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Childbirth

Share experiences and get support around labour, birth and recovery.

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Original poster

Tear or Episiotomy- MWs or ladies with experience??

38 replies

Leilababyno1 · 12/04/2011 20:33

I have just finished writing my birth, for what it's worth?!!

The only bit I was unsure about was the episiotomy question...

I wrote down that I would only like an episiotomy if the MW thinks I am going to sustain a tear that will be higher than a 2nd degree level (Or if needed for an assisted delivery).

BUT what is preferable? I have a friend who was never offered an episiotomy, as she wanted a very 'natural' birth (which the MW did her best to adhere to) and then sustained a 3rd degree tear and wished afterwards she had had the cut instead!?

Please advise!!

OP posts:

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porcupine11 · 12/04/2011 20:36

I had a cut the first time so they could use forceps. It was stitched up by the doctor who delivered the baby and it was extremely painful while healing.

Second time I tore (2nd degree) and the midwife stitched it. I barely noticed it healing, no probs at all.

MsScarlettInTheLibrary · 12/04/2011 20:37

episiotomy makes 3rd/4th degree tear more likely, and guarantees a birth injury which may take longer to heal than a natural injury. It's no longer considered good practice unless an emergency. I don't think you can elect to have one.

MyLifeIsChaotic · 12/04/2011 20:40

This reply has been deleted

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bemybebe · 12/04/2011 20:42

My midwife said they do not do them any longer.

Original poster

Leilababyno1 · 12/04/2011 20:42

Hummm.. it's seeming that a natural tear if preferable then, even if it's quite a big one?

Ok, might adapt my answer on my birth plan then..

OP posts:

bemybebe · 12/04/2011 20:43

Routinely, I mean, as in the 80s... I did not ask about episiotomies before instrumental deliveries, but will do next time.

Original poster

Leilababyno1 · 12/04/2011 20:45

Apparently, they only advise one if they can see that a BIG tear is going to be unavoidable- or often compulsory to enable an assisted delivery..

OP posts:

MsScarlettInTheLibrary · 12/04/2011 20:50

I can't answer if it's preferable as I've never torn or had an episiotomy. But I do know that episiotomy increases the risk of further tearing.

So if you have a 2nd degree epis, you are not only guaranteed a 2nd degree injury but increase your likelihood of sustaining 3rd/4th degree tear - because the injury extends as the baby emerges.

That's the main reason they don't do them routinely any more.

Lots of studies here
www.changesurfer.com/Hlth/episiotomy.html

buttonmoon78 · 12/04/2011 20:54

I've had 2 episiotomies and one tear (epis done in the days when they were just done). No difference in healing with either method in my experience.

Good luck!

mintpurple · 12/04/2011 22:14

Sorry MsScarlett - you are completely wrong there. A properly done epis should not increase the risk of further tearing or 3rd/4th degree tears, in fact quite the opposite.

In my experience, midwives generally do very few epis nowadays, but there are a few reasons for them, and they still get done if really needed.

The main reason that I will do one is if there is early tearing which is heading towards a 3rd degree. An epis will guide the damage away from the back passage. Few other uncommon reasons - severe fetal distress with first baby or skin at the fourchette just not stretching or tearing and baby is not going to deliver until it is cut/tears. Each midwife of course has their own views on when an epis is necessary, and some do more than others.

In most cases an epis is slightly worse than a tear (it is usually second degree) and healing can be a bit slower and more painful, as there is also some crushing of the tissues when the cut is made, although it is often easier to repair as it is straight edged as opposed to a ragged tear.

MsScarlettInTheLibrary · 13/04/2011 00:09

Obviously I have no personal experience, just reading what the studies say.

togarama · 13/04/2011 00:18

Mint, can you back that up with evidence / stats?

The main recent studies I've come across on this subject fall in line with what MsScarlett said (i.e. finding that there isn't a protective effect from episiotomies in terms of tearing, and some finding that episiotomies increased the risk of 3rd and 4th degree tears).

mintpurple · 13/04/2011 01:09

I cant back it up as I dont have research to hand to do so. But Im pretty sure I could find some if I looked.

As anyone who has done a degree can attest, its not hard to write a paper saying black is white and find the relevant research and statistics to back that up.

In a way I do agree that episiotomies are done way too often but mainly by doctors doing instrumental deliveries, and I have seen some which are way worse than the tear would have been. Without looking closely at the studies stated, I would say with some confidence that they are taking episiotomies performed, rather than looking at who does them or for what reason, to come up with a conclusion.

Personal experience, while extremely important for the mother involved, is statistically insignificant in a huge group of delivering women, and so it is impossible to say what is or isn't necessary or right at the time.

After being a midwife for very long time and having delivered many thousands of babies, I know that if I have done an episiotomy, it was really necessary, and I also know that I have avoided many 3rd degree tears in the process, by guiding the damage away from the back passage. And I think this is the case for the majority of midwife births.

This cant be said for doctors doing an instrumental delivery though, as most involve some teaching and often a lot of episiotomies do extend to 3rd degrees in this situation. Obviously we cant ethically study whether these women would have had a 3rd degree anyway (due mainly to poor instrumental technique) or not.

Just glancing at these studies I notice that they are mostly (all?) American, and the overwhelming number of deliveries in US are done by doctors, most likely in lithotomy.

So how relevant to the UKs midwifery led care and delivery by midwives are these studies, (which are not just fresh off the press either)? Probably not very relevant I'd think.

LEILA- to try to answer your question a little bit, it really is hard to tell if you are going to tear worse than the epis. Probably not but hopefully you will trust the midwife caring for you enough to be guided by her at the time. Just talk to her about it when you go in in labour.

Sorry if this is a bit rambling - need to go to bed!

Insert1x50p · 13/04/2011 01:22

I had an epi with my first child- was done right at the end as I'd been pushing for 2 hrs, was nearly there, but he had a big head and I was definitely going to tear if I didn't have one. It was done by an Obs and I was stitched up within 30 mins. I healed v quickly - could sit down comfortably 2 days later.

I am not an Obs, so can't say if this is right or not, but my Ob's opinion is that the amount of time the tear/cut is open, and the quality of the stitching are critical factors in how well it heals as opposed to just a cut/tear thing.

ConfessionsOfAnAchingFanjo · 13/04/2011 19:31

I had an episiotomy and still tore. However I think the tear would have been a whole lot worse with out the cut and possibly not have healed so cleanly/tidily. So if I'm told I need one again this time round I'll go with it. (the pain of the tear on that last push was the worst part of the whole birth and I'm still wincing over 3 years later thinking about it!)

OeufaBrain · 13/04/2011 19:37

my episiotomy was a bastard. I was stitched up too tightly afterwards and the perionum (sp) skin was thinner somehow and tore a bit everytime I had sex for a year after, which was a nightmare. i had to have it re-done and it was fine in subsequent births etc.
The thing I was totally naive about was that being induced was pretty much going to mean an epidural which was pretty much going to mean forceps/ventouse which was pretty much going to mean an episiotomy......I felt very pressurised into being induced.

Milliemuffin · 13/04/2011 22:12

Mintpurple - what are your thoughts when it comes to scar tissue? I've had 2 episiotomies and a 2nd degree tear and I'm planning a home birth in 2 months time however I'm concerned about tearing badly because of the amount of scar tissue I have.
Am I more or less likely to tear and more or less likely to NEED another episiotomy because of it?

Leila - apologies for posting this question on your thread, wish you the best of luck xx

blueeyedmonster · 13/04/2011 22:26

I had a 3rd degree tear with my forceps birth. As far as I know they didn't even think about an episiotomy.

They did however say I may need one next time to stop me tearing where I did previously if it looks like that will happen. If it doesn't look like I will tear there again though they will not do one.

bemybebe · 13/04/2011 22:33

OeufaBrain your story sounds absolutely petrifying.

springlambkin · 13/04/2011 22:37

My episiotomy was HIDEOUS. Also had 2nd degree tear as a result of same birth (lucky me).

I did have a ten pounder with forceps so prob was inevitable. Had an ELCS second time round and recovery from that was SO much better than episiotomy.

I remember going for a wee after catheter was out after my ELCS and in a post natal haze bracing myself for the whole wiping experience and breathing SUCH a sigh of relief when I realised it was only my tummy that was cut and that I didn't have to pee on or wipe my tattered fanjo (TMI I know!)

springlambkin · 13/04/2011 22:38

Oh fuck, sorry, OP are you a first timer? I genuinely didn't realise. Sorry, you don't need to hear that stuff.

blueeyedmonster · 13/04/2011 22:44

I forgot to say it was uncomfortable for a couple of days but it was generally 'ok' really!

mintpurple · 14/04/2011 00:59

MILLIE - probably wont need an epis, esp if youre having a homebirth but if you've had 3 cuts/tears then most likely you will need some stitches - sorry:(

However don't let it put you off a homebirth as it can be repaired at home if its second degree. Id say its really unlikely to be worse than last time though.

lilham · 14/04/2011 07:50

A positive episiotomy story here. I had a 2nd degree one with a ventouse delivery. I can walk and sleep with no pain from the moment I leave the delivery room. The only time it's painful was when I was actually sitting right on the scar. (I can adjust my sitting so it didn't hurt). It also hurt when I pee. Within 2 weeks, all the pain has gone and just a slight discomfort remains.

Milliemuffin · 14/04/2011 09:27

Thankyou mintpurple. It hasn't put me off and I am still hooked on my planned home birth. Fingers crossed! xx

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