Episiotomy Information

I think the general advice is not to have one - even if you tear, it's meant to heal quicker and there are less likely to be complications. I tore badly and it was uncomfortable for a few weeks - lots of stitches etc but healed well and I would rather go through that again than have an episiotomy.

Hi S.! You know, I think that there ae some Dr's. that still do this, but there are alot that do try to stay away from it if at all possible. I have been to alot of births. I am a labor doula. Most of my clients have not had to have episiotomies. The best thing about not having one, is that the soreness in the vagina area is not as bad. I had one with my first child, plus ripped and you know, I was so sore for so long. I did not have one with my other two, and I felt great after a couple days. There is alot of good things about not getting one. Have you talked to your Dr. about this? How far along are you? One great thing you can do to help so you can reduce the chances of you having to have one is perineal massage. You can do a google search to get more info on this and how to do it if you dont know, or also there are books that can help you. It really does work. It helps stretch that area out so when the time comes, it is easier for the baby to come out. If you have any more questions or need any help, let me know.

S. Bailey CLD
Aurora
www.tendermomentsdoula.com

If you have a good ob gyn, s/he will not do an epi unless absolutely necessary. Recent thinking is that the natural tearing, as long as it is no too bad, heals faster than the cut and is more sterile. With my 3rd child, my dr just massaged the area and coached me thru the pushing so that no tearing occurred at all--admittedly, it was my 2nd vaginal delivery (my middle child was a c-section) and the baby was pretty small, but just so you know, it is possible to deliver without tearing if your dr is good.

Ask your dr about it--how many epis has s/he performed, under what circumstances, what does s/he recommend as far as preparation you can do at home and during labor to minimize tearing? There are things you can do to get ready, and the dr should speak to you with confidence and reassurance. If s/he does not, dismisses your concerns, or tells you s/he does epis as a matter of course, you may want to consult a doula to help you make your concerns and desires clear, or find a more comforting dr.

Good luck! It is hard, but it is also a lot of fun (yes, it's true!) I found with all my deliveries that the rush of adrenaline and excitement I felt made the pain and hardship really worth it, and much more bearable than it would have been if I had been getting a giant, 7-pound tooth extracted or something.

Full disclosure: I also did the epidural thing with #1, and tried to with #3--she came fast enough that I did not get much benefit from it, but I have no regrets. I am not a person who thinks my womanhood rests on enduring suffering, so take my advice with a grain of salt if you lean towards so-called natural childbirth.

My midwife group (they are CNM's) thought it would be beneficial to massage the perinium (sorry, can't spell that!) area with cocoa butter starting early on in the pregnancy and that would make the skin there more supple and would stretch better. I would always forget though and only did it several times toward the very end.
They also massaged me there during birth. I have a pretty small frame and an 8lb 9oz baby and I barely tore at all. They would not even consider doing an episiotomy- they said you heal better from a tear and your body will naturally open to let the baby out.
I would say don't do it unless you have a complication. I hear it is VERY painful to heal from. I was comfortably healing from a tear in about a week and a half.
-Amanda

It is not common practice anymore. The American College of Obstetrics and Gynecology sets the practice guidelines for obstetricians and no longer recommends routine use of episiotomies. Here is a link to their policy http://www.acog.org/from_home/publications/press_releases... Here is an excerpt:

"Recent studies show that common indications for episiotomy were based on limited data. Additionally, there was a general underestimation of potential adverse consequences associated with the procedure, including extension to a third- or fourth-degree tear, anal sphincter dysfunction, and painful sex. Data suggest that women who have an episiotomy do not have significantly improved labor, delivery, and recovery compared with those who do not have one. Without sufficient data to develop evidence-based criteria for performing episiotomies, clinical judgment remains the best guide to determine when its use is warranted, according to ACOG."

The majority of serious (3rd and 4th degree- into the anus) tears occur as extensions of episiotomies. If you cut it is either too small and the mom will tear anyway, or it is too big and she didn't need the cut in the first place. Also, an episiotomy cuts through layers of skin and muscle, while most tears are superficial, skin only.

Also, when your skin tears it will tear along a naturally weak spot along a natural line. When you are cut the that doesn't happen.

I had second degree tears with both my babies. I didn't really feel the tearing and the healing was painless. I have witnessed some episiotomies and the healing and it has been much more difficult those without.

Definitely discuss this with your doctor beforehand. You will not be in a position to argue when the time comes and doctors generally do not ask your consent to perform the episiotomy. If your doctor tells you they will wait to see if you "need one" that should raise a red flag. Per the ACOG guidelines the only real indication is certain instances of fetal distress.

With proper help from your provider there is a good chance you will not tear at all. Slowing down your pushing when the head comes out to let the perineum stretch is a good way to avoid it. Good luck to you!

I had one done with my second child and I will say, the healling process was so much longer than with my first. With my first, they just let me tear, so to speak and I healed real quick, literally out taking long walks after 2 days, with the episiotomy, I had a hard time walking, sitting anything like that for at least a week.
M.

I had two children and two different docs from the same office delivered them. Neither doctor did one, and I was glad. I had read and they confirmed that if they cut you a bit, it's easier to tear further. They would only do them if it was necessary for the baby. A couple people I know who had them, ended up tearing after the cut to what they call 4th degree (ALL the way to the butt). Yes, they had big headed babies, but it can happen.

The analogy I was given is, try tearing fabric. It's pretty hard to do, but if you put even a small cut in the fabric, RIP! It's much easier to rip.

I had no problems healing after tearing. I tore 2nd degree with my first, and maybe two stitches worth with my second.

G-d no. Please do not get one under ANY circumstance. Its so much harder for you to heal afterward and every single one of my friend's who has had one has a horror story of being sewn up poorly and suffering with the after effects for months, even years. One of my friends who had one even to this day says sex is painful because he sewed her up badly from it and the outer area where the incision was made is still 4 years later raw feeling. For your best care, ask a midwife what to do. Doctors often do what's good for them and convenient not necessarily what is best for the mother and baby. If you need names I would be happy to share. You can go to a practice with midwives and doctors too if you're more comfortable with that.

I personally didn't have one because I ended up having a c-section but friends who did not have an episiotomy have told me horror stories of tearing instead. Friends who have, did not feel it, as the baby's head was pressing down in the area at the time. I would ask you Dr.

Hi, I used midwives with my pregnancies and neither of them believe that episiotomies are beneficial. I had a couple tears that were not terrible and no tears and no problems the next time around! I would look into it.

S.,
It shouldn't be standard practice. I just had a baby a month ago and my husbands main jobn was to make sure that there was no cutting. You would really rather let your body adjust to the baby rather than get cut.

I had superficial tears (soft tissue) and had no problem healing. When they cut you, its pretty deep.

B.

looks like you still have conflicting opinions :>) I had one and still tore but he was a big baby (9.7lbs) with a big head.
I can't say I noticed any difference to which bit healed first.
Ask your Dr what they think and their reasons. I went into the conversation with mine thinking I didn't want one, he's a bit old fashioned amd suggested one and in the end I had both.
best wishes for your birth by the way :)

I never thought of it as a big deal at all. I never even discussed it with my doctor or thought about it because I trust my doctor and knew that if it was needed he would ask me if it was o.k. and I would make the call if it came down to it There wwere so many other things to worry about for me, like the labor and delivery itself. I had a 9 lb. 3 oz. baby naturally and I did end up having one, the pain and healing was not even an issue for me. I was fine. Everyone will have a story of pro or con, as I have heard of people tearing horribly that chose not to have one. Ask your doctor and use your judgment. It is your call.

As I doctor, I still prefer an episiotomy to tearing any day, as if there is a tear, you never know how far it will go, the complications and healing. At least with an episiotomy- if it is done right, ( we were taught a cut to the side was better than a midline episiotomy-many now just do a midline episiotomy) you can see how well it is healing, and there's not excessive stretching or straining of the muscles in the area as there is enough room for the baby's head to get out. Another thing is you don't want any harm to the baby as he/she is trying to exit the womb.

Also, it's only routinely done for the first pregnancy. The second baby just usually pops out in their own.

It's your personal call, and you may want to discuss this with your doctor before the delivery, just to know he/she is on the same page.
Good luck!

Many doctors do not do this routinely anymore. Also, a tear heals better and more quickly than the cut from the episiotomy.
For more info. check out www.mothering.com
I tore, but healed nicely without having the procedure.
Amy

Do not have one done. If your doc is a good doc they will help stretch you to where you will not need one done. tearing is better for you and less painful and heals quicker. it is a proven fact. I did not do an Episiotomy and I had ONE superficial tear and needed done stitch. You can also prepare yourself to where you will not need one either.

I had an episiotomy with both of my children and both of my doctors did it as a standard practice. The pro of having one I believe is that you don't tear and it's easier to heal and the con is that you don't heal well. I healed very well from both of mine and I am glad that they did it. I did not experience any pain from either time that it was done. I think also that part of the problem could be poor hygiene once returning home. Don't get me wrong, I dont' want to sound as though some women do not take care of themselves but if they don't educate you on how to clean the incision area once you go home, then that is what can cause a problem.

Another thing that may or may not be a problem. After my first episiotomy, when my husband and I decided to start having sex again, it was hard because either the incision had been sown up too far or it had to stretch and that was painful for quite some time.

I had an episiotomy AND I tore (all the way to my bunghole!). I did not find healing that painful at all. Yeah, I was "tender" down south, but no big deal. I'd let your doctor decide....after all....she's the professional.

I did not have an episiotomy with my first. I had 2 stitches and was out and about in 2 days. I did have one with my second. It took weeks before I could comfortably sit or stand or anything. However, my second was 3lbs bigger than my first. (That definately had something to do with my healing and need for the episiotomy). I really think it depends on your body (do your kegals!), the size of the baby, and how well they are exiting. An episiotomy beats a C-section or any type of birth injury. Best of Luck with your delivery and episotomy or not, it is the most amazing experience of life.
E.