis., then you can still avoid one. Look into perineal massage and start that around the 36th week. Remember to push in a position that takes pressure off of the perineum (side lying, hands and knees, upright, or in water) and DON'T BE DRUGGED DURING YOUR LABOR. Epidural anisthesia makes it very hard to feel what your body is telling you. When your baby crowns (the most likely time you'll be cut or tear), you will *feel* it and it will immediately make you slow down and push slowly through the pain.

Lastly, KEGEL KEGEL KEGEL! There comes a point when you have to know what it feels like when your pelvic floor muscle is contracted and when it's relaxed. You will need to consciously relax that muscled at one point during pushing, so as you do your kegels, pay attention to how it feels. You can do this during intercourse as well. Do a Kegel so your DH knows what a contraction of the muscle feels like and then gently "push" him out, making sure to relax your muscles. He'll be able to feel if you aren't relaxed. Relaxating the pelvic floor muscle actually bulges the perineum OUT and helps prevent tearing.

Also, make sure that your MW KNOWS that you DO NOT CONSENT to an episitomy unless she discusses it with you and you both feel it's necessary. Too many doctors say "I'll let you try" with the intention of cutting one anyway.

[hawleyclan]

Ring of Fire...

Good point definitely!! Listen to that signal... especially if you have had a big tear in the past! You'll recognize it easily, its the intense burning and stretching sensation that makes you REALLY switch pushing gears from "Full-steam ahead" to "Easy does it, nice and steady..."

After healing from a 4th degree tear the first time (and the doctor had the nerve to act like it was my fault! "You tore all the way through" were his words... NICE. : Like I wanted an episiotomy and stirrups?!), I was really sensitive to pushing with the next birth. Something that I found was that without the numbness (from the episiotomy shot) I could feel the baby moving down as I pushed, and I could feel that burning sensation that made me slowly and firmly push the head out at my body's pace. I ignored the well-meaning pushing prompts from my midwife, and listened to what my body was saying... which was "No way am I pushing harder, this is the limit here..." Had I been off my back, I don't believe I would have had even a tiny tear...

I remember negotiating with my midwife afterward, when she told me she felt she needed to put in a stitch or two... I just really didn't want any touching down there at all- it was all pins and needles after getting my bundle out (who, by the way was the largest of all my babies!)... and after a 4th degree tear the time before- what is a stitch or two... I wish I had known about superglue...

My last two births I haven't had so much as a skid mark...!! So anyone who tells you that a 4th degree tear dooms you to tearing again and again because of the "inflexible scar tissue", Bah-Humbug!! Your body is made better than that!!! Work it Girl!!! It's a baby rollercoaster!!!!

(And I tell you what, pushing in the water is a wonderful way to go!!! )

The Lord bless you!!
Zoie

[hawleyclan]

http://www.gentlebirth.org/archives/...rotection.html

http://www.efn.org/~djz/birth/obmyth/episabst2.html

http://www.geocities.com/HotSprings/...pisiotomy.html

Hi Jean! Those are three good ones to start off with, and they have some helpful links...

The Lord bless you!
Zoie

[homebirthing]

I have to say that as a doula, one of the most important things that I have seen that can really work well, is to listen to your body. Nurses like to call it breathing your baby down. I call it spontaneous pushing. Make sure that you have a quiet enviroment and your body will tell you what to do. It is hard because a lot of nurses tend to see high epi rates and are yelling and counting to ten. You can say shhhh... and push as your body is telling you to. With that and ginger compresses or a waterbirth, you should avoid or reduce the amount of tearing. There are not a lot of midwifes that cut anymore. Ask what the percentage rate for your clinic is.

[velveeta]

Can I just say that you ladies RULE!

I am having our babe at a birth center, with a CNM. I am planning to be in the water. And, and definitely NO DRUGS. NO WAY!!!!

The midwife says wait and see, you never know what you'll want for sure (as far as in the water or out) until the time. But, I LOVE taking a bath. I read in the bath, meditate in there. I just *love* it. Plus, after reading Birth Without Violence, I just plain think that it will be less traumatic for the babe.

Does "lithotomy" mean lying on your back?

Zoie, thanks for the links, I will read those in a few minutes.

My mother said that I was the only of her children that she didn't have an episiotomy with. She thinks it is because she had me before the doctor could get there! Hee hee hee. So, she delivered me herself, and had me nursing before anyone else even came into the delivery room! Can you believe it?!

Thanks again you brilliant ladies!


Jean

[MysticHealerMom]

Originally posted by jeanvanzyl
Does "lithotomy" mean lying on your back?

Yup

[Greaseball]

I wrote on my birth plan "I would rather rip in half than have an episiotomy." And I would!

Despite a forceps delivery in stirrups with a lot of internal tearing, the perineum was left intact! It was great.

[ramlita]

My daughter was 10 lb, 8 oz, with a 15" head.

No tearing at all!!

Needless to say, I had a midwife. She held warm compresses against my perineum as I pushed, made sure I drank lots of water throughout my labor, and encouraged me to stay upright.
I was sore for the first few days, but by the end of the week, no pain at all, anywhere "down there."

It was a difficult birth in other ways, but I am more convinced than ever that homebirth with a good midwife is the way to go.

[lorijds]

I am a nurse at a birth center and have been for about 18 months. We have performed two episiotomies in that time. One was without consent...the baby was TIGHT with major shoulder dystocia and the mw could not get her hand in to try to corkscrew the baby out, it was so tight. So she made an episiotomy in order to get her hand it to get to the babe's shoulders. She felt terrible that she had to do it, but honestly felt that she needed to. I would mention that I have seen several instances of stuck shoulders since, and she has never even considered reaching for the scissors, so I trust in her judgement.

The other episode involved a woman with a tight hymenal ring. Her babe was crowning about 3 x 4 inches, but would not come any further. Gentle perineal massage was used, mom labored in warm water, warm compresses were used, mother's diet had been excellent throughout pregnancy...but this tough ring of tissue would *not* budge. Babe crowned like that for over an hour. Finally, after much discussion with mom, dad, nurse, and overseeing doc, mom decided an episiotomy was best. This was after the overseeing doc and mw both told mom they felt comfortable going a while longer, to see if the tissue would eventually give on its own (heart tones were fine, not eveidence of swelling of the perineal tissues yet). But mom decided to try the episiotomy, and I honestly feel like it was the right choice. The mw could pinpoint the exact ring of tissue that was not giving, she numbed and cut it, and babe was born in two contractions.

So never say never. BUT, an episiotomy, like any other medical procedure, while in certain circumstances are beneficial and necssary, should never be universally applied. Each woman, baby, labor and birth are unique, and I think the main thing is to find a practitioner who recognizes and respects that.

Just wanted to throw that out there.