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Blehhh I want to vomit at the thought of it. Can you lovely ladies give me facts as to why I don't want it? I've had this discussion with my mom, who is a nurse, and she things I'm ridiculous for not wanting circ and not wanting an episiotomy. <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/gloomy.gif" style="border:0px solid;" title="Gloomy">: Think what you want, but keep it in your thoughts please and don't bash her in this thread.<br><br>
I know my facts forward and backward regarding circ, but not episiotomies. Why is tearing better than episiotomies? I know I don't want to be cut but I need to be able to defend it. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/irked.gif" style="border:0px solid;" title="irked">:
 

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From what I have read, most tearing would be superficial and if one were to liken the tissue with wood, natural tearing would go along the grain which would thereby make for easier and faster healing. Episiotomies, i believe require a deeper cut and could worsen the tear. I have heard a lot of cases of episiotomies progressing to a bigger tear all the way to the sphincter.<br>
My personal experience- no episiotomy and the doc was really patient massaging my perineum when baby was crowning. Midwife and doula were also really good at applying counter pressure down there. I pushed for about 25 minutes to deliver an 8lb 9oz baby and tore less than an inch. The doc said it didn't need stitches but proceeded to stitch me up anyway, 'for support", he said. It took only one stitch. I did get impatient with the pushing. I believe in my heart that if I had waited only for a little bit, maybe 5minutes more, I wouldn't have torn at all. But with that said, I'm happy with no episiotomy and getting only one stitch. I've never heard of an episiotomy requiring only one stitch.
 

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because you may never tear if you are allowed to strech and not told to push, but pushed naturally, also compression and positiong can help prevent tears.<br><br>
Also, tears only make as much as they need, and sometimes arnt very deep. A cut is through many layers, and doesnt break as easily, so it heals mismatched.<br><br>
I had a second degree tear, but I had no perenial pressure, and ds's head delivered fast, with a nuchal hand. I was also in the lithomy position because of an epi. But it healed fast, even with stitches, and you would barely know I ever had a tear.
 

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I've read this in several places:<br><br>
If you try to tear a piece of cloth and it won't tear, cut a very small slit in it and try to tear it again. You will find that it will split right down the middle now. The same is true with episiotomy... if you start by cutting, it's easier for it to continue to split.<br><br>
Also, I did read what pp wrote about tearing being superficial and not as deep and into the muscle as an episiotomy.<br><br>
If you do "HAVE" to have one for whatever reason... I've read that it's better if they do it diagonally rather than straight down because that decreases the chances that you will tear into the anal muscles.<br><br>
Misconceptions by Naomi Woolf talks some about this I believe.... and I think it's also in The Birth Book by Dr. Sears. If I'm not mistaken, the cloth analogy (or maybe it was with paper) was first given by the famous midwife Ina May Gaskin who I know has some books as well (but I've not read any of them yet.)<br><br>
ETA- I tore pretty badly and I think it was 4-5 stitches, but healed VERY quickly and was able to sit comfortably within 3-4 days.<br><br>
'Manda
 

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Tonsillectomy... why not? <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/loveeyes.gif" style="border:0px solid;" title="Loveeyes">:
 

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<div>Originally Posted by <strong>pixiesmommy</strong> <a href="/community/forum/post/7976588"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">ETA- I tore pretty badly and I think it was 4-5 stitches, but healed VERY quickly and was able to sit comfortably within 3-4 days.</div>
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yeah, i had 4 stitches and i didnt have a problem walking or sitting 2 days after ds was born. I was walking around the mall with no problems and minimal discomfort.
 

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Where I work we have a 1% rate of episiotomy and most of those are for forceps deliveries. Most of the OBs dont do routine episiotomies even for ventouse or forceps now. Its very very rare that (other than instrumental delivery) that an epis is needed:<br><br>
-it does NOT prevent or reduce the likelihood of 3rd degree tears<br>
-it is NOT recommended for previous 3rd or 4th degree tears<br>
-it is no longer recommended routinely for breech or shoulder dystocia<br><br><br>
The few times it might be considered is: severe fetal distress where epis will speed up delivery; extreme delay with crowning. There are no other good reasons according to the research and the OBs where I work.
 

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<div>Originally Posted by <strong>fishface</strong> <a href="/community/forum/post/7976290"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I know I don't want to be cut but I need to be able to defend it. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/irked.gif" style="border:0px solid;" title="irked">:</div>
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No, you don't. You should NEVER need to defend your right to your body's integrity. The default position should always be that healthy people do not have surgery, do not get cut.<br><br>
The question here is not "why not have an episiotomy?" The proper questions are, "is episiotomy ever necessary? In what situations? What are the actual benefits in those situations?"<br><br>
Honestly, I have not yet heard of a single good, medically-necessary reason for episiotomy with empirical data to back it up.<br><br>
Don't defend yourself to the cutters. Turn the question around on them and tell them that if they're so hot to slice your body, THEY need to provide you with solid evidence that their procedure will benefit you and/or your baby. If they can't prove that (with FACTS, not stories), then you do not consent to what, in the absense of medical need, amounts to genital mutilation.
 

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added to all the other words of wisdom, an episiotomy is more likely to re-tear with subsequent births because it's a straight line but a spontaneous tear is jagged and, therfore, more sturdy after it's sewn up.
 

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Best analogy I've ever heard compares it to cutting a piece of fabric a bit, once you cut it, it will likely tear further so much more easily than it it was intact.<br><br>
Most tears are 2nd degree or less, and episiotomy as automatically a 3rd degree tear, and that's if you don't tear further!
 

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If you birth naturally and take measures to avoid tearing, you are likely to come out of it with an intact perineum, and if you do tear it will likely be superficial, through the skin only. Episiotomy always cuts through muscle and <i>guarantees</i> trauma to your genital area.<br><br>
Jagged tears heal together easier and faster, the sides can be more properly matched up when stitching (like fitting together the pieces of a puzzle,) and the resulting scar tissue is stronger, than if you start with a straight, clean cut. This has been long known in medicine, but surgeons like using scalpels which they can control precisely and which take less effort for them to suture together, and some still believe that episiotomy protects the pelvic floor because (as the theory goes) it does not have to stretch as much to birth the baby when an episiotomy is given. But then again many surgeons are simply trained technicians and not scientists nor critical thinkers. In fact, the human body is <i>made</i> to stretch, and those tissue fibers are extremely resilient when the right hormones are not prevented from making their way there.<br><br>
If you tear, it will be along natural stress lines and the body will self-minimize the damage. If you are cut, there is no telling how far the cut will extend, and for many women it extends into the rectum and cause further medical issues like incontinence and pain with defecation. Some women end up needing further surgery to deal with the extent of the damage.<br><br>
The cloth analogy is apt because the tissue surrounding the vagina is formed by an interweaving of fibers exactly like with cloth. As someone mentioned, you can do a simple experiment that shows how ill-thought out the pro-episiotomy argument is: take a piece of fabric and attempt to tear it in two. Nearly impossible isn't it? Now make a small snip with a sharp scissors and see how incredibly easy it is to separate the fabric into two pieces. If the fabric happens to have already begun to unravel or has been torn by getting snagged on something, it's still going to be difficult to tear further, because the tear will be jagged.<br><br>
So how do you minimize tearing? Well, stay away from things that will affect your tissue integrity adversely:<br><br>
-cold, dry air<br>
-feeling of being observed or self-conscious (causes tension in tissues)<br>
-hands on your tissues that are not your own (causes tension in tissues)<br>
-directed and forced pushing<br>
-pushing too soon (i.e. as soon as dilation as complete and before body begins spontaneously "throwing down")<br>
-pushing with unequal pressure applied by baby's head around outlet (which is one reason vertical positions are better)<br>
-an environment that interferes with normal hormonal release that affects flexibility and lubrication of tissues (i.e. lights, conversation, orders, eye contact, inhibition, etc.)
 

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My experience with both...<br><br>
DD#1 Episiotomy & a Tear - The part that tore seemed to hurt worse initially (tore into the urethra) but it healed much faster than the epi, the epi caused sex to be painful for over 6 months.<br><br>
DD#2 Small tear into the vaginal canal (forced pushing cuz OB was scared of shoulder dys., cuz of my first birth) only required a couple stitches & wasn't much of a recovery from it.
 

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The risks of routine episiotomies outweigh the benefits. Research has shown this a lot.<br><br>
Here is the link to the Cochrane review on the topic, if your mom is a nurse she should know that te Cochrane collaboration upholds the "gold standard" of meta analysis.<br><br><a href="http://www.cochrane.org/reviews/en/ab000081.html" target="_blank">http://www.cochrane.org/reviews/en/ab000081.html</a><br><div style="margin:20px;margin-top:5px;">
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Six studies were included. In the routine episiotomy group, 72.7% (1752/2409) of women had episiotomies, while the rate in the restrictive episiotomy group was 27.6% (673/2441). Compared with routine use, restrictive episiotomy involved less posterior perineal trauma (relative risk 0.88, 95% confidence interval 0.84 to 0.92), less suturing (relative risk 0.74, 95% confidence interval 0.71 to 0.77) and fewer healing complications (relative risk 0.69, 95% confidence interval 0.56 to 0.85). Restrictive episiotomy was associated with more anterior perineal trauma (relative risk 1.79, 95% 1.55 to 2.07). There was no difference in severe vaginal or perineal trauma (relative risk 1.11, 95% confidence interval 0.83 to 1.50); dyspareunia (relative risk 1.02, 95% confidence interval 0.90 to 1.16); urinary incontinence (relative risk 0.98, 95% confidence interval 0.79 to 1.20) or several pain measures. Results for restrictive versus routine mediolateral versus midline episiotomy were similar to the overall comparison.<br><br><br>
Authors' conclusions<br><b>Restrictive episiotomy policies appear to have a number of benefits compared to routine episiotomy policies.</b> There is less posterior perineal trauma, less suturing and fewer complications, no difference for most pain measures and severe vaginal or perineal trauma, but there was an increased risk of anterior perineal trauma with restrictive episiotomy.</td>
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If she still thinks you're nuts tell her that the burden of proof of advantages to episiotomies is on her.
 

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Discussion Starter #15
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">No, you don't. You should NEVER need to defend your right to your body's integrity.</td>
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Yes, I do. I know it's my body, my choice but you don't educate people on the dangers of such a decision but simply saying "my body, my choice". Same with circ. Yes it is his body, his choice but leaving it at that leaves no one the wiser.<br><br>
Thanks everyone for your answers. It never occured to me that while a baby's head won't rip through muscle, a pair of scissors surely will. After learning about the muscles of the pelvic floor in anatomy, I can see how that would cause huge and potentially permanent problems with healing. Good lord, the whole idea of being cut still has me gagging. The thought of tearing isn't pleasant but doesn't have that same tingly jaw feeling. :-(
 

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Here's why not:<br><br>
Because humankind made it this far without them. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/winky.gif" style="border:0px solid;" title="Wink">
 

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I think everyone has covered it well. I will say that my mother had an epi with me and said she never felt comfortable peeing again. When I was in college and a good friend was pregnant, I told her that and she ended up with an epi, and she later said the same thing.<br><br>
I think that in this day and age, epis are THANKFULLY becoming more rare. Even at my local hospital, where the c-s rate is incredibly high, if you manage to get lucky enough to have a vaginal birth, I've only seen one epi.
 

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<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
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<div>Originally Posted by <strong>grumpybear</strong> <a href="/community/forum/post/7976555"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">From what I have read, most tearing would be superficial and if one were to liken the tissue with wood, natural tearing would go along the grain which would thereby make for easier and faster healing. Episiotomies, i believe require a deeper cut and could worsen the tear. I have heard a lot of cases of episiotomies progressing to a bigger tear all the way to the sphincter.<br>
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yeah, that. it happened to me. i got to spend a few minutes cuddling my new baby before being rushed off to surgery to repair the damage (it was that bad), and he was a couple hours old before i got the chance to breastfeed. it still breaks my heart to think about<br><br>
it also caused DH some post-traumatic stress. he had nightmares about the sound of me being cut for the longest time ~ it really traumatised him
 

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Don't docs read the research? My dh is a family doctor who's delivered hundreds of babies, and he could name on one hand the number of times he's done an epi--most of them being in residency. What's the point of doing one? If things aren't big enough you will tear just the amount you need to get the baby out. The tissue down there isn't too tough to tear. And, how would they know before they cut the epi whether or not you would tear? There are no proven benefits to doing one, and research points to lots of reasons not to. IMO they're ridiculous. I pushed for two hours and had a second degree tear. Did they give me an epi to get the baby out quicker? No way! And I'm sure an epi would've been a lot worse. My mom tore badly with her babies (old-time doc gave her an epi) and she had fourth degree tears. Her babies were all smaller than mine too. Don't know if that tells you anything, but just thought I'd throw it out there.
 

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Wow, these girls sure know their stuff!! Nicely done!<br><br>
I had an episiotomy & tore w/ my first. Ended up a partial 3rd degree. It took 6 mos before sex wasn't painful every time. I cried a lot! And sitting down? Forget it. I reclined & laid down as often as I could. I tore only a little bit w/ my 2nd and didn't even need a stitch. I was fine in 3 days.<br><br>
I will only add this:<br><br>
SCISSORS. VAGINA. PAIN. BAD.<br><br>
That's all. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol">
 
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