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?

Yes but many of the things you're talking about are risks of vaginal childbirth generally. Forceps may make them more likely - though I'm not sure having an episiotomy makes them more likely which is what the original post was about.

I couldn't tell you what was said to me about risks etc at the point of deciding to use forceps. I was completely out of it having been in active labour for approx 18 hours and would have agreed to them doing anything they wanted if it meant getting the baby out!

I assume you had a difficult forceps birth and obviously I understand that you would want to share that. But it is often the case that the bad stories get shouted about a lot more than the good ones on the internet so I just wanted to share my story of an entirely complication free forceps birth. No incontinence, no prolapse (yet!), pelvic floor is as strong as ever (lots of exercises before and after giving birth) and my episiotomy has healed perfectly.

"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"

maternityindicators

RCOG figures, adjusted to control for risk profile of mothers at different hospitals. The national average for episiotomies is 35% (first time mums) but you can see that in some hospitals it's massively higher, and in others massively lower. Clearly there ARE some scissor happy HCP out there.

OP - if you don't want an episiotomy

• employ an independent midwife (massively lower rates of episiotomies and higher rates of women who are completely intact after birth)
• have a waterbirth
• avoid epidural
• stay away from labour ward if possible
• if possible not be induced
• perineal massage

Good luck!

Put your hands down to feel baby crowning yourself! Go slow and breath baby out. Don't push through the pain, the 'ring of fire', stop. And slowly push and stop again. Read Ina May Gaskin.

I had an episiotomy with my son because of his sudden dropped heartrate and I was just disturbed by it. It was the one thing I didn't want and, long story short, they didn't even tell me why it was done. I wouldn't have "needed" one naturally.

I plan on a homebirth now I'm 19 weeks pregnant nearly 5 years after my son's ruined delivery. Unfortunately you can't prevent emergencies sometimes but as they weren't physical problems last time I'm hoping it goes smoothly this time. I had a quick natural labour until I got cut so I was devastated and I'm hoping the same doesn't happen!

I had an episiotomy because my dd was back to back and has got stuck and was in distress. I had been on all fours the entire time in labour and bounced on ball etc but she still ended up back to back. I'm not sure what else I could have done! I was really grateful for the episiotomy as I was starting to panic and had been trying to push her out for two hours with no success. At that point I just wanted her out and safe. It wasn't too bad at all but I did get stitched by a student and I did have quite a difficult recovery in that I was in pain for a long time afterwards but a lot of that was bruising where dd was stuck.

I think a vaginal birth will always have these risks and c sections have risks too.

I'm pregnant now and hoping for a water birth this time as I am hoping that will help. J did want one last time but didn't get to the hospital in time.

You can say what you like in your birth plan, but the advice people usually offer on these threads is don't get too caught up on your plan, labour is a dynamic experience and you can't predict how you'll feel.
I had episiotomies during both DC1 and DC2's births and a 2nd degree tear after DC3. I did perineal massage before 1st and 2nd births but don't think it made any difference. You might as well do it in case it helps. I couldn't be bothered before DC3 but the stitches healed fine in all three cases.
It's hard to explain to someone who hasn't been through it how little you'll care what your birth plan said and how much you'll just -agree to anything to make the agony stop- want to get it over with when you're in labour.
Try not to stress about it now, because the evidence doesn't suggest that if you do need an episiotomy there's anything you could have done beforehand to avoid it.

I would avoid an epidural, and try to give birth in water for your best chances of avoiding.

Having said that, it's not the worst thing in the world if you need one. I had one with dc1, as I'd been in second stage a long time and was on the point of needing forceps. The midwife gave me an episiotomy and then one last chance to push - and miraculously I pushed dc out without needing forceps. The midwife will give a shot of local anaesthetic (assuming no epidural in) which isn't particularly pleasant having a sharp needle in your bits, but it numbs you so you won't be aware of being cut.

I tore quite badly with dc3 which was infinitely more painful (no pain relief!) and according to my medical notes required a far greater number of stitches. I was quite annoyed afterwards because he shot out far too quickly, and if the medical staff had been more aware he was ready to crown, it could have been properly controlled, or I could have been given an episiotomy.

Recovery time was the same with each; I think if you are lucky and avoid any infections the healing is usually ok.

I laboured in water (but got out to deliver as always ended up feeling too warm close to then end) which I'm sure must help as all tissues are softer after a long soak!

And I also did perineal massage with all 4 pregnancies from about 7.5/8 months onwards, 3 to 4 times a week. I had a slight graze with DC1 who delivered with her hand on top of her head and nothing at all with the other three. I used extra virgin olive oil because the name made me snigger!

Also a midwife should not offer an episiotomy just because delivery is slow or you look tight. Looks like a big baby... Maybe. Going slow is what helps avoid tearing and helps to stretch sufficiently. Defeats the object otherwise. It's not the 70s anymore where they cut women that may not have torn in the first place. Patience is their problem.