Episiotomy vs tearing naturally

[Dogsmom]

I was discussing with my MW about what needs to go on my birth plan and she said to put whether I prefer to be cut rather than tear naturally.

I can't think of any reason why I would prefer to tear but am i missing something? I imagine a tear would be more jagged and potentially go in any direction whereas a planned cut would be neater and therefore easier to stitch and quicker to heal?

I have had both and the tear healed much better, also I had my episiotomy with ds1 who is 13yrs and I can STILL hear the snip if the scissors in my head when I think about it which is hideous, massive big stainless steel scissors...

Thanks for all the replies.

I'm not sure if I'm glad I asked the question now!
Such a horrid subject, the consensus does seem to be that tearing is better though and my theory on episiotomies healing better was wrong, I wish they'd automatically put a local anaesthetic there as I'm about to crown though, the thought of feeling it rip gets me very panicky.

I don't think you feel a rip as its all very stretched anyway. I had an unusual and delicate tear with ds2 and they had to get a consultant to stitch me up but I didn't feel it tear. The stitching was uncomfortable but they give you a local and I had lots of gas and air. It healed fine, much better than the cut I had with ds1.

If you are worried have you thought of massaging your perinium? You use oil, and stretch and massage it in the weeks leading up to lab our. Googleit, its meant to help, can be tricky to reach, you may need to get your partner to do it for you!

tearing naturally is much, much better healing

you won't feel it tear, usually. You WILL feel the stitches, if you have any, but you could have some gas and air for that.

But remember that you might not tear at all! With dd1 I had a couple of internal stitches and a graze, worth dd2 I had no tearing or grazing or anything.

DD is 13 weeks so its relatively fresh in my memory. I had a 3rd degree tear (how do I know if it was a,b or c?) and I can honestly say I didn't feel it tear. I remember there was some blood and the midwife said DD might come quicker now and then until they said they needed to check how bad the tear was after skin to skin I thought nothing of it.
It was stiches in theatre under GA and its healed really well. I get follow up appointments to check it all and physio

I had to have a forceps delivery with DS who is 10weeks old, The episiotomy was really no big deal in the end and it was something I had been dreading! I had four neat stitches and looking at me now so to speak, nothing looks out of the ordinary, it feels fine, sex isn't painful. The healing was fine, like a PP said, keep your pad regularly changed and the hospital will probably give you 'cidal' soap to wash with to prevent infection.

I had an episiotomy with DC1 and then a 2nd degree (borderline 3rd) with DC2.

I found the recovery from the tear much quicker and much less sore.

Oh Cheddars thank you, that made me laugh hysterically for about 10 minutes non stop!

I read tears on average heal faster, but there's huge variation with both. I think the quality of stitching is probably more important - MN advised me to put in my birth plan I wanted epi only if considered necessary to avoid worse tearing, and an expert for any stitches. Which I got.
Two ventouse deliveries, after first couldn't feel anything by 48 hours later, second had epi and a 2nd degree tear, and about 45 min of deciding how to stitch it and do it, but again no pain after 2 days and totally fine in a couple weeks.

SIL not so lucky with a 2nd degree tear, but three years on it's now painless.

Bit of an od thing to suggest for a birth plan. An episiotomy should only be performed for fetal reasons, ie, to get baby out quicker if showing signs of distress in advanced pushing stage of labour. So you don't get to 'choose' as such (obvs they would get consent but it wouldn't be to be cut or to tear).

Just something to add - episiotomies are supposed to be better for directing the tear if it is felt to be imminent.

A tear that is predicted to happen by the medical professionals based upon whatever info they have (tightness, position, instrumentation etc) is quite often unpredictable in how bad it will be or where it will go. The point being that on rare occasions you can end up with a 3rd degree tear (eg through to the rectum or other surrounding structures) which can be much worse in the long run - difficult to repair, needing theatre, continence problems...

Whereas an episiotomy is at least predictable, and they cut at the point where minimal damage will happen to surrounding structures hence hopefully saving your continence! It is the control element that is the reason the professionals choose to do this, not "making it easier for themselves". The need for quick delivery if the baby is in distress might also be a reason for episiotomy I would imagine.

Since tears can heal quite well, it may be preferable to do that if you wish to take the risk - and lots of midwives actually enjoy the challenge of putting you back together and doing a good job of it after a tear . So its not straightforward to make the choice.

Personally (I am a FTM and 31 weeks and only recently realised perhaps I should think about this...) I have ulcerative colitis, so faecal continence is something that isn't great at the best of times... the risk of damaging that further than is already possible with childbirth does not appeal to me, therefore I would personally opt for the reassurance of an episiotomy if needed, so at least I know any further tearing is likely to head in a direction AWAY from my bowel...!

Sorry if TMI for anyone, but I felt I should put across my understanding.

I've had both. First time episiotomy to help me get her out after 2 hours pushing. Second one flew out second degree tear. The second degree was better but the epi also healed fine. I wouldnt worry too much honestly, by the time I had the epi I'd have let them cut an arm off if it would have got the baby out.

Very few midwives would do an episiotomy just to avoid a tear. The evidence suggests that this is not appropriate. Doing an episiotomy does not make the mother any less likely to have a third degree tear, if anything it is slightly more likely.
The fact is that if you chose to have an epis this guarantees that there will be a substantial amount of muscle involvement, if you don't have one you might well get away with an intact perineum or a small tear. Sometimes it looks as though it will be fine and the tear happens at the last minute and sometimes it looks as though it might be bad and it isn't at all.
I have done episiotomies for slow progress and fetal distress and twice (in 18 years) I have done one in the hope of preventing a bad tear as the women had unusually short perineums. This worked on one occasion, on the other occasion the mum had a fourth degree tear (didn't help that the baby was over 10lb!)
Whenever women put on their birth plan that they want an episiotomy I talk to them about it and advise them against it unless it seems necessary at the time and no one has ever refused that advice and told me they want one anyway! Having said that it is much more common to see that the woman would rather tear (on a birth plan).
As far as suturing goes episiotomies tend to bleed more and are deeper so from that respect they aren't always easier to do.