Question about episiotomies

[Molotov]

I had an episiotomy with dd1 in 2009. It healed fine but I was very uncomfortable for ages and it took 7/8 months for sex to feel bearable okay again.

I don't know why it has just occurred to me, but - what is the equivalent of an episiotomy in terms of tearing, as muscle is cut as well?

TIA

Do you mean what happens if they don't do an episiotomy?

I tore naturally, second degree, the midwives let me and it healed fine. I guess it's not straight like an episiotomy

Thanks Girl.

I meant in relation to what damage is done. You hear of a 'graze'; first/second/third degree tear, then an episiotomy is something on it's own.

An episiotomy is more than a graze, but less than a third degree tear, iyswim? (Good Lord, I hope I'm making sense!)

I remember the sound of being cut. Very odd

I believe that the degree of tear is related to which part of the anatomy is actually torn, although I am happy to be corrected by somebody with actual medical knowledge. I'm basing this off the fact that I had an episiotomy but then had a 3rd degree tear as well. I was told by my Gynae that it was classed as 3rd degree as it involved the sphincter muscle.

I thought the degree was based on how bad it was? Eg how deep it went so 3rd would be right through muscle?

An episiotomy (that didn't extend) would be the 'equivalent' of a second degree tear as it involves the skin and the vaginal muscle but not the anal sphincter.

Ah, thank-you all That makes sense, Seattle.

My epi was classed as 2d as was conventional, as Seattle says.

Please realise that not all episiotomies are necessary. I've just had my second baby and only for I didn't consent, almost had one that I did not need. I didn't even have a graze. Active management of labour-some units to them routinely. Check your Epis rate per hospital and care giver before deciding where to birth.

Thanks for that, becky. Hopefully that information will be of use to someone considering their birth options.

For me, the episiotomy was necessary. I'd been labouring for almost 2 days, pushing for 2 hours but she and I were exhausted and she was stuck. She was born via ventouse and I was glad about that.

The aftermath of an episiotomy was a shock to me. All HCPs said was that after 6w, all will be well. It took 7m for my fanjo to feel better!

I didn't do any research into the hospital where I first gave birth. I went there because it was the closest one. If I had known what it was like, I wouldn't have gone. The place should be closed down, I think. Awful management of dd1's birth.

The problem with a tear is that it's undirected. It follows the path of least resistance, which is often towards the anus. If you tear in that direction and get a third (involving the anal sphincter) or fourth (right through the sphincter, essentially making vagina and rectum one cavity) degree tear then you can have faecal incontinence.
An episiotomy is a deliberate cut made away from the anus. This means that the path if least resistance is now to follow the epis (should it need to extend any more) or widen the vagina to get the baby out with the equivalent of a second degree tear, thus protecting continence.
Without a crystal ball it is impossible to tell who will tear, by how much and in which direction. Sometimes an epis isn't enough and it extends or you tear as well, but again, hopefully less so or in a 'better' direction than without.
They are bloody horrible (mine was so painful but has fortunately now stopped hurting. At least for walking/sitting. Haven't tried anything else yet) and yes, some will be unnecessary, but you don't know which ones are because you can't 'go back' and see who would have had a 3rd or 4th degree without.
For instrumentals, where there is more than baby coming out, I think the odds of tearing are higher, hence a 'prophylactic' epis.
I think if rather have an epis if they thought I might tear than risk a third or fourth degree and incontinence.
And for those who think that a tear is more natural and therefore heals better - then why do scars from trauma look so rubbish and scars from surgery less so. Cleaner, less ragged, more controlled. Ask any plastic surgeon which they prefer for a better cosmetic result.

I definitely needed one - dd was coming out like a bullet train

Didn't even know I'd had it until my amazing midwife was sewing me up and it healed absolutely fine.

Lucky.

Thank you Jcb77. I, for one, feel better after reading your post.

Yes, me too, jcb - thank-you for your informative post

Fwiw, I had an elcs with dd2 - a direct result of the bad management of dd1's birth (the episiotomy was the least of my worries).

It was maternal request and the OB tried hard to put me off at the time. I told him that, amongst other , more pressing? concerns, I'd already had an episiotomy and would that make me likely to tear along that old scar line?

"It doesn't really matter. The vagina is made from many folds and lines and will tear naturally and come back together again. It's what it's designed to do".

I shot him such a look. If only I'd had the gracious answer of 'the path of least defence'. I remember thinking 'how do you know? And would you talk about it so casually if it was you risking ripping from your bollocks to your arse?"

I asked for an epi because like Molotov I had a stuck baby and she was in distress and I simply couldn't push her out without it.

She was born not breathing and didn't breathe for several minutes after birth (she's ok now though). I wish they'd done the epi earlier.

Anyway, just to say that it's not always about tearing or not tearing.

(Oh and mine was very neat and healed absolutely fine.)

The thing about a cut vs a tear is that if you have a cut, its MUCH more likely to tear than an already intact perineum.

Take a tea towel. Snip- just a teeny tiny snip past the hem. Now pull to stretch and you'll see how easily that snip extends.
Take an "intact" tea towel and pull to stretch. You need to pull VERY hard to create a tear.

Mother-Led pushing (when your body urges you and not a second before!)
Birthing up right
Warm Compress as baby is emerging
Breathing baby down

Will all significantly reduce the likelihood of a tear.

I appreciate your reply becky and, drspite what I am about to say, do not want this thread to turn into a 'tear or be cut?' debate.

As many posters have already explained, often the epi is made as a prophylactic choice to get the baby out aa quickly and safely as possible. For as painful as it was to recover from, I was relieved to be cut and have her delivered safely. I dont like to think of what could have happened had she stayed stuck. Likewise, I am aware that there was a risk of a larger extended tear, but better that it tore away from my bumhole.

To be truthful though, that wasn't what I was thinking in the delivery suite. It was more like 'please just cut me and get her out safe!'

A friend of mine declined an episiotomy in 2006. She tore quite badly (3rd degree, I think); was not sewn up and healed appalingly. As in, not straight. She told me that her urine no longer flowed in a straight line; that she pee'd to the side. She had to have a cut and re-stitch (Fentons Procedure?) 12 weeks later.

I think it's prudent for any woman to inform herself of the mertits and demerits of any mode of delivery, and assess which risks/benefits she is prepared to take. Of course, this can't always be predicted, but with hindsight its better to go in with your eyes wide open.

I don't know if this is true Molotov, but I was told that you were more likely to tear by an old scar line than along it. Because the scar tissue itself is pretty thick, so the weakest point is the stretched skin just next to it.

I'd rather have an epi than a serious tear, but at the same time I have had episiotomy, second degree tear and then a graze. The recovery was directly in reverse order of that: graze fine in a couple of weeks, stitches took longer, episiotomy took months and months. So I would trust the judgement of a medical professional who seemed to want to avoid an episiotomy if possible - if they told me to go ahead, I would.

Oh, also. Although they were equivalent (i.e. would both have been second degree if a tear), the tear healed a lot better than the episiotomy. The whole business about surgeons wanting a neat line makes sense to me (Dara O'Brian does a great sketch about it), but I don't know if my experience was just luck, or something else.

I was very happy with my episiotomy. Had DS at home, was in labour for about 7 hours, so not overly long for a first time birth but he'd wiggled himself round back to back and had his hand up near his face (didn't know any of this till afterwards, in hindsight realised they were probably asking me to try different positions to unblock him, before they suggested the epi as he was getting distressed and wasn't really budging. )

Healed pretty quickly, in fact before everything else felt fully settled back to "normal". Yes it was painful to sit on for the first few weeks, but I was really surprised how quickly it healed up - by eight weeks DP reckoned he couldn't actually see where it had been.

Thanks, penguins. I certainly dont know enough out tears over old scars - it was just something that was on my mind at the time.

I genuinely love to hear women's very empowering birth stories with regard to active birth, breathing the baby out, etc, but it just wasn't that way for me. I laboured for 31 hours with dd1. It was ridiculous. I got sent home 3 times and they almost sent me home a 4th, except I went from 2-6cms in about 20 minutes.

I tried to stand and do the whole active bit, but after a certain time, it was just impossible to stand. I didn't have the strength.
Then she got stuck low down in my pelvis and 'crowned' for 2 hours, bulging and retracting with each contraction (bouncing against my tailbone which was agony).

I was exhausted and she was distressed. I remember the midwives doing their obs the next day and they couldn't get me vein up to take blood. When they did pop the needle in, it only gave less than half of what the MW needed. I was so bruised between my legs, she asked if the med students could have a look see.

'Erm, no. And close the curtain on your way out'.

Ouch! My first was days long too. I had no choice but to be 'active' because any sitting or lying position was agony (b2b baby). But then I had synto, epidural, forceps for foetal distress, etc, etc.

Second two were better, thankfully.