View Full Version : Will I Need an Episiotomy?
I don't want one, I'd prefer to tear naturally, or not at all, rather than being sliced on a chance that I might.. or something.
But in what circumstance will I -NEED- an episiotomy? if at all.
Why are they used, is it just to reduce the risk of a natural tear?
Can someone help me out here :)
nemosmum
02-06-2006, 10:35
ok from memory you have an episiotomy if you have already had a natural tear and are in danger of tearing too far iykwim
I had a natural tear during labour and to stop it from tearing too far up my butt (sorry TMI:o ) my doctor gave me an episi.
I didnt feel anything while they did it OR afterwards, I had no problems with my stitches whatsoever and I had heard some horror stories so I guess i was lucky!
oo I see. See I'm glad I asked because I thought it was like "Right, let's give you a cut here because baby's head is big"
I had noooo idea what they really are for. I have a feeling that we're going to be going through my birth preferences at the appointment today so I thought before I tick or cross a box...
I still don't know what I want tho'
I had to have an episiotmy as they had to vaccuum extract DD2. An episiotmy is much better than tearing naturally as it is a straight cut, rather than tearing jaggedly. They give you an anasthetic in your nether region so you don't feel it that much - especially not after what you've already been going through:D
With DD1 she came out easily, no tear at all, but DD2 needed more head room:banghead: !!
If you do need one, get a haemmoroid ring to sit on for the follow couple of wks, as sitting normally will be a challenge. Washing the area with salty water helps it to heal.
I had major haemmoroids aswell so I didn't really notice the stitches that much!
I had to have an episiotmy as they had to vaccuum extract DD2.
Yup same for me, except I didnt have an epidural so I felt everything :( (I know you dont want to hear this Seekrit!). But they had to get DS out as his heart beat was dropping and he was distressed.
Good luck with it all, you will be fine! :D
the_queen
02-06-2006, 10:53
Unfortunately, whether or not you will "need" an episiotomy depends on your care provider. It also depends on how you've laboured in the first stage.
An episiotomy is a cut through skin, tissue and muscle - it is NOT better than tearing naturally. A natural tear may well end up being "jagged" but it also may well end up being on through the skin and tissue. Basically your perineum needs to stretch, and if it stretches too quickly you may tear. Being tense will also increase the risk that you may tear. Having had an episiotomy previously does NOT mean you must have one next time. I had a quite brutal episiotomy with my first child, but didn't even tear with my second :thumbsup:
With Vallerie I was induced, had internal monitoring and spent the whole time on my back. I was under the care of a hospital MW who basically gave me one without asking first. She (Vally) weighed 3.5 kgs, and her head circumference was 37cm.
With Curtis, I actively laboured at home for the first stage, I was upright most of the time (which enables gravity to help everything along) and I used water (hot showers) during the first stage as well. I didn't tear at all while pushing him out, I was only "grazed" which basically means my skin stretched a lot but didn't tear. He weighed 4.1kgs and had a head circumference of 38cm. Baby's size does not determine whether you'll need an episiotomy or not.
My advice?? Do lots of perineum massage now, during first stage of labour stay upright and relaxed (well, as relaxed as possible!!;) ) have hot flannels held against your perineum while you're pushing (this can also discreetly deal with any poo problems!!) and be as upright as possible whilst pushing.
ETA: You will need one if an instrumental delivery is required - but hopefully that won't be necessary for you.
I had to have an episiotmy as they had to vaccuum extract DD2. An episiotmy is much better than tearing naturally as it is a straight cut, rather than tearing jaggedly. They give you an anasthetic in your nether region so you don't feel it that much - especially not after what you've already been going through:D
Actually a natural tear heals better and stronger than an episiotomy.....
With subsequent kiddies you are more likely to tear along a previous epi than a previous natural tear....
But they do have there time and place, like emergency procedures, vacuum & forceps....
nemosmum
02-06-2006, 11:00
Great info Queen:thumbsup:
And yes I too was induced and had a fast, stressful (on my back) labour which obviously contributed to me tearing and my episi.
Actually a natural tear heals better and stronger than an episiotomy.....
I've been told that too!
Keep the advice coming. Queenie, thank you for sharing your experiences and advice, I'm planning on labouring for a while at home before heading to the hospie and they seem to advocate active labouring over there too! :thumbsup:
~Emmylou~
02-06-2006, 12:19
I had a vac extraction with DD and they did not do an episiotomy.
I tore a tiny bit, healed beautifully in no time.
I had a 2nd degree tear, I felt so much better knowing it was unavoidable rather than a middy going a bit too deep with the scalpel... plus I knew tears heal better.
It seems shocking to me that they're sometimes done without your express consent, so well worth putting it in your birth plan if you feel strongly about it.
When you get home its helpful to have a jug of warm water to pour on your stitches as wee can make them sting.... actually those green jugs with a long spout you use for watering houseplants are good, but hopefully you'll be OK! :fingerscrossed:
aprilbaby
02-06-2006, 12:42
I had an episidomy becasue I was tearing and my OB did it to stop me tearing further, towards the bum. I think the idea is to send the tear in a different direction so you don't get 3rd degree tears into your anus, which can cause long term problems.
She told me she was going to do it and it's true you don't feel it, so don't worry about that. She stiched me up very slowly and neatly and it's healed very well.
Just to add, I get a bit frustrated when I hear people say that if you do 'everything right' (eg. natural active labour, panting while pushing etc) during labour you shouldn't need an ep. I don't really think you have any control over it and you can do all the massage and panting in the world and if your perineam doesn't stretch it doesn't stretch. i had an hour and a half long labour and that wasn't enough time for anything to stretch! My DH could see when the head was crowning the perineam was so tight it kept sucking it back in again. And you will find no matter how many people tell you not to push at a certain time, if you body wants to push it's nearly impossible not to.
So, the moral of the story is, IMO don't worry too much either way. No OB will give you and ep unless you really need one and if stiched properly it is not that big a deal.
Its funny.... you tend to find that if your in midwife based care they tend to do epis less often.....
But ob's... they love to cut!!!
misskittyfantastico
02-06-2006, 13:03
Yup same for me, except I didnt have an epidural so I felt everything :( (I know you dont want to hear this Seekrit!). But they had to get DS out as his heart beat was dropping and he was distressed.
Good luck with it all, you will be fine! :D
this is pretty much what happened with me.... I was induced also and labour only took four hours. I felt the "nick" but I healed really well - no dramas at all.
Hi ladies,
I was given this info recently during a course that I completed, so thought I might share....
The most respected source for info about evidence-based care for the mum in labour is the Cochrane Library which is a register of controlled studies and systematic reviews.......These studies and reviews are summarised and analysed in the book "A guide to effective care in pregnancy in childbirth" by Murray Enkin, et al. (This whole book is actually available online at http://www.childbirthconnection.org/home.asp?Visitor=Woman )
Anyway they categorise all the common procedures, treatments and interventions into one of 6 types.....
1. Beneficial...demonstrated by clear evidence
2. Likely to be Beneficial...evidence in favour of these forms of care is strong
3. Trade-offs (some beneficial, some adverse effects)
4. Unknown effectiveness...insufficient or inadequate data upon which to base a recommendation
5. Unlikely to be beneficial...evidence against these forms of care is not as firmly established as for those in category 6
6. Ineffective or Harmful..demonstrated by clear evidence
Liberal or routine episiotomies are a category 6, so, based on clear evidence, they are ineffective or harmful.
So, unless it is ABSOLUTELY necessary (and in some cases they are) episiotomies simply should not be performed......:thumbsdown:
The good news is that there are things you can do to give your perineum a head-start so to speak:thumbsup: .......check out this site for more info and things you can do to try and protect yourself from tearing.....
http://www.gentlebirth.org/archives/perinealProtection.html
PS....Does anyone want to know the categories for any of the other procedures?
Mischief
02-06-2006, 13:54
I had to have an episiotomy (they cut right up and then veared off around my butt..sorry if TMI). I had an emergency ventouse delivery and they gave me a cut to help deliver Oliver faster.
Episiotomy are not routinely done now days....I didnt want one but needs must....
My stitches healed fine (I think..go to the Dr tomorrow) but it was a challenge sitting for a while....I spent alot of time on my tummy...as I was told laying on my back and sitting were bad for the stitches. After a week they felt much better.
Try not to worry about it to much. If you need one, it will probably be the last thing you care about at the time....most likely you wont need one though! :)
LittleBoysRock
02-06-2006, 14:00
I had an episotomy as I had a failed vaccum forceps delivery with DS. I also tore but DS was a big boy, almost too big for my pelvis. Most hospitals will let you tear rather than cut you these days. Their reasoning is that they might cut you more than is needed whereas if you tear you body will only tear as far as it needs too.
In the end an episotomy is not nice to recover from but it is worth it for the baby. I would do my whole labour over for DS. There is no way you can plan for this, I would never has chossen an epi but didnt get a choice.
Goodluck, I hope you have a great labour. :thumbsup:
Tea Lady
02-06-2006, 14:02
I had to have one because after pushing for 2hrs DD wasn't coming out because she thought she was superbaby and had her hand up next to her ear. Her heart rate started dropping so they wanted her out fast. Problem was that the epi turned into a very nasty 3rd degree tear :eek: I would suggest saying you don't want one as a routine thing, and then at least you know they'll only do it if they really need to. Like Kitkat said - you won't worry too much at the time! :)
I think Tea Lady has great advice - go in telling them you don't want one unless necessary so if you do have one it should be for a good reason.
I had one with DD1 - failed vacuum forceps delivery after being stuck in second stage for 4 hours. DH asked how many stitches were going in and the OB kindly said "oh we don't count them" as he kept stitching away and stitching away! With DD2 I tore slightly ( after a 2 hour labour with no time for anything to prepare) but tore next to the previous scar and both have healed with no problems.
I had an emergency vacuum delivery but no epi - I specifically asked not to have one if at all possible and the Dr said she'd just see how it went.
Had a second degree tear and a small graze but it healed in no time and I honestly didn't have any pain from the stitches.
Woo!
Thank you for all your advice! We did the birth preferences today and I spoke with the midwife about the episi and she explained when it might be needed (and said "most people don't care because it's for the well being of their baby" which I 100% agree with)
She said they weren't done routinely but suggested I don't tick the box.. because if I ticked the box it means - go for it. But if I leave it blank they'll ask me first (if it's not a saftey issue)
:smiliedance:
Thank you!
PS....Does anyone want to know the categories for any of the other procedures?
That's really interesting, can you post them up please, maybe on a different thread as I don't want to hijack!? I'm totally fascinated by all this stuff :yes:
:yes: Sure thing Bessie....I will add another post in this section.
Cheers
Tracie
reAllytee
02-06-2006, 23:21
I had a vacuum delivery with no epi either but in their desperation to get Boof out they didnt care what happened at that stage i dont think. He wouldnt budge after he crowned & was stuck this way for some time then when they got his head out they couldnt get his shoulders out so yeah it went from bad to worse but im glad they didnt cut me as i dread to think of what could have been as i had a 3rd degree with internal tearing & grazing.
I had en episiotomy cos bubby's head and my bits were not agreeing, as other people have said its way easier to stich up a cut than a jagged tear, I felt the needle to numb the area but compared to everything else that was going on, so not an issue. I didnt take any pain killers for the pain and didnt find the stitches a problem. Taking salt baths (just sit your bum and bits in) helped to heal it all up quick. I asked the midwife when I booked in if I would need another one with bub #2 and she sais it depends I might be more stretchy this time, also it depends on your ob. some are way more likely to cut than not. My auntie was alowed to tear (her choice) as she didnt want to be cut. I thought I wouldnt want to be cutbut didnt really get a say. I would be happy for another one though If I had to.:D
DS was born at 38 1/2 weeks (Gestationial Diabetes) but he was still almost too large to come out. he had a head circumference of 39cm so i had to have an episiotomy and have him delivered with the vacuum or else i would have had to go into emergency surgery to have a c-section.
i am a sook for pain but for some reason i didnt feel the needle that they gave me to numb it before they stitched and i didnt feel the stitches being made either. must of been still high on the gas and pethidine.
i cant remember if i was asked to be cut but i would rather that then have had a c-section or teared naturally.
my stitches hurt a little afterwards but were more uncomfortable than anything else. i even resumed having sex before the stitches were completely healed (probably a dumb thing to do but they didnt hurt)
cheezelkat
03-06-2006, 14:31
I didn't have an epi, and I only sustained a coupe of first degree tears but when they were examining me to see if I needed stitches I was blabbering about how I had just birthed a baby and there was no way in hell anyone was going to do anything down there anymore :laughing: Luckily I didn't need them!
When birthing the baby, if you have a good midwife who instructs you when to breathe, when to push and when to hold and follow his/her instructions - the chances of tearing are a lot less anyway so I vote to leave the box blank too.
Goosie22
03-06-2006, 14:55
Hi,
Episi's are not better than a natural tear, cutting an episi will damage your Pelvic Floor (http://www.childbirthconnection.org/article.asp?ck=10203&ClickedLink=282&area=27). There are times when it is required by the OB but a natural tear is usually not through muscle and an episi is. If you click on the link you will see some diagrams and explainations.
I would leave the box blank and be active during your labour.
iluvmeboyz
03-06-2006, 15:05
i did'nt have one but i only had torn with caleb and bailey so i dont know what it would be like.
I"m of the thought that I'd prefer to tear and heal rather than be cut and heal. I do'nt give a fig about if they have to stitch me in a straight line and it's easier on them or not, I'm more interested on how it will be to heal for ME!
Thanks for your continued advice, however! I really do hope to be very active in labour! :D I certainly want to avoid an epidural (although... I wouldn't completely rule it out heh) so I hope to be moving a lot!!
Thanks for the scary link, goosie ;)
Goosie22
03-06-2006, 20:22
Thanks for the scary link, goosie ;)
:hugs: Sorry didnt mean to scare you, knowledge is power and all that!:(
:hugs: Sorry didnt mean to scare you, knowledge is power and all that!:(
:kiss: Everything scares me these days LOL
Yes, knowledge is power!
Bubble*Crazy
04-06-2006, 02:43
I had an episiotomy with DS as I suffered a 3rd degree tear with DD which took 4+ months to heal. This way, I wouldn't possibly be put thru the same again. And it's been perfect so far. I haven't had any pain at all from the cuts (had 2! :eek: ) - my after birth pains were far worse!
Preggie1
03-04-2008, 13:45
Does Kegel exercises helps to reduce the chances of epsiotomomy or do we need to do something more in addition to kegel exercises to reduce the chances?
Is there any lady who laboured naturally and didn't require episiotomy in her first delivery? If yes what helped to avoid epsiotomy?
The skin behind the vagina (perineum) can be massaged from, I think its 35 weeks pregnant. I had 2 episiotomys with my first 2, and my second 2 I did the massage thing and it worked for me.
I had 7pd 11oz, and 8pd babies for my 3rd and forth and not a tear/episiotomy, Thank God.
Give that a go as well as the exercise.
[quote=gremily;378944]If you do need one, get a haemmoroid ring to sit on for the follow couple of wks, as sitting normally will be a challenge. Washing the area with salty water helps it to heal.quote]
I didn't tear or have an episiotomy just grazing with DS. He came out all in one very easily with no drugs and it was challeging to sit lol so I dont think it matters either way. After child birth you are stiff, tender and sore tears, episiotomys, grazes, it doesnt matter.
GraceUnhearing
03-04-2008, 23:00
I didn't tear or have an episiotomy just grazing with DS. He came out all in one very easily with no drugs and it was challeging to sit lol so I dont think it matters either way. After child birth you are stiff, tender and sore tears, episiotomys, grazes, it doesnt matter.
having an episiotomy isnt not anything like not tearing!
hurts like hell for a very very long time!
not something i'd wish on my worst enemy.
GraceUnhearing
03-04-2008, 23:00
Also i saw this thread and though
What Seekrits preggas again?
how did i miss that?
hahaha
I had to look at it a second time when it popped up too don't worry :laughing:
:laughing:... I just read the first post, and started looking at previous posts by Seek for the last 10 minutes looking for the announcement... Shoulda read the last page first :p
GraceUnhearing
03-04-2008, 23:18
or maby there something shes not telling us?
haha
hello Seek?
having an episiotomy isnt not anything like not tearing!
hurts like hell for a very very long time!
not something i'd wish on my worst enemy.
I think like anything its different for different ppl. I have hear ppl say tearing was fine, other say it was the worst and the same with an episiotomy. Besides dont know if its true but I've also heard that grazes sting the worst espec when urinateing as they are everywhere. THats what my midwife said, and let me just say I was weeing and it felt like someone poured acid over me. I couldnt urinate without that feeling for about 3 wks and up until 5 wks I was still pouring a bottle of water over me. But I have also heard someone say grazes meh didnt hurt ever. So as I said it doesnt matter to me what happens to you, the aftermath of birth is not without its pains.
An episiotomy is very uncomfy. But onto the funny side of things. Did your midwife recommend filling a rubber glove and freezing it, then snapping the fingers off and putting them into your panties?? :laughing::laughing: helps the backside and the frontside :laughing::laughing:
Funkychicken
04-04-2008, 09:12
An episiotomy is very uncomfy. But onto the funny side of things. Did your midwife recommend filling a rubber glove and freezing it, then snapping the fingers off and putting them into your panties?? :laughing::laughing: helps the backside and the frontside :laughing::laughing:
Our midwife recommended using condoms for this very thing!
WorkingClassMum
04-04-2008, 10:52
An episiotomy is very uncomfy. But onto the funny side of things. Did your midwife recommend filling a rubber glove and freezing it, then snapping the fingers off and putting them into your panties?? helps the backside and the frontside
My middy wet a few tampons and froze them (ahhhh), and then did the same with a pad.
With DS I had an episi. but then had a 3cm Y tear that was 2nd :(and third degree :crying: due the vacuum etc and had a tapestry:laughing:
With DD I refused an epsi - had a much more active birth, and had used lots of olive oil and had a tinsy tiny tear and refused stitches
My middy wet a few tampons and froze them (ahhhh), and then did the same with a pad.
With DS I had an episi. but then had a 3cm Y tear that was 2nd :(and third degree :crying: due the vacuum etc and had a tapestry:laughing:
With DD I refused an epsi - had a much more active birth, and had used lots of olive oil and had a tinsy tiny tear and refused stitches
I also refused stitches for my grazes. My midwife said they normally stitch them because sometimes your labia can heal together if you dont clean enough. He made me promise to shower at least 4 times a day and said if I didnt I'd be sorry. So thats what I did, I was uber clean, took care of it and now it has healed fine. I will admitt sometimes I'm still tender as being with DH - TMI but I'm sure thats more from having a vaginal birth rather than my grazes.
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