Episiotomy vs tearing naturally

(42 Posts)
Dogsmom Tue 19-Feb-13 15:21:12

I was discussing with my MW about what needs to go on my birth plan and she said to put whether I prefer to be cut rather than tear naturally.

I can't think of any reason why I would prefer to tear but am i missing something? I imagine a tear would be more jagged and potentially go in any direction whereas a planned cut would be neater and therefore easier to stitch and quicker to heal?

maxbear Fri 01-Mar-13 22:16:08

Very few midwives would do an episiotomy just to avoid a tear. The evidence suggests that this is not appropriate. Doing an episiotomy does not make the mother any less likely to have a third degree tear, if anything it is slightly more likely.
The fact is that if you chose to have an epis this guarantees that there will be a substantial amount of muscle involvement, if you don't have one you might well get away with an intact perineum or a small tear. Sometimes it looks as though it will be fine and the tear happens at the last minute and sometimes it looks as though it might be bad and it isn't at all.
I have done episiotomies for slow progress and fetal distress and twice (in 18 years) I have done one in the hope of preventing a bad tear as the women had unusually short perineums. This worked on one occasion, on the other occasion the mum had a fourth degree tear (didn't help that the baby was over 10lb!)
Whenever women put on their birth plan that they want an episiotomy I talk to them about it and advise them against it unless it seems necessary at the time and no one has ever refused that advice and told me they want one anyway! Having said that it is much more common to see that the woman would rather tear (on a birth plan).
As far as suturing goes episiotomies tend to bleed more and are deeper so from that respect they aren't always easier to do.

brettgirl2 Thu 28-Feb-13 20:32:48

I've had both. First time episiotomy to help me get her out after 2 hours pushing. Second one flew out second degree tear. The second degree was better but the epi also healed fine. I wouldnt worry too much honestly, by the time I had the epi I'd have let them cut an arm off if it would have got the baby out.

daholster Thu 28-Feb-13 13:33:58

Just something to add - episiotomies are supposed to be better for directing the tear if it is felt to be imminent.

A tear that is predicted to happen by the medical professionals based upon whatever info they have (tightness, position, instrumentation etc) is quite often unpredictable in how bad it will be or where it will go. The point being that on rare occasions you can end up with a 3rd degree tear (eg through to the rectum shock or other surrounding structures) which can be much worse in the long run - difficult to repair, needing theatre, continence problems...

Whereas an episiotomy is at least predictable, and they cut at the point where minimal damage will happen to surrounding structures hence hopefully saving your continence! It is the control element that is the reason the professionals choose to do this, not "making it easier for themselves". The need for quick delivery if the baby is in distress might also be a reason for episiotomy I would imagine.

Since tears can heal quite well, it may be preferable to do that if you wish to take the risk - and lots of midwives actually enjoy the challenge of putting you back together and doing a good job of it after a tear confused. So its not straightforward to make the choice.

Personally (I am a FTM and 31 weeks and only recently realised perhaps I should think about this...) I have ulcerative colitis, so faecal continence is something that isn't great at the best of times... the risk of damaging that further than is already possible with childbirth does not appeal to me, therefore I would personally opt for the reassurance of an episiotomy if needed, so at least I know any further tearing is likely to head in a direction AWAY from my bowel...!

Sorry if TMI for anyone, but I felt I should put across my understanding.

BeehavingBaby Thu 28-Feb-13 11:49:25

Bit of an od thing to suggest for a birth plan. An episiotomy should only be performed for fetal reasons, ie, to get baby out quicker if showing signs of distress in advanced pushing stage of labour. So you don't get to 'choose' as such (obvs they would get consent but it wouldn't be to be cut or to tear).

notcitrus Wed 27-Feb-13 23:00:38

I read tears on average heal faster, but there's huge variation with both. I think the quality of stitching is probably more important - MN advised me to put in my birth plan I wanted epi only if considered necessary to avoid worse tearing, and an expert for any stitches. Which I got.
Two ventouse deliveries, after first couldn't feel anything by 48 hours later, second had epi and a 2nd degree tear, and about 45 min of deciding how to stitch it and do it, but again no pain after 2 days and totally fine in a couple weeks.

SIL not so lucky with a 2nd degree tear, but three years on it's now painless.

bumpitybumpbump Wed 27-Feb-13 22:25:28

Oh Cheddars thank you, that made me laugh hysterically for about 10 minutes non stop! grin

PointlessCow Wed 27-Feb-13 19:17:12

I had an episiotomy with DC1 and then a 2nd degree (borderline 3rd) with DC2.

I found the recovery from the tear much quicker and much less sore.

I had to have a forceps delivery with DS who is 10weeks old, The episiotomy was really no big deal in the end and it was something I had been dreading! I had four neat stitches and looking at me now so to speak, nothing looks out of the ordinary, it feels fine, sex isn't painful. The healing was fine, like a PP said, keep your pad regularly changed and the hospital will probably give you 'cidal' soap to wash with to prevent infection.

TwitchyTail Wed 27-Feb-13 18:52:43

Speaking as someone 4 days post-episiotomy and ventouse birth with nothing other than gas and air (not by choice - labour too fast for much wanted epidural!), I honestly didn't find the episiotomy at all bad. They needed to get the baby out fast and the ventouse didn't have room for manouevre, so episiotomy was pretty necessary - it wasn't a choice between that or a tear for me. It didn't hurt, I didn't tear in addition, was stitched up by the registrar with a bit of local anaesthetic, and it's healing fine. Has been no more than a niggly soreness that is easily controlled by simple painkillers (and I have a rubbish pain threshold). Can't speak to the long-term effects and of course everyone is different, but it was a big fear of mind pre-birth so thought I'd chuck my pennys-worth in smile

Chunderella Wed 27-Feb-13 11:33:02

You can get a local anaesthetic if you have a ventouse birth!

DD is 13 weeks so its relatively fresh in my memory. I had a 3rd degree tear (how do I know if it was a,b or c?) and I can honestly say I didn't feel it tear. I remember there was some blood and the midwife said DD might come quicker now and then until they said they needed to check how bad the tear was after skin to skin I thought nothing of it.
It was stiches in theatre under GA and its healed really well. I get follow up appointments to check it all and physio

auntieobem Thu 21-Feb-13 20:57:25

But remember that you might not tear at all! With dd1 I had a couple of internal stitches and a graze, worth dd2 I had no tearing or grazing or anything.

cafecito Thu 21-Feb-13 20:49:58

tearing naturally is much, much better healing

you won't feel it tear, usually. You WILL feel the stitches, if you have any, but you could have some gas and air for that.

5madthings Thu 21-Feb-13 20:39:03

I don't think you feel a rip as its all very stretched anyway. I had an unusual and delicate tear with ds2 and they had to get a consultant to stitch me up but I didn't feel it tear. The stitching was uncomfortable but they give you a local and I had lots of gas and air. It healed fine, much better than the cut I had with ds1.

If you are worried have you thought of massaging your perinium? You use oil, and stretch and massage it in the weeks leading up to lab our. Googleit, its meant to help, can be tricky to reach, you may need to get your partner to do it for you!

Dogsmom Thu 21-Feb-13 20:28:14

shock

Thanks for all the replies.

I'm not sure if I'm glad I asked the question now!
Such a horrid subject, the consensus does seem to be that tearing is better though and my theory on episiotomies healing better was wrong, I wish they'd automatically put a local anaesthetic there as I'm about to crown though, the thought of feeling it rip gets me very panicky.

5madthings Thu 21-Feb-13 20:05:34

I have had both and the tear healed much better, also I had my episiotomy with ds1 who is 13yrs and I can STILL hear the snip if the scissors in my head when I think about it which is hideous, massive big stainless steel scissors...

Kafri Thu 21-Feb-13 20:02:23

oh rhe memories!

I tore - badly. that was a lot of stitches.

I only had gas and air and can honestly say the birth was easy in comparison to the stitches. I didn't particularly feel the tear but I certainly felt the midwife putting me
back together grin

whattodoo Thu 21-Feb-13 18:10:51

I tore and can honestly say that I didn't know anything about it until the MW started to stitch. I don't know how I didn't feel it (only had gas & air) but it must have just got lost in the whole contractions business.

Healed quickly and with no major problems, other than when we have sex at an unexpected angle.

shushpenfold Thu 21-Feb-13 18:05:13

LOL at Cheddars!!! Running with stitches stings a bit though grin

AmberLeaf Thu 21-Feb-13 13:54:06

I stated no episiotomy on my birth plan.

episiotomy is easier for the person stitching it back up than a natural tear.

Lucky for me I got away with minor grazes.

Shagmundfreud Thu 21-Feb-13 12:52:21

Women who have an episiotomy are more likely to report that intercourse is painful 6 months after the birth. I think it does more nerve damage than a tear. Most midwives I know are massively anti-episiotomy except in extreme cases.

Cheddars Thu 21-Feb-13 12:00:42

runs screaming from the thread

FirstTimeForEverything Thu 21-Feb-13 12:00:40

Message withdrawn at poster's request.

Radiator1234 Thu 21-Feb-13 11:57:16

Probably not a helpful comment but there is every chance you just won't care on the day.... I hadn't really given much thought to episiotomy v tearing before DD was born, but after 2 hours of pushing, and complete exhaustion, all I kept saying to the midwives was "please cut me.... Please just pull her out". They didn't and eventually I did push her out and had a 2nd degree tear. It was v sore after but healed reasonably quickly. One thing I would say though is whether its an episiotomy/ tear/ whatever, do make sure you change your towel often as my stitches got infected (and I thought I changed the towel often enough) which was pretty grim about 4 days into having a newborn baby and involved having to go back to the hospital/antibiotics etc. good luck!

FirstTimeForEverything Thu 21-Feb-13 11:55:04

Message withdrawn at poster's request.

Join the discussion

Join the discussion

Registering is free, easy, and means you can join in the discussion, get discounts, win prizes and lots more.

Register now