Anyone have any tips/advice to avoid an episiotomy?

[LillianFullStop]

Anyone have any tips/advice to avoid an episiotomy?

Of course if there is a risk to the baby and it is the only option then so be it - but I've read mixed documentation on the use of it these days. from it falling out of use unless in an emergency to some doctors still using it for non emergencies.

they don't ever tell you that recovery from it can sometimes be longer and more painful than a cesarean.

Do you think I can say that in my birth plan? To avoid an episiotomy unless there is a risk to me or the baby? Or even more extreme to say if it came to that I'd rather a cesarean than an episiotomy?

Giving birth in the water is meant to reduce the risk isn't it?

Why would you rather have CS than episiotomy? Not judging in any way, just curious.

Don't know about avoiding one but I ended up having one (DS was back to back and not budging so they went in with forceps) and it was not so bad.

Healed well and quickly - better than a tear would so they're not all horror stories!

I don't think it would be an either or situation - if baby is that low that an episiotomy would get them out then they'd be too low for a section?
I had one and my recovery was shit but would have been better if I'd avoided getting an infection.

Deliver standing up

Hi OP, you sound just like me before I had my DC1. I'd been reading Naomi Wolf on episiotomies and was determined to avoid an episiotomy at all costs, for the reasons you have mentioned.

Yes, I put it in my birth plan and made sure the midwives knew my preference.

But, when it came to it, it was the only option. DC1 was in a position that meant it was an episiotomy, or DC1 was at risk. It was nowhere near as bad as feared and DC1 was born a few minutes later.

What I will say is that, in my case, I healed from that much more cleanly and easier than with DC2, when I tore. Now THAT was painful.

Having been there, done that, and completely understanding your reasons, I would say yes, put it on your birth plan and discuss it with midwives. But keep an open mind. Because when it comes down to it, all that will matter is the safe arrival of your baby.

If you have been reading Naomi Wolf, I think her writing is from the American perspective, where births are much more "medical". It certainly hasn't been my experience in the UK that an episiotomy was performed as a default option (wasn't even considered for DC2).

Eposiotomys are most common with instrumental births. To cut the risk of an instrumental birth you can adopt upright positions in labour e.g on all fours, standing, sitting on a birth ball, leanibg firwards in a birth pool. This helps the baby get into a good position coming through the pelvis.

Also avoid an epidural or if you can't , delay for as long as you can. Epidural increases the risk if an instrumental birth and hence an episiotomy.

Generally, episiotomies are only done for Fetal distress and forceps deliveries. You won't even necessarily have one with a ventouse/kiwi, it depends how well your perineum is stretching. There is something called buttonholing where it also might be done, where the perineum gets holes in and can lead to a very nasty tear so an episiotomy is preferable. But that's rather unusual.

As others have said, it's not really an either/or choice as if you need an episiotomy the head will be far down in the birth canal, making a c-section very difficult to do. That said, if they were thinking about taking you for a 'trial' of forceps in theatre, where they're not completely confident they can deliver the baby with forceps, you could request to go straight to c-section instead. But it depends on where the baby's head is, position etc. as to how easy it will be to do a c-section as doctors do try to avoid doing them at full dilatation.

In terms of difficulty of stitching together, an episiotomy is considered on a par with a second degree tear. Most heal very well, I've seen a few recently where after a couple of days you could barely tell it had been done. That doesn't mean some don't get infected and sore, of course they do, but it's not guaranteed to be a disaster. My sister had both an episiotomy AND a c-section at the same time (failed trial of forceps) and she said her episiotomy didn't cause her any problems at all and healed very quickly, barely any pain but her c-section scar caused her a lot of pain. I know this is anecdotal but it's just to show that it's not a fait accompli that an episiotomy will cause you agony.

I always feel a bit sad when I see no episiotomies unless absolutely necessary on birth plans. I absolutely understand the reasoning behind it but It makes me wonder if they view us as scissor happy maniacs - I promise we're not! I've known midwives who've been qualified 2 years plus who've never done one. I saw once a labour where the head crowning was very slow - they suggested doing an episiotomy but as the baby was okay she refused so they didn't. They will listen to you.

As for avoiding one, there's not much you can do to avoid emergencies but the best way is to try and avoid having an instrumental birth. The best way is by being mobile in labour, possibly not having an epidural as it does tend to prolong the pushing stage of labour, thereby increasing your risk of having forceps etc. But equally if you're having a long labour and you're tired you won't be able to push well if you're knackered so you have to weigh these things up as you go along. But pushing in different positions rather than being semi-recumbent so being on all fours, laying on your side etc. can all help.

Try not to worry too much about it. Easier said than done I know but discuss it with your midwife antenatally and if there's time in labour, get the doctors to discuss why they might want to do one and the pros and cons of having one vs. having a c-section.

Also, if the baby's back to back/ posterior this makes having a long labour and forceps more likely. So being mobile, hip rotation, kneeling with your bum in the air (sorry, not very dignified) and apparently kneeling scrubbing floors is supposed to help the baby rotate. Look at the spinning babies website for positions you can use to help. There's also something called a rebozo which is supposed to be great for helping to rotate babies into a good position. I've never actually seen it used but I'm sure spinning babies will mention it, if not have a google.

Agree with others about avoiding instruments. The vast majority of forceps deliveries require an episiotomy (so they can position the instrument). Some ventouse deliveries require an episiotomy. And a smaller number of episiotomies ate performed on their own. So avoiding instruments should be your main objective I think.

No one's mentioned perineal massage in late pregnancy. There is evidence that for first deliveries it reduces the chance of tearing or needing an episiotomy/may minimise the severity of the tear. I'd do that too.

Having a competent birth partner also improve women's health outcome in birth. You'll need someone who can coach you (through breathing for example) and reassures you. Stating the obvious but someone with experience of birth is better than someone with no experience.

I had an episiotomy and the stitches never gave me a wince of pain. I kept asking the midwives to look at it because I felt some pinching but they said it was fine and eventually my dh broke it to me that I had an enormous bunch of piles hanging out of my arse - once I got anusol on that the punching went away

Perineal massage. It worked for me, I didn't tear either. And listen to your midwife, although you can't always avoid due to complications.

I did perineal massage and had four DC with no tearing or episiotomy.
I was offered episiotomy with DC2 and 3 both babies were biggish and both born with an arm up next to their head. I refused, the MW were fine about it and encouraged me to listen to them and stop pushing during crowning.

As an aside I have never had a birth plan. I could answer questions etc throughout the births and made sure DH knew important stuff just incase.

Perennial massage with almond oil
I didn't push much,the baby made its own way down & I pushed once it had crowned.
Had epidural & induction on all 4 and vacuum on no2.
Never had a stitch.

Is it a bit like stretch marks, your going to get them or not?

Had one twice. Key to very rapid recovery was my request saying that if I had to have one, I wanted it stitched by an expert, definitely not a student.
Second one took 45 min to assess and repair but both times I was complimented on the neatness a day later!
No regrets.

thanks for all the responses and advice. I think I will bring it up on my next midwife appointment - I want to know how common it is and their reasons for doing it besides fetal distress. I'm almost positive that even if I was exhausted and they suggest an episiotomy to speed things up I would find some magical store of energy to keep going. I'd like to know what the rates of infection are too.

Allthecarbs I think I have read more horror stories about episiotomy recovery than cesarean recovery. seems to be a very stark difference between one that heals smoothly and one that gets infected and requires months of recovery/antibiotics and further surgeries and pain during sex.

Wonder what the rate of infection is on episiotomies vs cesarean? I can see how it would be harder to keep the wound clean given where it is. I've read some hospitals send you on your way as having a 'normal' birth without much guidance on how to care for episiotomies whereas for cesareans they keep you in and keep checking your scar until they are happy you are healing well.

I think I will definitely try to stay as mobile as possible and not opt for the epidural too early. but I think the general idea is to avoid an instrumental delivery! Let's hope LO is not back to back.

If you have an episiotomy they will go through how to care for it appropriately before they discharge you, I was given a sheet to take away. The community midwives then checked my stitches at every visit (or at least offered to - towards the end of their visits I didn't feel I needed them checked).

My DS was back to back and got stuck in a corner - I needed forceps to deliver him so it was that an episiotomy or a caesarean. I can't imagine why anyone would choose major abdominal surgery over an episiotomy, the vast majority heal well. Mine caused me pain in the first couple of weeks - I was alternating paracetamol and ibuprofen and I definitely noticed if I didn't take them on time and the pain relief wore off - but it healed well. One of my friends has had one episiotomy and one natural tear and she said the episiotomy healed much more neatly than the tear did.

"I needed forceps to deliver him so it was that an episiotomy or a caesarean. I can't imagine why anyone would choose major abdominal surgery over an episiotomy, the vast majority heal well."

To avoid the (now very real) risk of serious injury to your pelvic floor which can cause urinary and/or faecal incontinence and/or sex pain because of increased scar tissue.
To avoid being unable to walk half a mile for 3 months after birth.
For example.

Knowing what I know now, in a situation where there's a choice of forceps or c-section I'd take the c-section.

pinguina those are rare complications. A c-section comes with its own risks.

No, I've had 2.

But highly preferable to a c section, which is longer recovery.

Try not to worry, it will be fine

I really think perineal massage worked wonders for me to. I used moisturise the area with oil everyday from about 4 months pregnant. I also think a water birth does make things easier on your bits.

Listen to the midwives and do exactly as they say if you can. I think that pushing too hard or too soon when your body isn't ready can increase your chances of tearing definitely which also can't be nice...

There is a device (I think it's German but it is also used in Australia and elsewhere) called an Epi-No which is supposed to stretch your perineum before birth, reducing the risk of an episiotomy. You can get them online here but no idea how effective they are - it sounds as if they're a more expensive way of doing perineal massage.

Can someone who has done perennial massage (or knows about it) explain exactly what to do and how long for?

Could I just use say E45 or some sort of almond oil on the outside? Or do you need to do inside too, and stretch it? Do you have to do it everyday? Several times a day?

I'm 7 months, should I start soon or is it already maybe too late?

This thread has me a bit worried.

You can get something called an epi-no.
It's like a little balloon that you place just inside the vagina and you blow it up until you feel a stretch. Think your meant to do it as often as you can to try and increase the amount of cm each time.
I've never used one but had friends who have and it's worked for them.
Have a look on google and read up on it. Worth a try :)

Me624 These are not rare complications I'm afraid. Around 5% of ne mums suffer severe tears. In some Trusts the figure is higher.
www.nhs.uk/conditions/pregnancy-and-baby/pages/ventouse-forceps-delivery.aspx
Prolapse also is a natural risk of pregnancy and childbirth and is much more likely after forceps, whether it's straight after the birth or ten years later. A prolapse means you won't be able to do high impact sport in running and jumping.

What sort of stats were you given when they asked for your consent? What risks did they give compared to an EMCS at that point? Did they explain the risk to baby and yourself?