Episiotomy or tearing? - Mothering Forums

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#1 of 35 Old 12-14-2003, 07:07 PM - Thread Starter
 
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Neither sounds fun to me but what is the lesser of 2 evils?

I would rather have neither but I just wonder if the ob "really" waits for the right time to do an episiotomy or if they really even try, kwim?

Single Mom to 2 amazing little men. T(7) and B(5)
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#2 of 35 Old 12-14-2003, 07:14 PM
 
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I had an episiotomy with my dd and that was the worst part of the delivery and recovery. They gave me 6 shots to numb before the cut and I felt each one and each one hurt! When the novacaine (or whatever numbing stuff they used) wore off, it was so sore and achy. I couldn't sit normally for weeks.

With my ds, I told them I didn't want to be cut and I wasn't. Didn't tear, either. I was ready to go out dancing 2 days later. I did have some 'skid marks' from stretching, but those only hurt when I peed and stop when I used the peri bottle to rinse off. (Sorry if TMI)

I don't know if tearing would be better than a cut, but I've heard it's better and I really don't want another cut- I thought it was just horrible. I've got a new OB now and I will be discussing the issue at length at my next appt.

Michelle -mom to Katlyn 4/00 , Jake 3/02, and Seth 5/04
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#3 of 35 Old 12-14-2003, 08:47 PM
 
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Here's a thread that might help you out, if you're planning a vaginal birth:

http://mothering.com/discussions/sho...hreadid=101149


That said, no matter how many times I've heard doctors say, "oh, I never routinely cut episiotomies", it seems that I always witness those extremely rare births where they do. Your doc has to be totally on board with what you want or your support person better be ready to knock the scissors out of his/her hands.

Sharp things do not belong near our genitals - male or female!
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#4 of 35 Old 12-14-2003, 10:05 PM
 
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I delivered a 10 lb baby and needed two stitches. It hurt a lot for quite a while. But I still wouldn't ever want an episiotomy. (I had a hospital delivery with a midwife.)

I have a friend with a traditional, male OB, and she told him "NO EPISIOTOMY." He relented, but then did NOTHING to support her perineum, and she ended up tearing (with a 6 lb baby) in a starburst pattern that is still not completely healed 2 years later. (She tore so bad she has a problem with fecal matter leaking out a hole in that area -- she won't let them go in and repair it.)

Her example is extreme, thank God, but I used it to illustrate that even if you say you don't want an epis, you MUST have a practitioner who knows how to support the "area". Unfortunately, a lot of doctors are not trained that way!
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#5 of 35 Old 12-14-2003, 10:48 PM
 
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With an episiotomy it's likely you will tear even further. There's no guarantee you will tear at all, especially with perineal massage. I wouldn't choose an episiotomy.
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#6 of 35 Old 12-14-2003, 11:01 PM
 
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I would rather tear....

It makes a lot of sense to me that a tear will hear faster and easier than a cut.

I had a 9 1/2 lb baby and needed four stiches from the tear, and to be honest, I didn't feel myself tear, I didn't feel the stitches, and by the time I got up the nerve to look down there after I had my baby, everything was back to normal. I was sore for about...oh....four days afterwards, but I think that was also due to delivering a big baby and not just the tear.
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#7 of 35 Old 12-14-2003, 11:15 PM
 
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I'd vote for not tearing and not getting an episiotomy. If I had to choose between the two, then I'd tear. The idea that tearing leaves tiny little edges that have more surface to glue back together VS. the smooth cut that a blade makes seems to equal faster healing time for tearing than cutting.

I do believe in perenial massage, woman in labor to decide when/how/where to push, and supporting the perenium during pushing (you can do that yourself if your provider can't). We did all of that during my last pregnancy/birth. I pushed my son out while he was posterior and had a compound presentation. He was an average 7#, 2oz, but I didn't tear at all. I might have had a minor skid mark, but I never did need the Peri bottle.

IMO, if my medical provider said that he/she did one or more episiotomies in his/her last 20 births...I would RUN.

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#8 of 35 Old 12-15-2003, 12:20 AM
 
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When women are allowed to care for themselves during birth, rather than have people "manage" everything for them, they support their own bodies instinctively at the right time and most of the time they do not tear at all. Some do have a slight tear which quickly heals on its own.

If you are forced into an unnatural position and are not permitted to do any of the things that feel right to you, tearing is much more likely.

But, I delivered on my back in stirrups and with forceps, and I did not tear.

I would much rather tear than have an epis.
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#9 of 35 Old 12-15-2003, 01:20 AM
 
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My babes were 9.5.lbs and 9lbs and neither tearing or an episitomy occured. I have heard the perenial message works, but I didn't do it. My widwife used olive oil, a warm cloth, and gentle stretching with her hands for my second birth, which was on land. For my first, which was a water birth, there was no help. Maybe it was being in the tub so much during labor.

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#10 of 35 Old 12-15-2003, 01:22 AM
 
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Also, my midwife told me about a midwife friend of hers who used seaweed to heal tears. She would put a small piece on the tear and it would heal on its own. Does anyone know more about this?

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#11 of 35 Old 12-15-2003, 01:53 AM - Thread Starter
 
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Where can I find info on perineal massage??

Is this something a doula can help with?

Single Mom to 2 amazing little men. T(7) and B(5)
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#12 of 35 Old 12-15-2003, 03:28 AM
 
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I'd rather tear. Who wants a knife down there???

I have given birth 4 times. I had no episiotomy, and no tear for the first 3. The last baby I had an OB who put me in stirrups, and I tore. After 3 babies!!! And she was NOT the biggest!
Anyway, needed only 3 stitches, and it healed nicely. I guess, I cant see down there! LOL

I wonder if a previous tear makes me more succeptible to tearing again and what I could do to prevent another tear.

Of course, no stirrups.....

I am planning a waterbirth in a freestanding birth center with a male OB.
I plan to discuss this at my next appt in 10 days.
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#13 of 35 Old 12-15-2003, 03:43 AM
 
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When you tear, only the amount that needs to tear goes, when you are cut, several layers of muscle tissue are severed, which can lead to further tears.

That said, I birthed a 9 lb 14 oz baby and had a slight tear on my labia that needed minimal stiching. If I had had an episiotomy, my perineum would had been cut, which didn't tear in the slightest.

When I was born, my mother was given an episiotomy, she tore three ways from that episiotomy, it was a third and forth degree tear, and I was only 7 lbs 6 oz.
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#14 of 35 Old 12-15-2003, 09:00 AM
 
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Megan --
Here's one site on Perenial Massage. http://www.childbirth.org/articles/massage.html

There are quite a few threads on it over at I'm Pregnant. Just do a search if you want to hear what other MDC women say about it.

I'm sure your doula knows about it. Personally, for me, it's a rather intimate thing. I prefered my MW to show my husband how and then, have him do it weekly until birth. Or just do it myself.

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#15 of 35 Old 12-15-2003, 01:33 PM
 
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I don't know if I should start a different thread for this, but it's pretty related....

I know for lots of cuts and stuff, some doctors and hospitals are using glue type stuff to close wounds instead of stitches. Does anyone know if they could use that same glue type stuff instead of stitches for a tear? (Probably not for epi b/c that cuts more layers....)

Michelle -mom to Katlyn 4/00 , Jake 3/02, and Seth 5/04
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#16 of 35 Old 12-15-2003, 02:59 PM
 
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Quote:
Originally posted by Boobiemama
I'd rather tear. Who wants a knife down there???
Too bad it's not a knife (scapel) used for this unneccesary surgical procdure--it's a pair of blunt-tipped Mayo scissors. Natural birth advocate and author Shelia Kitzinger cites the frequency that these scissors are somewhat dull (vs. a sharp scapel) and tend to crush and bruise tissues as they slice perineal flesh.

An episotiomy is ALWAYS a 2nd degree injury, that is, through skin AND muscles, whereas most times if a woman tears it will be a 1st degree (skin only) injury. A 3rd degree is to the anal sphinchter, 4th degree is clear throught tha anal sphinchter. 3rd and 4th degree injuries are most often a result of an episiotomy, and any OB textbook or episiotmy-slicing OB will tell you that (it's not just the crunchy homebirthers alleging that episiotomy causes those injuries.)

I always think it is worth keeping in mind the concept that the delicate perineal tissues/labia are just like the lips on a persons face--what would hurt more? A tear/crack in the corner of your mouth or a scissors-snip through the cheeck tissue?

THAT'S what's happening with an episiotomy--gross, hunh? Each winter I know I can live through some dry lips/cracked corner of the mouth with a little TLC & lip balm...I wouldn't want to cut 'n' sew my face to prevent a naturally occuring tear. (Ok, extreme example, but hey--just trying to illustrate my point.)

OBs who perform episiotomies "only when neccessary" do them all the time. These are docs who fundementally believe birth should take place in a hospital under physician's care. Snip, snip.
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#17 of 35 Old 12-15-2003, 03:10 PM
 
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double post
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#18 of 35 Old 12-15-2003, 03:17 PM
 
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Perineal massage/support are *not* necessary if the hormonal process is uninterfered with. (I'm not sure that they even help when it *is* interfered with.)

Here's one thing to think about: for most women, when anyone but their lover touches their genitals, they tense up. Is that the state you want to be in when you are trying to get a baby out? Tenseness in your tissues makes you *more* likely to tear.

It also helps to think about skin in general -- what helps with its elasticity? Well, warmth, and heat, and good nutrition. Cold dry skin cracks easily -- so it stands to reason that it would tear more easily.

Also, think about the perineum and vagina during sex. What is the state of the skin and underlying tissues when you are aroused vs. not aroused? The same hormones involved in sex are involved in birth. If those hormones are somehow not released at the right time or in the right amount (which happens if the process is interfered with in any way: bright lights, logical words, fear, inhibition, anything that takes the mother out of herself, also things like guided pushing, pushing in a reclining position, etc.,) the tissues will not be ready for the passage of the baby.
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#19 of 35 Old 12-15-2003, 03:50 PM
 
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That's right about the scissors. I looked at a breech delivery site that was posted in another thread here, and there were several photos (all crotch-shots, of course) of a very managed vaginal breech delivery in a hospital. I always thought episiotomies were done with a scalpel as the baby was crowning, but in this picture, before you could even see the baby, the scissor was about an inch into the vagina and then the cut was made. One of the grossest things I have ever seen; it looked like someone was being slaughtered instead of born.
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#20 of 35 Old 12-15-2003, 07:14 PM
 
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I had an emergency episiotomy, 2nd degree, because dd's hb was in the 60's for several min. and falling fast. The doctor was massaging and using oil and pressure and said I wasn't going to tear. I had photos taken of the birth, and there's one that shows my loose skin and muscles open and hanging right after baby was born. It's really gross.

I did see a birth of a posterior 10 pound baby and the tear was extremely deep, way into the mucle tissue. Friend didn't even know she had torn until the midwife gave her some shots before stitching it. But I feel that while in most cases that cheek vs. lip comparison might be accurate, it's not in all cases. This woman needed several layers of stitches to heal. I think it was even worse than my episiotomy.

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#21 of 35 Old 12-16-2003, 01:56 AM
 
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I ended up with an episiotomy (from a medwife at a birth center ) and it SUCKED healing from it. I would much, much, MUCH rather have torn. I am STILL angry about it.

One book you might want to check out is Get Through Childbirth in One Piece! How to Prevent Episiotomies and Tearing by Elizabeth Bruce.

I don't recall if anyone above gave you the fabric analogy - grab a piece of fabric, pull on it at either side and try to make it tear. Now cut a one inch slice along the top edge and try to make it tear. The notion that episiotomies prevent tearing is totally false! Episiotomies do worse damage than tearing.

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#22 of 35 Old 12-16-2003, 01:58 AM
 
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I am fortunate to work with moms who are unmedicated and mobile, so a quick "your baby needs to be born NOW" with a look into her eyes, a change of position and some good pushing can deliver a baby faster if need be.

It's true that some women have fragile tissues and they tear deep when they do. This is rare. What is more common is the tissues and underlying fascia is weakened and split with a cut and women tear beyond that - oftentimes into their rectums. As someone who has dealt with fecal incontinence and reconstructive surgery, I can never imagine taking a pair of scissors to a woman's perineum.

As you can tell, because of my personal experience, it's a sore spot for me.
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#23 of 35 Old 12-16-2003, 03:43 AM
 
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I teach my Hypnobabies students to push their babies out in between contractions to avoid tearing or an episiotomy, which is usually worse. It works very well for many women, and I did it myself with my last baby.

If you do push the baby out at your own speed, without the force of a contraction behind you, you have much less of a chance of tearing. If you need more of an idea on how to do this, just e-mail me at hypnobabies@comcast.net.

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#24 of 35 Old 12-16-2003, 02:04 PM
 
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Kerry, can you explain the reasoning behind pushing between contractions?

In my case I waited to push until I knew my body was absolutely ready for it -- that is, when my body was doing it itself. At that point, I couldn't help but push with the contraction, it was completely instinctive and spontaneous. And it makes sense to me that it should be so, and that trying to consciously do something other than the natural, instinctive process would only increase the risk of tears.

So I'm wondering what are your thoughts on the instinctive vs. controlled birthing? I do not know very much about hypnobirthing, I've always assumed that it could help facilitate instinctive birth, but after reading your post I am thinking that it could actually facilitate any means to birth, such as the controlled birthing you mention.
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#25 of 35 Old 12-16-2003, 04:15 PM
 
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Hi, I'm happy to explain a bit about the pushing process that I teach.

First of all, I teach my students that pushing is entirely *mother-directed*. This means that unless there is something going on such as the babys' heart rate going down, each mother is the only one who really knows how to push in a way that is indeed moving her baby down and out. That means, with the exception of her Birth Partner or hypno-doula giving her reminders about hypnotic anesthesia for her bottom, (no Ring of Fire) no one else need to gets into the act. The mother changes positions and pushes as she sees fit, and I give a bit of direction that they may try which is called, "AAAAHHH" pushing. Keeping their mouths and throats open, which has a direct correlation to their bottoms, they "AAAHH" the baby down and out. It works well for most women and they also can try other ways and decide what works for them.

As for the pushing the baby out between pressure waves, (contractions) I suggest this so that they can be in full control of the speed the baby comes out, so as to avoid tearing or the need for an episiotomy. These are the suggestions I give for doing it:

"When you have pushed your baby down your birth canal and baby’s head is crowning, your birth attendant says - “with the next [contraction], the head will come out”. You rest for only about 60 seconds, (not waiting until the next pressure wave comes) , then take a deep breath, make sure the doc or midwife is giving you perineal support, and push your baby’s head out without the force of a pressure wave behind it. You can then control the speed at which your baby’s head comes out without any extra force from a pressure wave, and without the need for an episiotomy. Tears are much less common when women use this technique! (Never lay on your back while pushing!)

You will feel the baby's head move forward, and if there is too much pressure you'll hold back for a moment and go on when you feel like it, instead of being *forced* to push as with a pressure wave. (or told frantically *not to*) Many attendants have not seen this done, and you may just be the one to show them!"

I actually did this with my second baby because I so did not want the force of that next pressure wave to come and (sorry) "split me open", which was what it was feeling like to me at the time. (not using Hypnobabies). It worked really well - no tears, and many of my Hypnobabies students do it as well.

Hope this helped.

Kerry
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#26 of 35 Old 12-16-2003, 11:38 PM
 
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i tore, had a couple of stitches and healed up w/o problems. i started doing perineal massages 8 weeks before edd 2x a day with a special oil for p. massgae that i got back home in germany. you can use olive oil for massage or vitamin e oil.
i would not let anybody cut me down there, yikes!
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#27 of 35 Old 12-17-2003, 01:08 AM
 
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I had an episiotomy with my first birth- I didn't know any better. My second dd was born in the van- an extremely fast and unplanned unassisted birth- and had a second degree tear towards my rectum, and upwards through my clitoris and urethra. I had to have a catheter for two days! But- I healed faster from the tearing than I did from the episiotomy, even though the tearing was "much more serious" according to the hospital staff. That's enough evidence for me.

Violin teaching, doula-ing Mom to Abby, (8) Ashlynn, (6) : and Max (11/13/08) Diagnosed with Metopic Craniosynostosis. First surgery 5/1/09, Second surgery March 2010.
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#28 of 35 Old 12-17-2003, 03:47 PM
 
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Quote:
OBs who perform episiotomies "only when neccessary" do them all the time.
I've been thinking about this for awhile. I'm sure there that there is not a single OB who has never done an epi. Instead of getting the 'only when necessary' answer, what question should I ask and what should the reply be to be sure I won't get one?

I think I was going to ask- in what situations is an epi needed and how often to you do them- would that be sufficient? Again, what answer am I looking for?

Michelle -mom to Katlyn 4/00 , Jake 3/02, and Seth 5/04
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#29 of 35 Old 12-17-2003, 04:30 PM
 
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shelbean91, you're right--there is no OB who's never done an episiotomy. Docs must demonstrate the skill on a live woman (vs. the rules for licensed homebirth midwives in the state of Minnesota, who, in contrast, must demonstrate suturing skills on a lifelike model.)

That being said--I think the best and easiest way to get an anwer is to be direct and open-ended, asking a doc: how do you feel about episiotomy?

The answer you want to hear would echo the posts you read on this thread, things like, GOOD GOD, NO, keep scissors away from birthing women's crotches!

My cousin is planning to birth with a male OB, and his respnose to her querey was that he performs about 1 episiotomy a year. (THAT could be an OB I would let near me, should the occasion warrent.)

I think you want answers like:

"A little tear is usually a superficial wound, whereas an episiotomy will always cut the belly of the muscle, and cutting muscles is a terrible idea, surgically speaking."

"I will use warm compresses and support your perineum, allowing the skin to stretch while you push in any position and with any frequency, intensity, and duration you wish."

Some OBs, loyal to their surgical origins, probably wince at the idea of skin tearing or stretching, such that they want to 'rescue' the laboring woman and provide a quick snip.

I think many OBs tend to believe that a woman's going to need stitches anyway, so why not cut 'n' sew the way the OB has a thousand times before, preffered to wagering the possibility that a woman will tear (and when you're on your back in stirrups it's quite likely) and will need to be stitched in an UNUSUAL manner.

In my opinion, an OB will cut--a woman's perineum or her belly.

In any case, when asking a birth attendant questions, it is important to hear the answer, rather than what you WANT to hear, y'know?
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#30 of 35 Old 12-17-2003, 04:44 PM
 
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Hi Michelle,

You wrote:

>>>Instead of getting the 'only when necessary' answer, what question should I ask and what should the reply be to be sure I won't get one?>>>

You might ask, "In what circumstances do you do an episiotomy?", however what you also need to know is that "to be sure you won't get one" is not a doctor issue, it's your reponsibility if indeed you don't want one. If you don't, just say NO. You are always in charge of every decision regarding your pregnancy, labor and birth, if you want to be. If it's important to you not to have an episiotomy, putting that specifically in your Birth Plan is necessary, as is telling the doctor flat out that you won't be having one unless thereis an emergency situation, and also having your Birth Partner remind the doctor as soon as he walks in to your birthing room that, "We have been preparing for a birth without an episiotmomy and would very much like your help in getting this". This simply reminds the doctor not to automatically cut you as so many do, and since all of those tempting sterile instruments will be right there next to him, he just needs reminders not to use them, and to provide perineal support for you.

>>>I think I was going to ask- in what situations is an epi needed and how often to you do them- would that be sufficient? Again, what answer am I looking for?>>>

There are 2 indications for having an episiotomy:

1) Fetal Distress while pushing

2) A tear that is starting to go up into the periurethral area instead of down.

A natural tear beginning as your baby crowns, if it is going down, is usually not an indication for doing an episiotomy since that will only make the wound *bigger*, (although easier for your physician to suture, which is not your concern.)



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