Is a 2nd episiotomy easier to deal with?

[babyblabber]

so as i'm having another giant baby have been told an episiotomy is inevitable. doc said it won't be right over the scar tissue but will be right beside it. last time i couldn't sit down for weeks, couldn't walk very far for weeks either, cried my eyes out with agony after 1 hour in the shops 5 weeks post epi and was too scared to have sex for 5 months. was on painkillers (ponstan, then panadol) every single day for 8 weeks. it doesn't hurt but i am still aware of it from time to time and i have pelvic floor issues (not serious but am seeing a physio).

cannot imagine being that incapacitated with a toddler as well as a new baby so am dreading it.

any chance a second one will be easier to recover from?

i don't think a big baby necessarily means an episiotomy actually

my friend had to have one with her 7lb 6 baby

i tore with my first who was 9lb 1
but i got away with a tiny graze with ds2 who was 9lb 5 and nothing at all with ds3 who was 9lb 11

there are things they can do to help prevent tearing/episiotomy

I don't know about another one, as it seems unusual your doc would have a crystal ball about this. If I were you, i would possibly insist on a "wait and see" for the birth? Espec when the last one was so painful. Was it the same doctor?
Would a tear not be better? And heal faster and less painfully? Research says yes.
Any doc that told me something so unpredictable was "inevitable" would be getting from me. But then I am a bitch to deal with when it comes to my precious bits!

How big do they think your baby is likely to be. I 2nd thisisyesterday in that an episiotomy is not a definate with a subsequent pregnancy.

I am presuming that they will let you see if you can deliver without one.

You could try perineal massage to see if that might help.

I had an episiotomy with my 1st who was 8lb 2ozs. Worried that I might have to have one with ds2 as the scar tissue from the 1st one might not have stretched. Didn't have to though, although I did get birth standing up which I would really recomend (much easier for me than lying down), although this was by chance, not planned as ds2 made an incredibly speedy entry.

Are you in the UK, and if there are is there a reason you are seeing the doctor? It's very odd that they say 'inevitable'.

Second labours are generally easier, so will have fewer of the risk factors for an epi, regardless of the size of the baby (things like instrumental deliveries).

I had an epi with DD1 and tore along the scar tissue with DD2 (she shot out like a speeding bullet. No panting during crowning, etc!). It actually improved that area, despite being a second degree tear. So even if you have a second epi, it might be better.

DS was 11lbs and this one is bigger. i'm quite small so i think he was just being realistic, i can't stretch enough to accomodate and 11lbs+ baby (head was big too). i'd rather a section than forceps again so thought if i planned to refuse them and refuse coached pushing i might get away without one but he (same doc as last time) thinks that it's very unlikely that i'll need forceps but very likely that i'll need an episiotomy :(

should add, am not willing to give birth to a whopper without an epidural if i can help it and there are no light epidurals in my hospital so i will be on my back more than likely.

I had an episiostemy with both labours, and yes, the second was easier, but I didnt have forceps the second time so it wasnt as bad all round!!

Epidural will increase your risk of an episiotomy but I can totally understand why you would want one.
Weight estimates can be notoriously out. Is this baby 100% over 11lbs?
If they are, what other options are open to you, if you are willing to not have an epidural? Water? Moving around? Midwife led delivery? All proven to reduce interventions.
Or, completely alternatively, a planned c-section?

It's not the choices you've outlined that bother me about this, it's your doctors' lack of flexibility that stands out, for me.

no water available, labour will be with midwife with doctor only present for the actual birth but midwife still leading it. could move around but to be honest, i found the contractions unbearable last time and was delighted with epidural and able to look forward to baby coming rather than focus on pain so i want the same again.

am debating asked for a planned section but just want to weigh up the pros and cons.

I had a 3a tear first time (8lb 2oz, forceps), and an episiotomy (11lb 7oz, forceps) second time.

The episiotomy has been considerably more painful during recovery than the tear was. If you don't need an assisted delivery, I'd take my chances with a tear rather than a cut.

Baby - Has the doctor said that this one is definitely bigger? That would be a real warning bell for me because scans are notoriously inaccurate on predicting size.

Likewise size is a notoriously inaccurate predictor of how labour will go. And size is a notoriously inaccurate predictor of pain levels.

I know someone who felt just like you. First baby 9lb and forceps. Would tell anyone who asked that she absolutely was having an epidural with no. 2. She had him in three hours on gas and air and he was 11lb. Said it was waaaay easier than the much smaller first.

I would try not to focus on size. Section rather than forceps is a separate issue, but I think the size is a bit of a red herring.

he hasn't said it's bigger, he thinks it'll be about the same or sometimes says it might be smaller but think that's just to comfort me! but i have my notes from last time and it's measuring bigger at each scan than DS was at the same stage. i know the scans aren't hugely accurate, DS was supposed to be 8.5-9lbs but to be honest that only makes me worry that it could be even bigger than predicted and come out 13/14lbs!!!

i know it COULD all be fine but at the same time it COULD mean a huge epi/tear (not to mention my fears about shoulder dystocia etc!) and am a bit freaked by my own previous experience and a friend's recent experience where she got an infection and was in pieces.

if i knew i could have a normal labour with a small tear/epi that easily healed i'd be fine, just can't imagine being so immobile again with poor DS who will have enough to deal with with the sudden arrival of a new baby.

True, and I think if you have strong fears you need to talk through your options with your midwife and doctor. Of course, equally, there could be mobility issues after a section, so it is quite hard to second guess.

if you want a c-section because you are worried about the size of the baby, having a forceps delivery and possible episiotomy/bad tear, shoulder dystocia etc then I think you are well within your rights to push for one. I can totally understand why you would want one

if it's just the mobility issues once baby is born though I think you will probably find that a c-section leaves you just as, if not more, limited than having an episiotomy to be honest.

do you have a midwife or anyone else to talk your options through with? remember that consultants generally deal with "high risk" patients so can often see things in a worst-case scenario kind of a way, whereas I find midwives often have a more positive view of things (prob over-generalising here!)
it might be worth even asking for a second opinion from another consultant before you make a final decision?

DD1 was forceps and third degree tear. I had physio for pelvic floor issues which weren't too bad but noticeable.

DD2 I chose to have a c-section. By the time I got to 36 weeks (when I had to decide) my pelvic floor issues had got a lot worse.

The first consultant I saw said I was no more likely to tear this time round (at 24wks).
The midwife said I was much more likely to tear this time round.

The second consultant I saw agreed to give me a c-section because by that stage I was having continence issues. (Happily all resolved after baby made an appearance).

It was a very good experience. I found the recovery from a c-section not easier but I guess more what I was expecting . You will need some help for the first week or two if you have another little one though.

girls, an update, am just back from the doctor and he's agreed to a c-section. i thought i would have to fight for it as the hospital is known to be quite anti-section and he told me before he wouldn't like to induce me early, likes nature to take its course and thinks i'd be well able after having an 11lb-er etc but he agreed almost immediately.

am 34 weeks today and baby is already 6.5lbs so looks like it will be at least 11lbs if not more. according to the scanner it's measuring 37 weeks. he asked me about my recovery last time and was quite sympathetic. we discussed shoulder dystocia etc too as i'm quite small, i know i got DS out but still worries me that an even slightly bigger baby could get stuck.

am so so relieved. quite sad that i'll never experience going into labour myself (was induced last time) and it is a bit of a loss that i won't be giving birth myself this time, would love to if baby was normal size, but am so glad i can stop worrying and start looking forward to meeting my baby!

Great to hear you are happy with the outcome.

You are giving birth to your baby 'yourself' though. Having a section doesn't mean you aren't doing that!