episiotomy question

[Honey693]

Is it better to tear or be cut? Also when would an episiotomy be necessary? I know that if forceps are used, it is, but beyond that I'm clueless. I tried googling it and it said in the case of a large or premature baby. So I'm not trusting Google on this since that seems to make no sense to me.

[MamaRabbit]

Tears heal faster. They are harder to stitch up which is why care providers prefer to cut. Tears go only through the skins while cuts go through skin and muscle. Episiotomy is not a requirement for forceps. And the World Health Organization says it should be 0 to 5%. I can't see how an episiotomy would be necessary. Big baby? So tear it's usually still better. In the mean time find a care provider with a low episiotomy rate.

[nashvillemidwife]

The reason they do episiotomies for premature babies is to reduce the pressure and trauma of birth on their tiny fragile little skulls. That's not necessarily a bad idea.

The best reason to do one is if the baby is in trouble and there's reason to think that cutting the mom will actually help get the baby out quicker. If there's a shoulder dystocia where the attendant has to go in and turn the baby's shoulders a cut might be necessary to make enough room to accomodate the hands. Same for forceps, though only if there's not enough room - usually on a woman who has never given birth vaginally before.

I have also seen it done on a woman who had genital warts. The skin was already so friable and fragile it was inevitable she was going to tear so the midwife made a little cut to guide the laceration in a direction that was not going to tear right through a wart.

[nashvillemidwife]

Originally Posted by MamaRabbit

Tears go only through the skins while cuts go through skin and muscle.

This is not true. Tears can and do extend through muscle, just not as often. Since I don't do episiotomies, the only third and fourth degree tears I have seen have been the result of natural tearing.

[MamaRabbit]

^^^ Yeah true I was generalizing a bit. I should have said rarely.

[alegna]

There was a study a few years back that basically showed that episiotomies should NEVER be routine. That they very very rarely are needed (extreme preemies etc)

-Angela