episiotomy and subsequent births

[Focusfocus]

Hi all

I've had first baby three weeks ago and plan to have another in a couple of years time. I just wondered if this birth would in any way shape the course of the next?

I was in painful prelabour for 29 hours but apart from that labour was pretty textbook. I delivered on gas and air, kneeling upright, and had my hand around his head as it crowned to give me an idea if what was going on. So - when it turned out DS had a hand by his head, I requested for a small incision (it as my request and the birth was gradual enough to discuss pros and cons with midwife before the incision) and the epi was done and he emerged fine.

I needed 3 stitches which never really stung or caused any pain, there was a 125 ml blood loss in total over the course of the birth and I had no issues with incontinence etc. the epi didn't get extended by birth and there were no other complexities. FYI DS was born 8 lbs at 37+4.

My question is about the epi scar/implications on the perineum. How difficult is it likely to make a second vaginal birth? Does it put me at a significantly increased risk later?

I had a much bigger epi than yours and without pain relief so I was quite traumatised by it for a long time afterwards and it took forever to heal (infections, manual stitch removal, physio for months). I asked my gynae what might happen in future births and she said if I tear second time around then I would likely tear along the same scar. I'm now pregnant again so would be interested in hearing other responses. I can't lie, I'm a touch nervous!

Episiotomy with DS 1 here, as he was in distress -cord round neck.
DS2 "fell" out with 3 hrs of contractions start to finish. No intervention, as I laboured on my own til the last 30 seconds when medical assistance arrived.
So not a forgone conclusion.

I had an epi and forceps delivery with my DS. I had about 20 stitches, according to the doctor (he lost count!). I felt like I had been hit by a truck and couldn't get out of bed for at least 24 hours.

With DD I had no intervention but tore slightly in three places which was a significant improvement! I was out of bed within 2 hours after I had been stitched and baby had been fed.

So don't worry, every pregnancy and labour is different.

I had a forceps delivery with dd1 which required and epi. I'd had every pain relief under the sun. No idea how many stitches but it was very tender and painful for a good few days afterwards.

2.5 years later Dd2 arrived quite quickly and tore just a tiny bit. MW put in a stitch under G&A and that was that. Walked out a few hours later, no pain or tenderness at all.

I had episiotomies five times. I have no idea how many stitches I had any of those times. I didn't ask. I had a perineal block each time so felt nothing of the cut or any tearing. I imagine it would be hard to separate one particular sensation of pain from everything else that was going on at the time. Recovery was straightforward and quick every time.

The only time I did not have a straightforward recovery was when I developed a very painful thrombosed hemmorhoid that required lancing. This was not related to the episiotomy.

The post natal care package the hospital sent me home with included chemical ice packs, which you can get on Amazon if your hospital doesn't supply them. Google perinatal ice packs. The ice really helped for a few days.

I don't know why episiotomies are dreaded and considered a negative. Extensive tearing is far worse. It doesn't make a subsequent delivery any more difficult. It doesn't put you at any risk of anything later.

If you deliver vaginally either with or without an episiotomy or tearing you need to do your kegel exercises religiously.

I was up and walking around a few hours after delivery each time, taking showers, and when going home, up stairs to the second floor apartments I lived in. I was discharged within 24 hours of delivery each time thanks to hospital policy -- I would have left earlier if it had been up to me.

Math if you don't know why they are dreaded and considered a negative then you are very lucky. Read my post above. Trust me it's very easy to separate that pain from all the others and I relived it many times afterwards. I find your comments highly insensitive!

Btw an early discharge means nothing. You can be walking around and still have problems which don't come to light straight away. The swelling of the stitches doesn't happen for a few days and makes the pain so much worse (I couldn't sit down for a week, yet I had no problem sitting for the first three days). Continence issues are also something which you don't necessarily spot immediately.

I had a big epi first time after horrendous labour, subsequent recovery was terrible. Was very worried about dc2's birth.
Anyway he came much more easily 21 months later- no epi but did suffer small tear...but he was nearly 10lb! (First 7lb5)

I had an epi and ventouse first time round due to fetal distress. When I got pregnant again I was terrified about tearing the scar tissue, to the point that I actually requested an episiotomy (thankfully the midwife said no!). Baby number 2 was a lot bigger but I only ended up with a small graze and the previous scar tissue didn't tear at all.

Thanks everyone, every useful to know. I'm so sorry to hear of your experience lostindubai - childbirth carried just so many uncertainties and painful possibilities :-(

Focus, that's true alright! I'm glad you asked the question though because I've found some of the replies quite reassuring.

Congratulations on your baby btw!

I had forceps and episiotomy first time. A tear along the scar tissue second time and a graze the third.

I was told that there is a slightly increased risk of tearing if you've had a previous episiotomy, but nothing that they would consider material enough to affect your care. And DD2 did shoot out like a speeding bullet. Was more controlled third time!

Lostindubai, I saw you were interested in hearing other responses. My post was a response. I think with proper care to use anesthetic and above all good nursing care in the hospital afterwards, plus something like the perinatal ice packs there don't have to be complications.

My discharge from hospital wasn't early. Most women in my neck of the woods got sent home at the 24 hour mark or first thing in the morning after that point.

A tear that is deep and uncontrolled might also result in a complicated recovery and another where the first tear was in a subsequent delivery. My obstetrician used to travel to Africa to teach health workers there to mend and prevent obstetric fistula. Tearing can have very serious effects. If serious complications was the norm after episiotomy or in subsequent deliveries then the practice wouldn't be as widespread as it is. It sounds as if you were really unlucky and perhaps the care you received was not up to par. With anesthesia, you should have felt the icy cold sensation of the block and nothing more.

Ice packs can be bought online if they are not supplied by the hospital, and they help - I was sent home with some from the hospital along with advice on how to use them and for how long. Continence issues can be headed off by taking kegel exercises seriously. An episiotomy should not interfere with getting these started soon after delivery.

My DC1 was 7lbs5ozs - I had an episiotomy, and DC2 was 9lbs4ozs - ventouse and episiotomy followed by a thrombosed haemorrhoid. The remaining three of my DCs were close to DC2's weight and I had three episiotomies but no more ventouse. Youngest DC is now 14 and I have had no issues since recovering from her delivery.

I had a ventouse with the associated episiotomy - incredibly painful post partum and I struggled to sit down at 6 weeks. I had some sort of scar tissue excised about a year later. 2 subsequent deliveries were very easy in comparison - no episiotomy and only tiny tears which didn't require any stitching and didn't give me any discomfort or pain, I only knew about them because the midwife told me.

I understand episiotomies can be scary things, but you are well numbed (I didn't even feel the needle going in, and I have a massive needle phobia) and it's much better to have a controlled snip than an uncontrolled - and potentially far more damaging tear.

I had an episiotomy for ds1, much bigger than yours op with more stitches, I recovered Ok though.

Ds2 I had a small tear that required a few stitches, ds3 a graze, Ds4 nothing at all and dd again no tear or grazes etc.

I am expecting dc6.

All is fine I could feel.the scar tissue for a while after ds1, I did some perineum massage to help and it was fine.

Pelvic floor exercises are a must in pregnancy and forever really, they should be taught with Sex ed at school. And they will help with healing.

For a long time episiotomy were standard and just given to women, now they tend to be if you look like you will tear etc or you need forceps or ventouse , you can also refuse if you want. I had mine with ds1 due to three hour pushing stage, he kept crowning and going back up again.

They should numb you but it doesn't always work and somwtimes in an emergency there may not be time but they should explain everything to you.

It sounds like yours was small op and has healed well so it's unlikely to affect future deliveries.

Yes. It's a balancing act. Routine episiotomy is not a good thing. But they definitely have their place. And they don't have to cause problems in later deliveries.

I found the stitching after ds2 much worse Btw, apparently my tear though small was unusual in direction/placement and the local anaesthetic was not working well. But they gave me gas and air as well and whilst the consultant was stitching I had another midwife who held my hand and helped with my breathing and keeping me calm. The consultant was very apologetic and kind. They really made sure to reassure me. Part of the problem was as my tear was unusual they wanted the consultant to sew it, this meant waiting a few hours by which time I was a bit swollen and bruised which probably contributed to the pain and discomfort, but it healed very well and I was at toddler group with ds1 and newborn just a few days later!

I had an episiotomy for DD1. DD2 was a straightforward birth but I didn't tear along the scar, I tore in the opposite direction. It was a second degree tear but took longer to recover from than the episiotomy (I had no pain during sex after DD1, it took a long time after DD2 was born to have no pain). DS I had a second degree tear again but that healed very well and I had no pain during sex after he was born, although since we had 3 under 5 for a while there wasn't a lot of sex going on when he was little.

I had a large episiotomy for my first birth, which took months to heal, and was very nervous then for the second birth. I ended up with a small tear and 3 stitches.

I understand how episiotomies can be traumatising for some women, it was for me. So I know where lostindubai is coming from. Although I didn't feel the local (if I had any?) or the cut, I felt traumatised because I didn't want it or ask for it. My mum even told her "she doesn't want it". I didn't hear the conversation at the time but my mum said she said "this baby needs to be born"... and why couldn't they tell me that afterwards? A bit inconsiderate!
It was done in an emergency situation and felt like the doctor burst in and just cut me in haste. Turned out my son's heart rate had dropped, they didn't say a thing and I found out 3 years after!

It's just the thought of someone cutting you down there with a pair of scissors! No, no, no, no, no! But then to find out your baby was at risk relieves the heavy weight of the concept of that procedure but you're still left with the trauma. It definitely depends under what circumstances it's done. If it's done with informed consent, and discussion I think it's less likely that the woman will feel threatened. But if it's done in a rush with little or NO discussion (or consent is not obtained) then it's more likely the woman will feel attacked!

I feel absolutely petrified of giving birth vaginally again. I felt so abused after I had my son and I never got over it. But in terms of scar tissue playing a part in subsequent births... you never know. I think gradual delivery of the baby's head should be monitored more after a cut or tear. Surely it's not good at all to have too much scar tissue there?

There is hardly ever time for much discussion or informed consent that would follow. A doctor tells you the baby will be born in under five minutes and needs to perform an episiotomy in order to minimise risk of tearing -- you have only a few minutes, at a time when you are completely preoccupied, there is a lot going on, you are told the baby is in some sort of danger, your partner is all for it/hears something different from what you heard, etc.

Before my first baby I intended to deliver without pain medication and to have no monitoring or surgical intervention unless absolutely necessary. DD1 threw a spanner in the works. I had an epidural and some pitocin, and she had internal monitoring, and a CS was on the cards for a while. I ended up delivering in the theatre as labour speeded up tremendously while I was being wheeled there. DD1 recovered very well.

Birth rarely ends up going exactly as a mother might like it. Women are encouraged, falsely I believe, to think we will have a say and that our preferences will be honoured. We go to hospital with a false sense that we will have some control over how things pan out thanks to the assurances that we will have pools and birthing balls and showers available, and that a unit is midwife led, or whatever. Words like natural and woman-centered are bandied about. Very often your experience of pregnancy has led you to hope that staff will treat you as well as your family and friends have over the past few months, and that they care as much about you and your baby. The fact is that once in the hospital you get exactly what everyone else gets by way of attitude, and you are treated like a number in most instances. Even without events like internal exams, staff insisting on a drip, monitoring, having to fight for an epidural, and an episiotomy or CS that you hadn't counted on and weren't properly discussed, delivery can be traumatic, and poor nursing care afterwards can leave you feeling you have been treated like a slab of meat.

Having had a doctor's practice and one midwife for five deliveries who were really good at gradual delivery of the baby's head, I can attest to the wisdom of that practice. I had mediolateral episiotomies. I knew the possibility of episiotomy existed because I had discussed it ahead of time with my doctors and midwife (in a system where you see the same hcp throughout pregnancy and s/he attends your delivery too).

^ They had enough time to tell me "You're getting a bit tight" but not "Your baby needs to be born now!"
I was on G&A and fully aware of what was happening... If they had told me I would have known why they were rushing and panicking. I felt like they gatecrashed my birth for no reason, just for convenience because they were ready to get it over with as my labour had been quick anyway, so "might as well finish her off". They didn't even encourage me very well or tell me how close my son was to being born, so was shocked when she said it. I had no idea he was that close. I think they were lining me up for an episiotomy all along, telling me to "Push! Push!".

It's such a shame that you feel that - I can imagine that you feel as if it was beyond your control.
I had the opposite experience - I had been pushing for ages and was exhausted. I requested intervention which I got in the former of a venture and he was born within minutes. I really felt as if I was in control. Completely agree that it's not always possible to make that decision or choice though.