Episiotomy - should this bother me?

[questionfromme]

Had my DS (first child) last Thursday.

All went fine (well, you know, it was still childbirth so it's all relative but you know what I mean!) except I came out of it with an episiotomy, and separately a 2nd degree tear somewhere on the inside.

DS did have a head on the 98th centile at the scan so I knew both were a possibility and beforehand the idea horrified me but frankly the reality hasn't been that bad at all.

Healing and stitches have been fine (touch wood!!!) I'm taking it easy but still able to sit, pass urine without any stinging etc etc.

So what's playing on my mind is I found out in the past couple of days it's not usual to have an episiotomy without clear reason. Is that true? My pushing stage was 40 minutes, DS was not distressed as far as I know, there were no forceps or ventouse. The midwife did not consult a doctor first (I gave consent but of course I'd have given consent to anything at that point).

I feel like I must have been cut 'just in case'. Should this bother me or am I making a fuss about nothing? I can't decide whether I should be following up and asking questions or if it's not that big a deal and I should just leave it. Especially as the recovery has actually been ok so far.

Anyone?

not unreasonable to ask.
There probably was a reason (sometimes done if starting to tear oddly or if baby's head stopped advancing at the perineum) but it sounds like it either wasn't explained or the information wasn't retained.
Ask your community midwife about how you would go about having a notes review with someone. Locally we call it birth reflections.

I think the use of episiotomies has really reduced, I know 20 years or so ago they were standard practice. Most of the stuff I read handed out at hospitals and by midwives stated that it's better to tear naturally than create a cut bigger than needed. However, if they are at all concerned, they will cut rather than risk a bad tear.

I had one 15 months ago, also 98th cent headed dd and mine has healed absolutely fine, and very quickly.

Yes, when I had one with ds1 and I had to sit on my leg for two weeks. It was still stinging like mad at this stage. I used to treat myself to a wee in the bath for that concentrated first wee of the morning. I did clean it after! Then I'd line up wet toilet roll to place on 'the area' after. It it doesn't smell or have a discharge it should be alright. I did bathe with a couple of drops of tea tree oil in the bath.
Congratulations for your baby!

Congratulations on your baby :) and hurrah that you feel alright!

So is it that it seems you were cut to prevent further tearing? I'd rather take an episiotomy and a lesser tear personally than just one big tear. For example, I had an episiotomy and still had a 3c tear, so I'm grateful I didn't go the whole hog and have a 4th degree.

Or is it that they didn't ask your consent? Because I agree that's a bit irksome especially if there was time to ask!

Lavender oil is great for this. A few drops in the bath help with inflammation and is also a natural antiseptic.

Thanks all. That does make me feel a lot better, knowing that a) there can be reasons other than baby being in distress and b) not everyone has a terrible recovery and thinks it's the worst thing in the world.

Overall it was a very fast delivery and from memory (which is hazy) I do remember him being stuck at the crowning point for the majority of the pushing stage. So perhaps that was the reason. I may decide to ask though. Flicked through my notes after but don't remember reading that bit and have been discharged now so would need to request them I guess?

This all came about because I googled 'episiotomy recovery' thinking I'd pick up some good tips for making sure all goes ok, and came across loads of women talking about how traumatised they were. To be fair their experiences did sound dreadful so perhaps I am lucky.

I believe that episiotomies are given nowadays only for very good reason. If your baby was larger than average, I would guess that you had the episiotomy to either simply enlarge the vaginal opening, or, to give control to a tear they saw as inevitable. Perhaps the midwives thought you were going to tear, and so snipped the perineum to move the tear site away from your bottom.

You can ask the hospital where you gave birth why you had the episiotomy.

Congratulations on your newborn!

bendy it's not the consent thing - I dont really mind that. I was asked and did say yes, but frankly I would have consented to having my arm chopped off anyway! I had a very intense and quick labour and wasn't hugely coherent by that point.

It's more not understanding why it happened, why it happened so quickly (I thought I'd picked up elsewhere that you can spend two hours in the pushing stage if no worries about baby - mine was only 40 minutes), why the midwife didn't ask for a doctors opinion first, why she didn't suggest trying a different position instead or something. I guess just having confidence in the treatment I was given, which looks awful written down.

p.s. And I only just found out the episiotomy is off to the side!! To me that is FAR better than back towards the rectum.

Does make me feel I could have done a bit more research before childbirth

Thanks for all the flowers and congrats . He's perfect!!

Ah yeah. It is hard to come to terms with a quick labour in a way, especially if you were expecting it to be much longer as everyone says it will be. My labour was 40 mins so I feel ya.

does make me feel I could have done a bit more research before childbirth don't beat yourself up, you can't be prepared for every eventuality!

Thanks bendy. 40 mins in total?? Wow that is fast!! My second stage was 40 mins, first stage a bit longer though but still quick especially for a first (who was also not in a great position which I thought was meant to slow things down).

Did the speed of delivery contribute to your tear?

Ds1 was crowning but not moving beyond. I think that was why and it had been 2 1/2 hours of pushing and he was back to back. It didn't put me off having another! I didn't need the episiotomy second time. As my friend said pea out of a Wellington boot! I don't think you'd have been given one unless you needed it.

Well I was induced so took a few hours to get going, then went from 2cm-delivery in 40 mins. I had forceps but I do think the speed must have contributed too! I also had a meanie midwife who kept telling me as a first time mum and an induction I'd be there for 48 hrs and then need a section helpful. Haha I sure showed her! I was just pleased it was over quickly!

I hope you continue to heal nicely :)

Honestly?

Depends on which hospital you are at.

If you look at the stats there are clearly hospitals doing it, with far less justification than others due to the huge variations In the percentages done.

Re doctors opinion. Not necessary and they would have advised for an epis to speed it up

red that's interesting. Where are stats found?

I don't want to sound ungrateful as obviously I'm hugely grateful that DS and
I got through everything ok.

I had an episiotomy and a 3a tear with DS. When I saw the obstetrician about my next birth, he said that having an episiotomy undoubtedly prevented worse tearing (DS was only 6lb but turned at the last minute). Now 38 weeks with DS2 and waiting to see if I tear again!

I had episiotomy with both of mine. First one was a forcep delivery, baby was 6lb 8oz. Second was because he was a bruiser 9lb 9oz delivered at 37 weeks. Both of them were back to back too. Midwife didn't want to do episiotomy last time but I just knew I couldn't get him out. She admitted afterwards I probably would've torn from front to back if she hadn't done it. I'm now 11 weeks postpartum and everything is fine. There's just a faint scar and no pain during sex. They probably did it to stop you having a worse tear. Congrats on your new baby 👶🏻👶🏻

Also re. Epis and extensive tearing, epis are more likely to cause 3rd and 4th degree tears

indicators.rcog.org.uk/

RCOG site. You have to hunt around a bit (Go for the results).

The graphs really highlight how hospitals are so different to each other.

The Royal Free London NHS Foundation Trust has a rate of 50.8% for ALL VBs.
North Bristol NHS Trust has a rate of 16.2% for ALL VBs.

(Note: The above figures include instrumental deliveries. There is no figure for deliveries without instruments. The national rate for first births is 35.5% and for subsequent births its 9.2%. There is also a rate for instrumental births only, but I won't put that here as it will confuse the issue. However its a figure that does suggest that the majority of episiotomies are linked to instrumental deliveries).

So I have to say I very much dispute the idea that 'episiotomies are given nowadays only for very good reason' as the figures seem to tell a different story.

That's not to suggest that your particular case wasn't appropriate. Its just that it is clear that different criteria are being employed from hospital to hospital.

I have done 4 episiotomies in 8years. This is around the same rate as fellow colleagues. However, some older midwives ie. Qualified longer, do them a lot more frequently as that is how they were trained. Doctors do Epis very frequently, almost all instrumental births and if they get their hands on a normal birth they are keen to do them to speed things up.
In the OP case she said the head sat on the perienum for most of the pushing so this is probably why the midwife did the Epis in the end. Midwives usually do them for rigid perienum, fetal distress, heavy bleeding, perineum not stretching any further after head sitting there for long time.

The reason hospital rates vary could be based on age/length of qualification of midwives and amount of agency staff. I see agency staff giving Epis more frequently

I had an episiotomy as I wasn't stretching enough and they were afraid of a bad tear (or, as my obstetrician put it, "You have a tiny bottom"). Anyway, I was prepared for the recovery period to be really painful, I had my spray bottle ready to use when I peed and was written up for strong painkillers.

I'm not exaggerating when I say I didn't have a moment's pain from it, ever. Never used the spray bottle, no painkillers, nothing. If I hadn't been told they were doing it at the time, I'd never have known.

I've not read the whole thread but if I was you I would just forget about it and move on but if you have another child mention it if your worried about getting another one.

Episiotomies give me the fear ive never recover from it though no problems with the tears, i asked why it was done they said it was to make space for the forceps really at the end of the day it was done and I cant change it so no point worrying about it. For ds2 coming in going for en elcs I can't face another instrumental birth and episiotomy.

That's v interesting that there is so much variation even amongst midwives.

Mummyme87
Performing 4 over an 8 year period- do you feel it's something that you get de-skilled at?

I think sometimes it's luck of draw which midwife you get during labour.