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Tear v cut (birth plan)(22 Posts)
Just been to see my midwife who looked over my birth plan and questioned why I had written "prefer to tear than be cut". I had thought a tear would heal faster whereas he suggested that a cut was better at controlling the size of the wound etc.
Any thoughts on this?
I guess with a tear its a gamble on what you're going to end up with. No idea about healing.
In my birth plan I had "I would prefer to tear than be cut unless it looks like the tear would be very severe, in which case please advise me".
In terms of healing it's usually better to tear (according to my MW) because jagged edges knit back together better than straight, smooth ones and a tear is often less severe than an episiotomy. I tore with DS, second degree, which was stitched. It healed beautifully, I even felt ready to have sex again just two weeks later, and I've never had any problems from it.
The main problem with a tear is that the path and severity can be difficult to control.
You'll find schools of thought on both sides of the debate so it's important to weigh up the pros and cons of each, personally though I'd rather tear.
I read up on this a lot before having DD1 and my birth plan said I didn't want an episiotomy.
DD1 didn't read my birth plan and wrapped her hands around her head. I pushed for 3 hours to no avail. I dread to think how badly I would have torn if I hadn't given in and gone for the episiotomy in the end. As it was, she managed to do me quite a lot of internal damage.
I think you are right that tears heal more easily, but please be prepared to be flexible if circumstances dictate.
I tore with DS2 (DS1 was CS). It took an hour to stitch me up, I could barely walk for three weeks, and I didn't feel right down there for the best part of a year.
So with DD, I asked for an episiotomy. It was quick, easily stitched, and took the wound well away from my anus. It healed very quickly.
My sister was faecally incontinent for sixth months after she tore. Nothing is worth that IMO.
Wow, this is really helpful, thanks for sharing. I guess what I can conclude from this is that the worst case scenario for a tear is far worse than being cut.
Is it always a cut / tear situation or is it possible that I'll have neither? If I am cut, will the anaesthetic mean I can't have an active birth (ie will I still have enough feeling to support my weight or will I need to be on a bed?)
As far as I was aware, the anaesthetic for the cut was some gel or a very local injection. It certainly didn't numb a large area, as the internal stitching afterwards required an epidural. I wasn't totally aware of what was going on, to be honest! DD popped straight out afterwards so my role wasn't very active.
I've had both and the tear healed better and quicker.
I like CBear's "I would prefer to tear than be cut unless it looks like the tear would be very severe, in which case please advise me". I think that's great. I know someone that needed a ga and surgery after a particularly bad tear. However, she's just had her second baby with neither a cut or tear!
It's possible to have neither, I only tore with DS because of his position (forehead first and face up instead of face down, after three hours of pushing he turned his head while it was halfway out) but other people don't tear or need a cut at all - it's the luck of the draw. Giving birth in as upright a position as possible or on all fours can lessen your chances of either because it takes pressure off the perineum, also tell the MW to let you know when to slow down for the head coming out because that gives the skin time to stretch slowly.
If a cut is needed and you decide you want one they use a local anaesthetic which works quickly, it won't affect your mobility.
I wasn't offered any anaesthetic for an episiotomy, MW just said that I wouldn't feel it if she did it during a contraction. I declined and decided to tear instead and didn't feel that when it happened so she was probably right.
Just to answer the question I didn't tear with either DD1 or DD2 but DH and I have comparatively small heads as do the DCs. If you are writing a birth plan I would go with CBear's suggestion just in case someone in the delivery room is scissor happy but I have never written one as I agree that babies tend not to read them.
I second CBear before anyone gets freaked out!
Episiotomy with back 2 back ds1 who was dragged out with forceps, tore a bit with ds2 (my smallest!) and nothing with dd. Hoping this one will just fall out .
99/100 they will tell you why they're suggesting they cut you and then you will agree or refuse. Sometimes circumstances might arise where they don't think you're going to tear but that you need some kind of assistance to deliver and they recommend an episiotomy for this. It's best to keep an open mind and just request that they tell you why they're suggesting something (which they should anyway) and you make a decision at the time.
My friend refused an episiotomy when one was advised (due to it looking like she'd have a substantial tear) and ended up with a tear from front to back and faecal incontinence for the best part of a year. Now this isn't common but sometimes they will recommend an episiotomy to control something which looks like it could be quite damaging.
Sometimes you can tear all the way to your anus... which I've heard is very painful.
I had a cut. Nice and clean. Got anaesthetic so didn't feel a thing.
Cut healed fast and didn't have any problems with it afterwards.
I had to have an episiotomy when having dd as she was a ventouse delivery. I was stitched and afterwards whilst using gas and air for pain relief. I was obviously a bit sore afterwards but nothing horrific and healed really well, no infection and stitches dissolved within 10 days.
I spoke to a friend of mine who is a MW in Germany, she said that over here they seem quite keen to cut when it is not necessary they do it as a precaution. She says you generally heal better from a small tear than a cut but they should tell you why they are cutting not just tell you you should be cut. It is a bit of a nightmare for me as I hate the thought of cuts and stitches but would rather have a small natural tear that doesn't go through all the layers of muscle than an unnecessary cut but will go with advice from above posters of do it if necessary but please explain it first. (fingers crossed I won't need either)
er, personally I'd like to prepare to avoid both scenarios! Perineal massage, in advance and you can ask your midwife to give you perineal support to avoid tearing the perineum as you push out your baby. Also learning to relax, and prepare for how to push in labour so you feel confident that it's possible to give birth without tearing.
I know the idea of childbirth can be freaky but our bodies are designed to do it without tearing or episitomy, and I'm trying everything I can to avoid it!
Lucinda that's really good to have positive thinking, and I really agree it's great to try to prevent as much as you can, but ultimately I think people are correct to be realistic about things. I am size 8 but have a husband with a big head which meant that sadly my 9lb+ babies with their heads on the 98th centile weren't going to just slip out. It's a really good idea for people to have a plan, neither tearing or an episiotomy is nearly as bad as you would imagine (and I am currently pregnant with Dc3 and have to keep telling myself that!)
The plan of going with tearing unless it looks like it's going to be bad is a very good one, and as someone else said, they are very good at telling you why they think a cut is necessary.
you're right grubbalo, I actually have quite a big head myself so who knows what my baby will turn out like! I will hope for the best, but choose tear over episiotomy. I heard once that episotomy's are done more for the convienece of doctors than any other reason, as a straight line is easier to sew up than a jagged tear. Not sure if this is true though.
lucinda you sound like me Pre-DD1. I was so upset when I realised I needed an episiotomy, having done perineal massage to avoid that outcome.
You should be optimistic, and question the medical need if presented with an episiotomy as a possibility, but please keep an open mind on it too. It really wasn't that bad, and certainly better than the alternative for me, which would have been a very serious tear (DD had arms wrapped around her head).
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