episiotomy or tear - which is best?

[justlemonade]

I've just read in my birth plan section of my notes I might want to consider whether I have an episiotomy or tear. With my first birth I had an episiotomy. But given a choice, which is best? For them to cut you or you to tear naturally?

Well, it depends. Episiotomies aren't done routinely anymore as there is no evidence that they prevent the more significant tears. They're really only done for a purpose, such as for some assisted deliveries (as deemed necessary) or to enlarge the vaginal opening when baby needs to come out quickly.

I suppose then, that a natural tear is preferable. With an episiotomy, you'll definitely have the equivalent of a second degree tear I.e. Skin and muscle will be cut: you will have a deep cut to heal from.

That said, being a minor surgical procedure means that there will be a degree of control to the cut and you should be able to be sewn back to heal 'as you were' IYSWIM.

I guess the best thing to hope for (if you have to tear at all) is a 'graze', where just the skin of the perenium tears. Eitherway, you'd be guided by the midwives, so get them to inform you of your options at the time.

HTH!

It does help thanks. It also explains why I had an episiotomy done in my first delivery. Up to now I've been ignorant as to why they went down that route.

I had an episiotomy with my first as I had a ventouse delivery. Then with my second, natural delivery, I had a tear along when the previous cut was. In my experience the year was much less painful when going to the toilet afterward, and healed a lot quicker for me.

Ok. I'm hoping for a non-assisted birth second time round so tearing is the preferable option.

wish i had been cut. i tore sooo much, and in places i didn't think you could, ie labia and above.

I've had both twice, first time epi was to speed ds getting out but I tore a bit, second the epi was to stop me tearing any more. But I think key is to insist on an expert to do the stitches and take their time, as I recovered really quickly and only discovered I'd had a 2nd degree perianal tear this time when I read my notes 4 days later, and DP confirmed it was the case!

I wish mw had cut me. She hesitated because I think they are very reluctant to cut, and I tore so badly next delivery had to be elcs.

It is generally better to tear, even if they do an episiotomy to try to prevent bad tearing, the epi itself can then tear further anyway.

I would only consent to an episiotomy if I needed another assisted delivery, or if the baby was in distress and needed to come out straightaway. Otherwise, a tear would be likely to be less severe than an episiotomy and heal better.