elective episiotomy - is this a good idea??

[KaybeeandZak]

Just saw my MW today who said the hospital would usually offer an elective episiotomy after having a 3rd degree tear previously. This is the first i have heard of it!

They have said so many different things to me at the hospital each time I see someone, it's driving me crazy. Was offered elective c-section, then told the MW's would try to support the perenium as much as poss to prevent bad tear again, then told I shouldn't tear like that again unless big baby (it will prob be at least 9lbs)

Am due in 2 weeks and am really freaking out about the birth.

[happymumathome]

Hi KaybeeandZak the biggest risk factor for sustaining a third degree tear is having an episiotomy! So no, an elective one would not be a good idea.
I am a midwife and did my dissertation on perineal protection at delivery from that and from observation if I were you I would avoid induction,avoid epidural, avoid having your waters broken, bear down only when you really want to and try and pant as much as possible as the head and shoulders are emerging to give your perineum time to gently stretch.
Perineal massage for the next two weeks will not do any harm and may be helpful, studies are unclear. Position for birthing is difficult to decide in advance as you don't know what your body will be telling you to do at the time, but all fours or left lateral appear to relax the perineum most. Is waterbirth a possibility for you?
Write a birth plan outlining your wishes.
You do have a great chance of not having a third degree tear again, enjoy your birth and baby

[expatinscotland]

I had forceps delivery with DD1 and huge epi.

I had only a graze with DD2.

[fingerwoman]

I had a second degree tear with ds1.
nothing with ds2, who was bigger.

hope it all goes well. and what a fab response from happymum!!!

[Heated]

Like you pushed from pillar to post re birth of 2nd child following 3rd degree tear and complications with my 1st.

I was offered an elective by the consultant and a see how it goes by my covering mw, neither of which appealed. I did a lot of reading and the stats are reassuring. Of those women who have a 3rd degree tear, 75% to do not tear to the same degree or worse again. In my case I had an epidural and induction which gave me my controlled delivery, which I know is contrary to happymum but a good alternative for me.

I did find the midwives online helpful and I also read a number of obstetric studies from the Royal College of somethingorother (from which I got my stats)

www.radmid.demon.co.uk/thirddeg.htm

www.radmid.demon.co.uk/perineum.htm

[amytheearwaxbanisher]

i had a tiny four stitch episiotomy with ds and will be telling midwife if im in labour again to slice away if needs be as the scar tissue is thin and id be afraid of tearing although im probably flattering myself that my undercariage would need one these days

[solo]

I had forceps with Ds so had a epi and had at least a year of problems having sex afterwards as my skin tore at the cut point every time, it was horrendous and painful.

I was really against having one again(wouldn't have chosen it if no intervention with first either)and luckily didn't need any help and ended up with a 1st degree tear which caused no problems at all with healing...not that I've had sex since the birth! Sorry TMI.

I would not choose to have one.

Waterbirth is FANTASTIC highly recommend it and it softens the area nicely.

[solo]

' an' epi (new keyboard)

[sweetkitty]

I had a second degree tear with DD1 (6lbs 3ozs) and was scared of tearing again.

DD2 was 9lbs 3ozs and I had nothing just felt a little tender for a day. Had a homebirth so knew MWs and they knew my fears, she said she could see the tear start to strain a bit so she slowed everything down and supported the scr tissue as best she could.

[KaybeeandZak]

Thanks so much for your posts everyone.

Happymum, thats what I thought about the elective epi.... made no sense! But why on earth would my MW suggest such a thing, and why would the hospitals do it all the time if its a big risk for tearing. Is it all just about getting people in and out asap, not really caring about patients well being?!?!
My hospital has one birthing pool I think, and I have been considering using it (thats assuming it is available of course) as I thought it might help. I wanted to use it last time but was induced so obviously that was out of the question. I am worried they will tell me I can't because of the previous tear...

[solo]

You can always buy a birthing pool, or hire one...to buy one is not that expensive really.

I was given a brand new one from freecycle, though the hospital provided one so I didn't need to use it.

If you take your own in, as long as they know in advance you can have your waterbirth(assuming that there is no medical reason why not). Keep in mind that you are limited to TENs before the pool and Gas and Air throughout should you want he pool option.
The water is very pain relieving during labour in. Good luck!

[solo]

PS. The water also softens the perenium so enables the area to stretch more easily, so less likely to tear anyway.

[happymumathome]

Unfortunately every health care professional you meet may have differing ideas regarding episiotomies depending on how much research they read, who they trained with and were influenced by during that training.
In the 70s midwives were told off for not doing them!
The only research based reason for doing one is to expediate delivery if there is fetal distress and baby needs to come out now.
It is unfair but to increase your chances of having the kind of delivery you want, unless you "know" your midwife and can discuss issues prior to labour, you need to decide what you feel you want to do and write a birthplan. Have a look at this link too. www.efn.org/~djz/birth/obmyth/epis.html
If you want to use the pool and they are not keen, say that you might like to have the baby at home and use a pool, and watch the rules bend!
You "allow" or "disallow" not them, it is your birth after all

[SpecialOffer]

I have been told this as well. I had a 4th degree tear with my DS and I asked then if I could have a natural bith again, and the MW said then that yes but I would be cut to stop me tearing again!!!

CRAZY (Not pregnant BTW).

Have been told by a few people who had really bad tears with their first that they didn't tear at all with their second / third!!

Good luck with it all!

[KaybeeandZak]

How can you take your own pool into hospital? Where do they fill it up????

I know I need to write a birth plan, thanks happymum, I will get on to it tomorrow and try to put down what I want. Just feel like last time I did one it all went out the window as I was induced so it didn't matter that I put 'water birth' 'want to remain mobile' I just got tied to the bed with the monitors etc, hence why I had an epidural in the end.......

[maxbear]

As a midwife I do very few episiotomies, in fact I have only done two in the last five years (in the same week oddly enough!) One of the women went on to have a 4th degree tear as well as the episiotomy. In her case I would recommend that she has a cs next time as her perineum was one of the shortest one's I have ever seen and I suspected that she would tear badly before she was anywhere near the birth (didn't help that the baby was large either).

I did once have a woman who had had a previous 3rd degree tear and I did do an epis for her as she asked me too. I tried to persuade her to give it a go without but when it came to it she also had a really short peri so I felt that doing one was probably not too bad and idea I did a tiny epis which did not extend. I have also delivered women with previous 3rd degree tears who have sustained no perineal trauma subsequently.

So to cut a long story short, I am saying that for many women having an elective episiotomy is not the right thing to do, but for some women it probably is a good idea as it may just be enough to take the pressure off and save a 3rd degree tear without resorting to a cs.

[Trolleydolly71]

Message withdrawn

[CoteDAzur]

I would also choose c-section over episiotomy.

[blueshoes]

maxbear, you mentioned short perineums as a risk factor for bad tears. Is this something you can tell before a woman is near crowning?

[KaybeeandZak]

oh my god, you'd seriously have an elective c-section over tearing/episiotomy???? Even with a toddler (16mo) as well?????

[CoteDAzur]

Friends with c-sections were up and about in a week. I was useless for 3 weeks after episiotomy. Unable to walk. Unable to sit. Unable to care for newborn. Ate lying down with plate under my chin. Had to breastfeed standing up, crying in pain at the same time.

Yes, better c-section than another episiotomy.

[hazeyjane]

hello Kaybeand zak (from 2 under 2 thread!)

I had a 3rd degree tear and episiotomy with first labour, and then went on to have small tear in second labour, but very superficial.

The 2 births were so completely different, and although I had THE PERFECT BIRTH PLAN with both of them, I ended up with ventouse with dd1, and being induced with dd2.

I was pressured into having a caesarian with dd2, (the consultant even came in during labour and tried to convince me it was the best option, but dh, the MW and I told him where to go!)but, found a really supportive MW who went through my birth plan and made me feel a lot more reassured about the possibilities of tearing again.

Good luck and go with whatever your gut is telling you, I had a friend in a similar situation , and she went with a c-section, because her biggest fear was tearing badly again, whereas my biggest fear was c-section's!

[NorthernLurker]

Cote - what did they do with your epi to have that effect? I've had three and no trouble at all - in fact I was doing the school run 48 housr after the last one! Your experience sounds dire!

[pooka]

Ah see recovery time from episiotomy and from c-sections vary greatly according to the individual IMO.
Have had friends who have had both. So had c-section and recovery a breeze first time, awful next. And vice versa. And the same for episiotomy.

[lulumama]

with a c,section you can guarantee you will have a cut , with a VB, you might well not tear at all

also, if you want more than 2 children and have a c.section, it can impact on future birth choices.

water is good to support the perineum, all fours is a good position to help avoid tearing, perineal massage can be helpful too

in your first birth, did you deliver on your back? lots of things can impact on whether you tear or not

[Smithagain]

My consultant suggested an elective episiotomy, for the same reason. I queried it next time I saw my community midwife and she hit the roof! She expressed the opinion that he must be from the dark ages ...

She agreed it would be reasonable for me to write I HAVE NOT CONSENTED TO AN ELECTIVE EPISIOTOMY all over my notes, just to be clear I also wrote a very short and succinct birth plan which basically consisted of "please do anything you can to help me deliver gently and avoid another third degree tear. But I do not want an episiotomy unless it is absolutely essential."

The MW in the delivery room was great. She bullied me into a less vertical position and was very stern with me when I pushed too hard . Had a quite gently birth, considering it was a very short labour. I did tear, but nowhere near as bad as the first time - easily mended, much less traumatic all round.

Just my experience.