episiotemy vs. none vs. tear - what's it like after the baby? - Mothering Forums

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Old 03-23-2005, 04:12 PM - Thread Starter
 
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my sister is due in a few months and is unsure about the post-birth vaginal differences between episiotemy vs. natural tearing vs. no tearing. her doctor, of course, says that he normally gives 1st time moms an episiotemy (arrgh) but that he can stitch anything (implying that there's no way she won't tear). i'm sure he's never witnessed a natural birth so he probably can't believe that women's vaginas are actually designed quite perfectly :-)

she fully understands that the episiotemy is not natural and not necessary during the course of a normal birth but is very concerned about what sex will be like after giving birth in general. i had a c/s so can't help :-( i think she may be under the impression that not having an episiotemy means there is more stretching and that sex will be very loose or something.

can any mamas share their experiences with either tearing, no tearing or episiotemy...like what's sex like, what was healing like etc.
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Old 03-23-2005, 04:31 PM
 
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In my opinion, it is better to not have either tearing or an episiotemy but if you need one an episiotemy is better than tearing.

While delivering my first child - the Dr. indicated that I needed an episiotemy. I resisted as I had frequently heard on sites such as this that they are rarely necessary. The doula supported my decision not to have one. The Dr. indicated it was against his medical advice. I tore 4 degrees in each direction - all the way to my anus and tore my clitoris in half - I had nearly 20 stitches. The recovery was terrible and my child was well over a year old before I didn't need a drink to have sex.

During my second delivery, I was again told I needed an episiotemy and this time I had one. I needed two stitches and hardly remember any discomfort during recovery.

I am sorry to be so blunt but I think that some people do need to have an episiotemy. I am sure I am going to get blasted by people who had little tears or didn't tear at all but I think it is important to share that resisting medical intervention isn't ALWAYS in the best interest of the mom and baby. That being said, I would not work with a Dr. who gave one to EVERYONE nor would I deal with a midwife or Dr. who never thinks they are necessary.

BJ
Barney & Ben
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Old 03-23-2005, 04:40 PM
 
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Well, as a doula, I'd have to say that 99% of the time, tears are less severe than episiotomies.

Most doctors don't know how to help a woman stretch out and birth without an episiotomy, which is one reason doctors see tears far more frequently and of a much harsher degree than midwives do.

My midwife's clients don't get episiotomies. She's only had a couple of tears that equalled the severity of an episiotomy. Many women don't tear at all, because they push their babies out veeeery slowly in an upright or semi-upright position while she works their tissues over the babies' heads with olive oil. Most ob's don't have the time and patience for this.

So...... you have docs like your sister's that guarantee a deep cut through tissue and muscle for every person.... and other practitioners that rarely do episiotomies and whose clients don't tear as deeply as an episiotomy would cut them.

That's like cutting off every woman's breasts because a few might get breast cancer.

As a doula, the most extensive damage I've ever seen done to a woman's perenium was done by a "medwife" in a hospital. She had my natural birthin' momma in stirrups with directed pushing. As the baby crowned, it's heartrate dropped (totally normal, happens at every birth) so she told the mom the baby was in distress and she had to cut an episiotomy.

She cut an episiotomy, and as the babe crowned, it ripped down into her anus. Now, if the "medwife" would have let her body do its thing, the worst that could've happened was a regular old tear.

So, I do believe that for the vast majority of mothers, when birthing with a person EXPERIENCED in preventing tears to begin with, episiotomies do far more damage than a small tear would.
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Old 03-23-2005, 04:40 PM
 
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I had a strange (but imo minor tear) Absolutely no cutting (sharp objects have no business down there ) The midwives kind of wanted to stitch it- but would have had to call in someone else as neither had seen a tear like it... lucky me- I feel special... but I digress... no stitching. It was a little stingy for a week or so, slightly tender for a couple of weeks then basically back to the same as ever. By 3 months pp (probably before, but who has time for lots of sex with a new baby?) everything was absolutely back to feeling the same as before. There is one tiny bit on the outside where I can feel with my hands that it's a bit different, but can't see any difference and can't feel it while doing anything- DH definitely doesn't notice any difference now. At 6 weeks pp it was a bit looser than pre-baby, but it's tightened back up.

hope that bit of tmi helps!

-Angela
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Old 03-23-2005, 04:43 PM
 
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Think of it like a piece of fabric...if cut, then pulled on either side, it is very easy for it to tear even more! If you just pull on the fabric without first cutting it, it is very difficult to rip.

Our bodies are similar.

My first birth I was cut, and then tore even more. I ended up with a 3rd degree tear/epis. It was aweful, and far worse than the birth itself. I had pain during sex 18 months later. I was also pushing in the position they told me too (flat on back, legs in stirups) and pushing when they told me to, not listening to my body.

Second (home) birth, I pushed in what ever position I felt most comfortable, pushed when my body told me to, and no tear or epis. and a bigger baby. I had sex 2 weeks after the birth with no pain.

I vote for push in whichever position you want, listen to your body to know when to push, and DON"T let the Dr cut you!!!
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Old 03-23-2005, 04:51 PM
 
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I had a second degree tear, and everything seems to be back to normal at 7 weeks pp. My baby came out pretty fast. Her head didn't mold. I was unable to hold myself up on the squat bar, and the staff wasn't clueful enough to help me so I got stuck in semi-lithomy. Everything that could encourage tearing, basically. I can't imagine an episiotomy would have healed any better. That area, at least, feels perfectly normal.

You might advise your sister to look into different birthing positions, and talk it over with her doctor.
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Old 03-23-2005, 04:54 PM
 
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I had a LARGE episiotomy with my older son.
The doctor was very in favor of natural births, so he let me stretch as much as possible, but when I started tearing, he did a small epi to try to stop the tearing, but I tore through that even. I ended up with 12 stitches (6 inside, 6 outside), but Sebastian's head, even as a newborn, was HUGE.
I remember it was very painful - I had a hard time defecating and needed stool softners before I could go. I waited 6 weeks post partum for sex and it was brutally painful that first time - even with my then husband being very gentle.
I don't mean to scare her, and everyone's experience is different, but I was relieved when I had a c-section with Trystan (despite pushing for 90 minutes, there was no tearing because he never came down low enough!) because there was no episiotomy!
I've heard that olive oil applied frequently pre-birth can help the skin soften and prevent tearing (it stretches easier).
I would also be adamant that the doctor is NOT to cut... I've heard from others that tearing is less painful then the cut when it comes to healing.
Hope this helps!
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Old 03-23-2005, 04:55 PM
 
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Something i heard a midwife say once is that if you think of fabric, it tears alot easier once you've cut into it KNIM? I had no epis. and a tiny tear which noone even mentioned. I think it's all about hot compresses and oil massaging pre and during labor. Also, laboring in h2o gets things nice and elasticy!
As far as the sex thing- If a baby is comming through your birth canal period, things are just naturally going to open up. There are always exercises you can do to "tighten up" but once you've been cut there's a definate wound.
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Old 03-23-2005, 05:24 PM
 
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I had a 2nd degree tear before my c/s w/ AJ and I don't remember any problems (maybe it was b/c my c/s hurt so bad?). I had a 3rd degree tear this time (he needed out ASAP and this was faster than a c/s and what I wanted) and let's just say I'm not real into sex. I know not all of that has to do w/ the tear, but I think some of it does. Did it feel better than my c/s? YES! I was up moving around just fine after the birth, but it has taken some time and w/ more workin the bedroom I'm sure I'd be fine, but as a SAHM to 2 babies, who has time?! :LOL

Jennifer, LPN and nursing student, Doula, CPST, and VBAC mama x3 to
AJ (5/03), Evan (12/04), Ilana (11/06), Olivia (2/09), and Unity (8/2012)

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Old 03-23-2005, 05:37 PM
 
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I had an episiotomy with a midwife. It did not cause additional tearing, thank God. I am still not sure it was necessary. It was supposed to have healed at the 6 week post partum appointment, and was still bleeding then. (I think I was also late to the 6 week appointment as well, we couldn't make it until a week or two later.) Two years later it seems to have healed okay.

I never went back to the midwife after that 6 week appointment. We came to see her filled with gratitude that I had managed to give birth vaginally, because I had my water break without going into labor. I must have the world's most pitocin-resistant uterus. I knew that without her expert help during that crazy labor, I would have had a c/s. We even brought her presents!

So I come in and I'm still bleeding from the episotomy, which I didn't even want, and she's like "oh yeah, that'll heal up soon, I guess sex will be a bit like losing your virginity, don't sweat it. Have you had sex yet?" Then she pressured me into being fit for a diaphragm--I put it in right there in the office and bled all over it because the @#$*& incision wasn't healed yet. I never filled the prescription for the diaphragm. (the OT part: she also gave me a hassle about my weight at the 6 week PP appt. Thanks lady.)

I am feeling guilty that I need to have a regular pap smear but I just don't even want to deal with trying to find a good OB practitioner.

Divorced mom of one awesome boy born 2-3-2003.
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Old 03-23-2005, 05:38 PM
 
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Our bodies are designed to give birth. Our perineums are meant to strech to accomadate the head of a baby and then return to almost its same shape as before. Of course it wil never be virginal, but its pretty darn close. Just don't look at it too soon after birth .

Sex for dh and myself is better now than ever before (after 5 kids thank-you very much). This is probably too much info but...dh being a man and not a virgin when we met said that some women are really loose to begin with. So I can see where someone would think that childbirth is gonna strech it out so much more that sex would be almost non exisitent. But if a woman does her kegels (remember its a muscle - you don't use it you loose it) than I think her vagina will be nearly the same as before birth.

Now you throw in a tear or an episiotomy and that changes things. From the women I know that had tears or episiotomies sex was much more painful, for longer than those that hadn't. And the scar will not strech easily. So if she gives birth again she has a good chance of tearing or needing cut since the scar won't strech. THe same hold true for sex. Sure it can be tight because it won't strech.

I would be worried about a dr who gives all first time mothers an episiotomy. I would have a hard time giving birth because I would be to afraid he was gonna cut me! I would probably be pushing with my legs crossed!

Oh....My mother said to me after my first was born, "Oh how nice you didn't tear, you will be able to sit afterwards right away!" She would know having had 6 kids and 4 of them she was cut.

Michelle

Expecting #9.  Always busy hsing.
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Old 03-23-2005, 06:26 PM
 
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I did have an epis with my first because I had forceps. I think probably didn't need either but in fairness this was after close to 3.5 hours of pushing with an old school OB. I feel lucky to have managed with just an epis. My next birth also had a small one. My third birth was also my first natural birth and the medwife I had insisted that I push flat on my back. She suggested an epis several times and when I would refuse would just say "oh well that's fine you're just going to tear on your old scar anyway." I had her head all but out but couldn't seem to get her past this little lip and I felt so much like I was tearing upwards probably due to being on my back. Anyway I finally agreed to the epis which I'm sure I did not need. I jsut need a nonsucky midwife. Fortuantely I guess she just snipped enough to let her head be delivered. I did not tear and everyone commented no how small my epis was. I had no discomfort from it at all and was sitting right away. : With sex I always waited until at least 6 weeks any way just because I had been told to wait until after the pp check. With none of them did I experience any great deal of pain related to sex. As for looseness I have actually had partners shocked that I had had children because I was so tight. I do Kegels like a madwoman though. So yeah it's a muscle exercise it and you'll probably be fine.
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Old 03-23-2005, 06:36 PM
 
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I had a c/sect and a VBAC with a 2nd degree tear. I had some scar tissue that needed to be removed after the tear healed, but after that sex felt great! I honestly feel the same as before babies. While nursing I was dry vaginally, but Astroglide gel helped a lot with that. After weaning, I didn't need the Astroglide anymore.

My sister had an episiotomy with her 1st baby and none (no tearing either) with 2nd baby and she says her sex life is as good as before

Hope this makes your friend feel better!
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Old 03-23-2005, 06:37 PM
 
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I was mean and told my midwife if she cut me she'd better run, cause I'd be coming after her. I did walk, swim or squat daily in prep for labor. I did not tear any of the times I've given birth and always felt like having sex within two weeks of delivery. I think I just got lucky.
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Old 03-23-2005, 06:51 PM
 
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My understanding is that natural tears are usually less severe than episiotomies.

Add to that the fact that a DEFINITE episiotomy from a doc who routinely cuts them (what the heck is his problem?) will certainly be worse than a POSSIBLE tear. I would rather take the risk of tearing...and possibly escape with little or no injury...than have the episiotomy.

I did end up with an episiotimy, which then ALSO tore. Childbirth without medication, no problem. The pain of a healing episiotomy, OH MY FREAKING GOODNESS.

Issues I had with my episiotomy:
- About 1 week of intense pain, all from the surgical wound. This had a profound effect on my ability to function post-birth and I am certain it affected me as a parent during that time.
- The sutures dissolved before my tissues healed back together. 1 1/2 weeks after birth, I took a look with a hand mirror and discovered that I had a gaping wound where I should have had a healing scar. It took over 6 weeks for the whole thing to close. This is not typical, but it can happen.
- I have definite scarring - kindof a trough-like scar on the outside, ropy scarring on the inside.
- Didn't dare to have sex for 3 mos. Hated it every time until after 1 year. Fortunately, sex is now fine. I have no residual pain or numbness. I consider myself lucky for that.
- Lots of emotional trauma from the birth, the post-birth pain, the healing troubles, and now worrying about what my 2nd birth will be like.


...so like I said, I would rather risk tearing than have a definite surgical wound. I would never choose to have an episiotomy, and I would be uncomfortable with a physician who cuts them on ALL of his first-birth patients. That habit of his makes me concerned about what his beliefs are about birth and how those beliefs are reflected in other practices, too.

I have lots of friends who did not have episiotomies. None of them had as horrific an experience as I did. Many of them didn't tear at all, most who did tear had a few "skid mark" type of tears that didn't require any stitches and healed quickly. The rest mostly had small natural tears and only one or two stitches.

For "tightness" issues regarding sex after birth, check out the "happy husband stitch" thread. Tightness has much more to do with vaginal tone than the perineum. Kegel kegel kegel kegel....

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Old 03-23-2005, 08:40 PM
 
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I had a teensy tear that never bothered me. The stitch my midwife put in it bothered me more than the tear itself did, and I removed the stitch on my own before it had time to dissolve. I never had any swelling or pain like I had been expecting from what others had told me, peeing was a little uncomfortable so I used a squirt bottle with cold water or my bidet/mini-shower as I went. Yeah, things were and still are different, but not worse. In some ways sex is much better now than it ever was before.
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Old 03-23-2005, 08:53 PM
 
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I had 3rd degree laceration tearing. No episiotomy. It was BAD and sex hurt for a good 6 months. I asked my midwife about it concerning this pg and birth and she said she has only seen that kind of tearing with an episiotomy or an unskilled delivery. I wouldn't get a routine episiotomy by any means, but some of us do have bad tearing, and it really sucks.
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Old 03-23-2005, 10:15 PM
 
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I've never had a stitch in my perineum. ~~knocks wood~~ and sex after my first was uncomfortable for a few weeks... but got back in the normal groove pretty quickly. If anything I felt too tight. After my second, I was really concerned that sex would be miserable but it wasn't. No special discomfort at all.
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Old 03-23-2005, 10:35 PM
 
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I had a hospital birth with an OB/GYN. I ended up with an epidural but it wore off comepletely by the time I needed to push.

I did NOT do an episiotomy. They very thought of if completely creeps me out and I made sure my doc knew my feelings. And my OB says she rarely does them anyway. (Again, the fabric example. YUCK!)

I ended up with 2nd degree tears, and I did get stitches. The funny thing is that I didn't even notice anything with the stitches while they healed.They didn't itch and they didn't hurt. (Just general soreness in the area from pushing out a 7+ lb. baby.)

I wasn't even worried about post-partum sex by the time I got my OK at 8 weeks or whatever they say. (Can't remember now.)

I think it's best to just let the tear happen IF it needs to. I didn't even know I had torn until the doctor told me anyway.

BTW, I didn't do the vaginal stretching stuff with my partner. If you are worried about tearing, I would suggest doing that.

Baby's waking up from her nap. Hope this helps.

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Old 03-24-2005, 12:00 AM
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I think it really depends truthfully...I can't speak from personal experience, but my midwife ONLY does them in the event of some kind of trauma to the baby, like the baby literally can not come out--she says that in that rare case, she prefers what she calls "to make a tiny snip" rather than keep the baby in there...but she tries to avoid it all together--and manages to, in almost every situation.

That said, my MIL told me she had an epi with DH and nothing has ever been the same. Sex was painful for years, the scar was painful for years, it was not a good situation at all and she calls the doc that delivered DH a "butcher"...my Mom on the other hand, had 2 epis with my brothers and said that they didn't seem to affect her in the sex or pain department and healed pretty quickly, so I don't know.

I am not a fan of them, (epis)...and prefer to stretch/tear on my own, but I have heard okay, and not so okay, to downright bad stories across the board from tearing to epis...

So maybe this post was no help at all...lol
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Old 03-24-2005, 12:43 AM
 
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My DD was ten pounds, eight ounces, with a 15" head.
I birthed her in an upright position, and did not tear at all.
I was sore for a few days, but felt better really quickly!

It seems that the less a mom is messed-with during labor, the better chance
a) the hormones that help this brief stretch happen well will be able to do their job, and
b) mom will choose a position that works well not only for pushing, but for letting baby come out in the best way for her body

Drugs and stress during labor mess with labor hormones, and being pushed down on your back to deliver means that an undue amount of pressure will be applied to your perineum, greatly increasing your chances of tearing.

For everyone I've known, tearing is much better than getting cut, if those are the only options.

DIYer mama to DD 11/00 and DS 6/05- both intact, naturally!
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Old 03-24-2005, 01:02 AM
 
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I just had my baby a week ago and I didn't tear at all- the female body is really amazing- I was even pushing really quickly and didn't slow down to pant at all when he was crowning- I was upright in a squat on a birth stool though which I think helped a lot. I had some brusing but that's all.

I could easily have sex right now if my bleeding had stopped. And it's not loose by any means :LOL

I would say that Kegels really help-I did them religiously throughout pregnancy- and having sex helps too- Ina May Gaskin reports that women who stay sexually active during pregnancy tear less often- and that was true for me.

Basically I would never have an episiotomy because if you risk tearing at least you have a chance at an intact perineum which will produce the best possible sexual outcome- muscle gets back to normal faster and no chance of painful intercourse from scar tissue. If you have a slight tear it's still much better than an episiotomy- with an episiotomy you have an automatic 2nd degree laceration which involves the muscle- the muscle is what makes sex enjoyable and what makes your vagina go back to normal.

The best way to avoid tearing and make an episiotomy totally unnecessary is to not give birth on your back- there's just too much stress on the perineum when you're on your back.

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Old 03-24-2005, 02:49 AM
 
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It took me a good 6 mos. to recover from my 2nd degree episiotomy. I had a very hard time with sex, passing bm's. It took me over a year to be able to comfortably use an in-vaginal menstrual product. (The epi was done b/c Abi's h/b remained at 40 for several minutes. She was born screaming and alive and well.)

When it was time for Nitara's birth I said no way do I want any scissors near my body, I'll just take my chances with tearing. I tore just a tiny bit to one side, and it did not need stitches. I was fully healed and not sore anymore after just 2 weeks.

I had epidurals/back delivery with both.

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Old 03-24-2005, 09:15 AM
 
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I think we can all agree that no tearing, no episiotomy is what feels best after the birth. My second choice would be to tear, absolutely. I would only have an episiotomy if the baby's life depended on it.

I think the best way to avoid serious perineal trauma is to avoid an epidural and to avoid giving birth in a position that puts pressure on your tailbone. (Standing, squatting, on your side, in the water --- all better than reclining or semi-reclining. ) These positions can create 30% more room in the pelvis, which for some women, is all they need to avoid an epi or a C-section. Even with an epidural, a mom can still push on her side, with someone holding her top leg up.
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Old 03-24-2005, 10:30 AM
 
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I had a small epi with dd and must've gotten lucky or something because it has never caused me one bit of pain. I am pretty sure it was not necessary though (the OB said I had an unusually thick perineum) I birthed on my back with no pain drugs whatsoever. We resumed sex at 5 weeks PP with no issues. That said, if there is a next time I will not get an epi unless absolutely necessary.

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Old 03-25-2005, 04:37 AM
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I had a homebirth to hospital transfer and I told the very interventionist doc that he better not cut me, I'd rather tear. Of course I would rather not have torn, but he wouldn't let anyone support my perineum (sp?) and it was one issue I wasn't going to fight with him about (long story) so I did tear, and badly (they tell me) *but* I healed in about 4 days (really) and was feeling "normal" in just a few weeks. Not lingering problems and all is well with "relations" with dh

I have heard mostly horror stories about epis with long healing times from friends and relatives.

I would take my chance again, but this time I will make sure to have someone help me to reduce my chances of tearing.

Good luck,
Ellen
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Old 03-25-2005, 05:17 AM
 
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i had an episiotomy, and the sex would be much better if my vagina had been left intact and left alone to do it's job. i have a loss of sensitivity around the scar, and my anatomy just feels "wrong" now. like my perinium is up too high. i haven't read the replies, this may have already been said, but you know when you make a cut in a piece of fabric, how you can then tear it really easily? it's not so easy to tear a piece of fabric that has no cut in it. same thing with your perinium. the incision and the tearing that can result from it is usually worse than if you just tear. mine was.

i wouldve rather have torn than had the episiotomy, but it was never discussed b/n me and my ob (mistake.mistake. mistake)

he tells me, as i'm pushing out 8lbs15oz of baby, uphill in the lithotomy position, with the knowledge she passed meconium and could die running thru my head, and he tells me "you're either going to tear wide open or i can make a tiny cut, which do you want?".
oy
under diress, i chose the cut, and it was horrible. the stitching up afterwords was more painful and uncomfortable than anything else during labor had been. i took heavy pain meds for 2 weeks, and it took me 7 months before sex was even possible without extreme pain. it was another 5 months after that before i got any kind of pleasure out of sex.

what wouldve helped me was birthing upright, and birthing at my own pace, listening to my own urge to push, without people yelling at me to "PUSH PUSH PUSH".

Erin, 33, salty southern mama, sitting by the sea with my DH35, DD10, DS4, &DD2!
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Old 03-25-2005, 05:46 AM
 
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Tears usually happen because the woman is laying flat on her back, and the doctor does to bother to massage the perineum or allow it to stretch...doctors have no skill in this regard because they are not trained that way...they are first surgeons, and obstetricians are usually men, so what do they know or care?

If you go to a surgeon, you are going to be cut.

I had four children at home; two with a homebirth doctor and two with his midwife. I never tore, and the soreness from the delivery lasted only a day or so. Sex was never a problem. We usually resumed within a week...

"The great enemy of the truth is very often not the lie, deliberate, contrived and dishonest, but the myth, persistent, persuasive and unrealistic."
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Old 03-25-2005, 06:40 AM
 
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well... i've never had an episiotomy...

i tore very badly w/ my 1st, icluding a cervical tear + tons of stitches... we waited about 2.5 weeks before making love... and it was awesome. (can i say this at MDC?) it was absolutely some of the best sex ever... *because* i was so loose, and sensitive... it was awesome. my partner didn't think much of it... but the intimacy was nice i guess... and WOW it felt good. even with the pain.

then fast-forward 4 years and many kegels later... w/ my daughter i had an au naturelle home birth, no tearing at all... we made love the night after she was born. : which was also nice, but much more painful. i'm not nearly as... floppy... as i felt after my son's birth, and i feel... smaller. i loved my pregnant yoni ~ all full and ripe... my whole body was just brimming with fertility. i'm still getting used to my post-partum body & it's been 8 months. however, the sex is better than ever. & my partner & i are more connected than we ever have been.

Quote:
Our bodies are designed to give birth. Our perineums are meant to strech to accomadate the head of a baby and then return to almost its same shape as before. Of course it wil never be virginal, but its pretty darn close.
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Old 03-25-2005, 07:55 PM
 
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I had three episiotmies that tore to the 3rd degree with my first DD. We were a homebirth transport after about 10 hours of pushing. She was malpresented and I ended up with a vacum extraction. My recovery was terrible and it took me many months to heal emtionally and physically from it.

With DD #2 I gave birth to a bigger baby in a free standing birth center(no homebirth MWs around) and had a small skid mark. I gave birth on my back(my choice) and I recovered great. I could sit, stand, poop, pee, and even felt like sex within a few days.

Sara
I love my girlsMadaline(9), Mary-Grace(7), Georgia(3), & Evelyn(1)
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