Episiotomy or tear ?

[reAllytee]

Hi im curious about this & was wondering what everyones thoughts & experiences were/ are.
I was always told by friends & family that if i was offered the cut to take it as it was better than tearing now im not sure whether its true or not just thought i get everyone to talk about it.
I tore quite badly internally also so i doubt the cut wouldve helped (?) but then again who knows they were just so desperate to get bubs out they didnt care i suppose & then again neither did i.
So please discuss
:)

[drewid]

Hiya

From my readings (not very extensive) a natural tear heals more easily than an episiotomy. So if its only small and not going to do any damage to front or back then generally let it tear. Episiotomies are more for emergencies sake really - if a tear is going too far forwards or backwards and is going to cause problems, then the doc/mid will intervene to help prevent too much damage.

Hope that makes sense. I always sort of saw it as like the whole caesar thing - its for emergencies.

I think some people say its better to be cut, cos you get numbed for it - but by the time you are at tearing point anyways, its all so stretched and naturally numbed already that you don't usually feel it.

Anyway I imagine there will be a few more knowledgeable people here to answer you properly shortly!!

Take care

[reAllytee]

Yes i understand its an emergency thing. Im just curious about it.
My aunty has had both & says the cut is better maybe due to the numbing (?) but i didnt feel a thing i know i had an epidural but i had started getting feeling back before they even turned it off ( my hospital turns the epi off before so you can push ) so it was all off an hour before they allowed me to push. But boy did i feel them stitching me back up OUCH !
Then i was in a room of 4 women to which there was one girl continuously complaining about how sore she was. Finally i heard one midwife ask whether she had stitches to which she said "oh no i only tore a little & it didnt need stitches" so me being all emotional at the time got rather angry & upset as i was torn so badly & in heaps of pain was ready to go over & strangle her. Now dont get me wrong i do understand everyone has it different & has different pain levels i was just rather angry. So now i just want to understand it some more.
:)

[DoulaFelicity]

Hi allyoo,

Evidence shows that episiotomies do not heal better than a natural tear; they may go on to tear further along the cut line (causing the very injuries they are supposedly designed to prevent, or making worse injuries where none may have occurred in the first place if left alone), and there is very rarely any genuine medical "need" for someone to cut through the muscle and tissue of your perineum during birth (obviously there are (very) few exceptions, and in those few cases, episiotomies may be necessary). Many episiotomies are done because Obstetricians feel unable to, or afraid of, "delivering" a baby over an intact perineum. They can also be cut in a misguided attempt to "speed up" labour, or simply because they are routine - "we've always done it this way, we don't know why, it's just routine".

An episiotomy involves cutting through the muscle and tissue of your perineum with a large pair of scissors after an injection of local anaesthetic (or without anaesthetic when the head is crowning as you will be numb from the stretching anyway - which leads one to wonder why cut when the baby is on its way out on its own at the time...but I digress). It is a guaranteed second to third degree tear. Compare this to the fact that, when birthing in an active labour position (ie: squatting, standing, on all fours - anything upright and off your back!), with good perineal support and when allowed to just follow your body's cues (no coached pushing, intervention or "hurrying along" by outside influences), tearing is actually unlikely anyway. And, if it does occur, it will more than likely be totally painless.

I had an unmedicated, active labour, and sustained a second degree tear with internal grazing that I didn't feel at all (I was proudly proclaiming I hadn't torn because my vagina felt great after my babe slid out...I was shocked when told that I had torn...no pain whatsoever. The nerves were numb due to the immense stretching my body had naturally done.) - the tear happened because, when my babe began to crown, I got impatient and shoved (different to just allowing your body to push the babe out) really hard and got him out in one go...not enough time to allow my vagina and perineum to gently stretch...next time I'll know better. My recovery was for the most part painless. A bit tender (mostly just a tight feeling from the stitches when I sat down) for a few days, no big deal.

You might like to read "The Thinking Woman's Guide to a Better Birth" by Henci Goer, which contains up-to-date information (including unbiased "Pros and Cons") in regard to every medical intervention in birth you could imagine.

Some informative links you might like to check out for more information:-

http://www.gentlebirth.org/archives/perinealProtection.html (this link contains heaps more links within it that are all related to perineal tearing versus episiotomy - a must read site)

http://www.efn.org/~djz/birth/obmyth/epis.html

http://www.washingtonpost.com/wp-dyn/content/article/2005/05/03/AR2005050301206.html

http://www.changesurfer.com/Hlth/episiotomy.html

...there's so much information out there, those are just a few sites.

An epidural may increase the risk of your perineum being cut by your Ob, as you may be unable to push if the epidural is still active in second stage labour, and so an instrumental delivery (forceps, ventouse) may occur - for which an episiotomy would be cut.

The "being cut is better than tearing" belief has been proven to be an outdated myth. Why cut into your vagina, when there are ways to care for it during birth to avoid any mutilation or injury - or at the very least, minimalise it?

[reAllytee]

Thanks Felicity !
I was just curious as i thought well wouldnt they be along the same lines due to the fact either way you would need to be stitched up ? So in some ways yes but otherwise they seem to cause more probs as you said & i never got the reason it was done either. Id always avoided the subject as it petrified me.
I was in shock when they told me id need to be stitched cause i was all like wow that was good i didnt even tear with all that pushing nor did they have to cut me for the ventouse HAH silly me ! And boy was i glad my body did numb it all ! And im glad i was allowed to tear when it comes down to it when i received a third degree & internal tearing cause gawd knows what wouldve happened otherwise.

[xkwzit]

Hi Allyoo
I can only tell you of my experiences. With DD1, I had an episiotomy because right at the end my OB was worried that I would tear around the front. I could feel extreme burning so I said "go for it". I didn't feel the cut (and like you, my epi had been turned down). Also like you I could feel the stitching afterward (even though they had turned the epi back on?). I didn't have any serious discomfort as it healed up (although I had a bit of excess tissue after it had healed up that I had to have removed - which I guess could happen to a healing tear too :confused: ).

Before DD2 I asked a physio her opinion (I happened to be chatting to her about labour pain etc at the time). She'd had 3 children, two episitomies and one tear. Her experience was that the tear was more painful and took longer to heal. When I was having DD2, OB said, "shall we try to avoid stitches?" I said "that'd be great, but I REALLY don't want to tear". (there was some puckering around the original scar) So he cut, again no serious discomfort during the healing of the episiotomy and I didn't feel a thing as this time they let me push with the epi running :D .

My episiotomies were due only to the "risk" of tearing (which was in my mind undesirable), not to speed up or allow other forceps / ventouse interventions.

Cheers

[Imogensmum]

Hi,

I had 3rd degree tearing- and it really didn't hurt like i thought it would!! I had a very quick birth and so my body didn't prepare as well as i would have hoped!

I had quite a few stitches and didn't find them painful- just uncomfortable the next day! I used ice packs to numb the area- brilliant, i recommend this.

I don't think i would have gone the episotimy(sp??) as i was told it can take longer to heal and the scarring is more pronounced! I don't know how true that is- each Dr has a different opinion!

I had a check up at 2wks- 6weeks and will have a ultrasound to check the muscles at 8 mths! And so far no real problems!

Hope my ramble helped you somewhat!

I think either way there will be discomfort- and if an epi stops you from getting a larger tear than necessary go for it.

[LittleBoysRock]

I had an episotomy and an internal tear...

Bub was big (9lb 4oz) and was a failed vaccum, forceps delievery so I had no choice but to be cut. I wasnt even told they were doing it.

The healing took about 6 weeks and is still tender when having sex or sitting on anything too hard.

The healing of the epistomy was horrible and has put me off another natural birth.... I will see how I go next time but might be looking at a caesar.

[DoulaFelicity]

I had an episotomy and an internal tear...

Bub was big (9lb 4oz) and was a failed vaccum, forceps delievery so I had no choice but to be cut. I wasnt even told they were doing it.

The healing took about 6 weeks and is still tender when having sex or sitting on anything too hard.

The healing of the epistomy was horrible and has put me off another natural birth.... I will see how I go next time but might be looking at a caesar.

Monyfelix, I am so sorry to hear that they didn't even ask your consent to perform this procedure on you! :eek:

I do know of a few support networks that could help you work through your experience, if you felt that was something you would like to explore. Feel free to PM me if you'd like any details. :)

[reAllytee]

Wow !
Yet again it seems that it comes down to the mum !
Monyfelix - Im sorry to hear you have been put off another natural childbirth but then i was also, in that i didnt want anything near my vagina for so long ! sorry for TMI ! but i did want more kids !!!! But now i dont really care what happens i just want more !!!! heheheheheh
US WOMEN ROCK !!!!
Hahaha & they say men are the stronger sex PFFFFFFT !!!!!
I think we should get medals or something each time we give birth i mean common seriously !!!!!!!!! ;)

[xkwzit]

Hi Allyoo

That's what I thought too. I've given BIRTH - I can do ANYTHING :D .

Cheers

[annsam]

If you have to have either, go for a tear, it heals better, it heals faster and if the episiotomy is cut wrong it can tear to your bum. There should be very little reason why you have to have an episiotomy as your body is designed to stretch or tear if required. The only reason episiotomy was ever done was so medical staff could get foreceps in there of which there.

[xkwzit]

Tears can also tear to your rectum ... this happened to a woman I know.

In the end, you've just got to decide what is right for yourself, having armed yourself with all the knowledge you can get and knowing all the risks associated with each option. There's no right or wrong answers here :D.

Cheers

[DoulaFelicity]

Natural tearing is directly related to things such as the position in which the labouring woman is pushing (ie: sitting or lying down reduces the width of the pelvis and restricts blood flow to the perineum, which prevents stretchiness and contributes to tearing), the length of time in which her babe is born (ie: a rapid crowning can be slowed down with the appropriate techniques), coached pushing (pushing against your body's cues, or being told when to push because you can't feel it yourself), etc.

Knowledge is power - when you know the things that contribute towards tearing, you can do all in your power to prevent them from occurring. The likelihood of tearing at all (let alone a severe tear) is then greatly reduced. (I know exactly why I tore, and it was my own doing. :rolleyes: Impatient, silly me. I got sick of waiting for my babe to come out, scared by the sensation of him going back up inside me a little in between each push - so I pushed against my body's cues and I ignored the midwife who was trying to help me slow it down - result? Very quickly pushed out baby, and second degree tear. :D I know more for next time...)

I also know a woman who tore to her rectum (4th degree tear) with her first birth, due to labouring on her back and coached pushing - the tear had to be repaired under general anaesthetic in surgery. She was told she could not have anymore vaginal births, or she would tear worse, and need a colostomy bag. She did lots of research and found that tears were linked to the reasons above...anyway, short story long ;), she went on to birth her second child with a second degree tear and is jussstttt fine. :D

[reAllytee]

Wow thanks DF guess im going to have to find a great midwife who will be willing to help me out next time & give me another vb as i cant say a cesaer was something i was looking forward to next bub unless completely necessary.
As im a wuss & hate the unknown see as bad as things got for me (obviously nowhere near as bad as that lady) i now at least know what the pain is etc & what to expect.
Next bubs will definately be well researched before arrival !

[mel]

i was terrified of being cut, i had visions of yelling "keep those chicken scissors away from me!" at the dr :D i ended up with a 1st degree tear and some internal grazing, but i had no idea, i asked did she cut me? there was so much burning i didnt notice the tear. thankfully the area was numbed before the stiching, but i'm glad there was no cutting...

[Sarie]

From what I've heard the tear will heal better.
I tore with my first but not with number 2 even though his head was bigger.