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Discussion Starter · #1 ·
It's been 4 days since I had my second baby and I'm still trying to process the birth. Overall, it was great and exactly how I wanted it to be, except one thing....getting another episiotomy.

With my first birth, I had sciatic nerve pain in my leg with each contraction and by the time I was pushing my leg had given out. We tried a few upright positions, but I ended up flat on my back trying to push. The minute I layed down I lost the full urge to push. I purple pushed for almost an hour before the midwife suggested the episiotomy. The baby was not in distress, but I think she was nervous about him being stuck, because the ultrasound a few days prior showed that he was over 11 lbs. At that point I was getting exhausted, but I gave it four more contractions before I gave in.

After the birth I felt that the episiotomy was probably unnecessary and had all to do with position. I was angry that neither my midwife or my doula had suggested we try a different position before doing the cut. Even though my leg was out, I thought that if I had tried a birthstool or something upright that was more supportive I would have been fine. I hated that I was so vulnerable that I didn't push to try something different before giving in. I was never able to fully discuss what happened with either of them as my doula left the country the week after I gave birth and my midwife just said that my perinium wouldn't budge and I didn't want to put blame on her since I felt like I was a failure for giving in.

Fastfoward to this birth. I was determined to NOT get another episiotomy. After 4+ months of healing and a traumatic afterbirth, not to mention my feelings that it probably wasn't necessary, I wasn't going down that road again. I did a ton of kegels and squats and applied evening primrose oil in hopes of keeping things toned and elastic. Both my new midwife and doula were very mindful of my desire to avoid another cut.

Well, labor day came and the labor went great! I labored virtually painfree for about 3 1/2 hours. Transition sucked, but lasted about 15 minutes, and then the irresistable urge to push came minutes later. I did not have this uncontrollable urge with my first son. After pushing only about 10 minutes I felt the ring of fire come on. I thought for sure it would be over in just a few moments. I was wrong. The baby was crowning for well over a half hour before the midwife started talking to me about cutting. I actually knew before she even mentioned it that it was going to happen. The crowing pain was getting unbareable and we had tried every position imaginable to get this baby to slide past my perinium. She cut as small as possible and just enough for the baby's head to slide out.

After the birth both my midwife and doula said that it was necessary. My tissues had started to swell and the perinium was not budging at all. My midwife said she had never seen a perinium that thick. Later, when I was just talking to my doula she said that she has only seen 2 necessary episiotomies in her hundreds of births and mine was one of them. She said that the tissues behind the outer portion of my perinium were actually getting stretched out and turning white, but not the outer ring area. She couldn't believe that I just didn't tear down my old episiotomy scar.

I just don't know how to feel about it. I came on here and read throughout my pregnancy about some of the midwife never having to cut and feel like maybe I was a failure and gave in too soon again. Have any of you seen cases where the episiotomy was necessary (not including the obvious cases where baby needs out now). Is it possible that I'm a rare minority statistic? I don't know if it makes any difference but my first son's head was 14" and my second son's was 15" and they were both near 10 lbs at birth. I want to believe that my midwives had my best interest in mind and I made the right decision both times to cut, but I am struggling to believe it. I'm really curious to hear your opinions. TIA!

Amy
 

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The first time I don't think it was necessary. I think that you are absolutely right that you should have been able to sit on a birthing stool (or even the toilet). I also think that you should have been given more time to perhaps develop the ejection reflex that you experienced with your second birth.

Did they do any periennial massage in your second birth? I'd think that sort of situation would be where messing about with the tissues could actually be beneficial.
 

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I don't have any personal experience but I just interviewed a midwife this past weekend. She's been an LM for over 20 years and attended 1,000's of births. I asked her what her episiotomy rate was and she said she's only done one. She said in that one case the baby was basically born but due to some skin condition the lady had down there the perineum just wouldn't stretch and it didn't tear at all. It sounds about the same as your situation. I think your doula saying she's only seen it twice where it needed to be done and yours was one of them says a lot since she's so experienced.
 

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Discussion Starter · #5 ·
Quote:

Originally Posted by sapphire_chan View Post
Did they do any periennial massage in your second birth? I'd think that sort of situation would be where messing about with the tissues could actually be beneficial.
No, there was no massage during the second birth.

Quote:
were you standing when you were pushing?
Not during the first birth. At the second birth I tried standing, squatting on a birth stool, hands and knees, leaning over the edge of the bed and supported squatting with help from my doula.
 

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FWIW, my teaching midwife cut her first ever episitomy during my apprenticeship and it was a situation very similar: the perineium was beginning to "buttonhole" tear further down toward the anus, but there was still a thick band of skin around babe's head. She cut, then cried
. Until that point she had always maintained that no epitisomy is ever necessary. After that she questioned whether it occasionally is necessary....I'm not sure what she decided, though.

I think the important thing in your situation is this:

Quote:
The crowing pain was getting unbareable and we had tried every position imaginable to get this baby to slide past my perinium.
You wanted to be done with that pain and the episitomy helped you accomplish that. Maybe it wasn't "necessary" in someone's eyes (or maybe it was!), but it was a decision that you had an active and informed role in making (as opposed to the first time) and the intervention you chose accomplished what you wanted it to accomplish. To me that's the most important part of your post!

I'm going to stop now...I'm my computer room is cold and I don't feel like I'm saying what I want to say very well.
 

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You didn't go into this birth with a unscarred "natural" perineum. It's possible that you grew back an extra strong perineum. Lots of women have a little weakness along the old scar line. I think it's kind of cool that your body healed so well that there was not that weakness.
 

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this is what scares me... i think my 3rd it could have been avoided, but the dr was worried i woudl have tore all the way back and had a 4th degree tear, ect ect. i only had the burning for about 1-2 min before he was cutting... and saying there was NO time for a local down there ... if there was no time for local wouldn't the baby have just been born.. i'm not sure, i do know that i have a ton of scar tissue down there from a focept delivery and 2 pervious episotimies, but this 4th time i'm really hoping that my midwife can avoid it... but with my scar tissue i wonder if it's even possible
 

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Discussion Starter · #10 ·
Quote:

Originally Posted by sapphire_chan View Post
Evening primrose oil? Is that the one that's supposed to help soften tissues?
Yes, a lot of women will take it orally and/or vaginally to help soften and ripen the cervix. My doula recommended applying topically to the perinium as well.
 

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honestly, it sounds like it was necesary. If she's only ever seen/done 2 that she believes were necesary, and your was one...I'd be likely to believe that. Also, my own conclusion based upon what you described also leads me to believe it was likely necesary......would the baby have come out if you had just waited? Who can say? I want to say yes, probably...but would the baby have suffered some distress? again..how to know? Although i think it's also a probably....
 

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Hard to say...after four hours of pushing what turned out to be a relatively small baby (6 lbs), my midwife asked my consent to do a "tiny" episiotomy. Baby came out with the next push, to my very very great relief, and I had no healing problems from the episiotomy whatsoever.

I was having VERY strong urges to push, and tried a lot of positions, before ending up on my back because I was so tired from laboring all night and day. Could things have been different? Maybe. It turned out that DS' head was turned the wrong way which is what made pushing him out so difficult. I don't know that changing my own position would have necessarily fixed that.

Personally, I felt a lot of relief at that point that the pushing was over and my baby was born, so I did not have any regrets over the episiotomy at all.
 

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With the midwife that I work with, I've seen a couple of episiotomies where there was a tough band of tissue that just would not give. We hardly ever do them, not even for shoulder dystocia or anything like that. We don't do forceps or vacuum, we have all different sorts of birthing positions, we don't often coach mamas in pushing, we encourage laboring in the water, etc.

Two were with first time moms and one was with a multip. I vividly remember the one--the baby crowned for forever. The mom and the mw discussed the issue, the mom wanted to push for a while longer and did. Then the mw tried to just pinch the tissue, thinking that if it broke down a little bit, it would stretch. No go. Finally she snipped it a tiny bit, like less than a centimeter, thinking that if she just started the tear, it would still be better for her tissue to tear than be snipped, for the healing process (overlay of fibers, tearing along muscle fibers instead of through them, etc). She had to snip it farther after a few minutes, because this band of tissue just would not give. The baby was born the next contraction, and the snip didn't extend (thank goodness).

The mom felt okay with it--not only does our mw hardly ever do one, but the mom was an active participant in the discussion, and that coupled with the fact that her baby was born the next contraction made her feel that the episiotomy was worth it.

A pp stated that you should feel good about being an active participant in the process--I second that feeling. You did everything you could and you were active and helped make the decisions. That is the best any of us can do. Does that make sense?

Lori
 

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My preceptor doesn't carry episiotomy scissors in her birth bag. I don't plan on including them in my birth bag either when I am done apprenticing.

:

I find it very hard to believe that our perineum isn't able to give (either by stretching or tearing) to birth our babies. It sounds alot like how OBs like to say our bodies grow too big of babies to pass through our pelvis. I don't buy that either.

I am not trying to discount everyone's experiences here.
I just wanted to share a different view.

I would be curious to know how often a perineum would have a tough band of tissue that holds up the baby's birth in undisturbed, private births, such as unassisted births.

Hmm, now you have me thinking.
 

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I had a TOTALLY unnecessary episiotomy with my first baby. The doctor "said" he started to see a little bit of blood and SLICE...
: Luckily it healed ok and I was able to birth at home, episiotomy-free with my second child. I had no tearing either. The procedure of cutting the perineum didn't start until roughly the 17th century, at least that's as far back as some historical records show. So what did people do before then? Let nature take its course is what I'm guessing. If you tear, you tear. The body knows what its doing. I just have a very hard time believing that an episiotomy is ever necessary.
 

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Quote:

Originally Posted by Lennon View Post
My preceptor doesn't carry episiotomy scissors in her birth bag. I don't plan on including them in my birth bag either when I am done apprenticing.
Mine didn't either, and used her cord (or suturing?) scissors for that, her one and only episitomy. After having to use scissors that weren't as sharp as scissors for skin should be, she considered carrying epis. scissors.
 
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