Avoiding instruments/episiotomy! Suggestions...

[MissingMyHeels]

I am seeing my consultant tomorrow morning to discuss my birth plan etc and potentially discuss induction. I was booked for a El CS on 28th Feb but a few weeks before my consultant (at a different hospital) decided I could labour naturally as he believed my hairline fractures had healed. Great!

I am now overdue and have been really thinking about what I want/don't want in order to talk things over with my consultant. Is it possible to request a CS at the point of them cutting me or deciding to get the instruments out? Or at that point is it just up to them what they do or too late indeed for a CS?

Just wanted to say that episiotomy is not the end of the world - I've had three - you barely notice the cutting and they do the sewing up with great care and excellent pain relief. I'm absolutely certain that it takes less getting over than a c section - and I think by the time you get to that point it is really too late to do anything else unless baby is stuck.

If they start talking about an instrumental delivery, they MAY also talk of CS, but normally it is to 'late' for a CS, and they will only do that if instrumental doesnt work.

xx

p.s. have faith in what your body can do, it is amazing!

good luck, i hope all goes well. xx

the two major things you can do to reduce your risk of an epi and instrumental deliver are:

do not labour on the bed, or still , keep moving and active so you can work with your body, all fours or supported squat are two good positions to open up the pelvis . labouring in water is good for supporting hte perineum too

also, tyr to manage without an epidural, the relaxation of the pelvic floor can stop the baby;s head rotating correctly, necessitaing instruments. also, unless you can get a mobile one, your mobility will be reduced to virtually nothing.

I keep scaring myself silly reading birth stories about people who have cuts and then they are incontinent/can't have sex/no control over anal sphincter etc. I think I should maybe just stop reading...

If I write on my notes for my midwife to make me move etc would they then encourage me to get into good positions? I'm worried I'm going to forget all the active birth stuff as soon as I'm in labour!

Hm, have you been reading my messages on the other thread? If so, then you should probably know that I was exceptionally unlucky that I had an OP baby, she was big, she didn't turn (at all!) and that my scarring has healed very badly. 95% of OP babies turn during labour (and that's 95% of all OP babies, probably half of which have the woman labouring on her back, and you can greatly increase the chances by being active, as I was). The great majority of women who have an episiotomy are perfectly capable of sex after the 6 week check-up (although I reckon that most are too tired!). Like I said, I was really unlucky.

I think that my birth experiences were 100% down to genetics. There have been similar experiences in my family on both my Mum's and my Dad's side. Luckily for you, you're not in my family!

Too late at that stage plus you really won't be half as bothered as you are now 'cause you'll just want the baby out.

Try not to worry.

I had read that MrsTM - sorry you had such a bad experience - I have also read lots of other birth stories and my Mum had very bad tearing with me. It doesn't seem to be that uncommon, although I guess maybe lots of the people who post online about birth stories are people looking for help regarding traumatic labours etc?

I feel like it'd be quite nice just to fall asleep and wake up with it all done and delivered. I seem to have SO many decisions to make which I know logically is a good thing but equally seems like a big responsibility. I keep having these dreams about the baby dying if I refuse induction/have an epidural or pethidine etc.

dreams ./nightmares are normal at this stage.

FWIW, 3rd & 4th degree tears that are so severe that a woman's continence and sex life are dramatically affected are rare. terrible, but rare.

i had a VB of an OP baby,who remained OP, and not a tear..had a small graze internally, but intact perineum.

so that is the polar opposite to MrsTM;s story.

and you are more likely to hear bad stories, as part of the healing process is to tell and retell teh story over and over

it is highly unlikely you will forget to move when you are in labour.. but you can certainly put something on your birth preferences for your MW and birht partners to remind you to move

if you are unmedicated ,i.e no opiates or epidural, you will most likely work intuitively with your body and move as you need to

Thanks Lulu, I thought I was crazy thinking all of these horrid things. I'm going to go back to thinking positively now instead of worst case scenario

Thinking positive is a good idea And fwiw - like I said I've had three episiotomies (sp?) and I have no continence or sexual problems

agree that episitomy isn't too bad and the point of doing one is to avoid 3rd or 4th degree tearing so it is definitely preferable to that. I took arnica tablets from 2 hours after ds was born and used a combination of lavendar and tea tree oil in my bath after an episitomy and healed really quickly and easily. I would really recommend getting stuff like that in advance just in case.

Had episiotomy for DS and tore slightly with DD.

I think the only step I could have taken in advance would have been to have chosen a breeding partner with a smaller head.

However, massaging your perineum with baby oil/olive oil is supposed to increase elasticity.

The episiotomy didn't hurt at the time, but it took a couple of weeks to recover completely. It was done at the last minute - DS's head had been crowning for a bit but progress slow. I wouldn't have wanted to have a CS at this point (although that would have been last resort).

The slight tear with DD didn't hurt at all - wasn't aware of it and had anaesthetic for stitches. Recovered pretty much imediately.

I think you are right about birth stories - if the episiotomy is fine you forget about it.

Try not to worry too much about episiotomy. I tore and needed stitches with my first, and was cut (and stitched, obviously) for my second, and the healing time was the same for each, although there was less pain and swelling after the cut - maybe because of better after care?

I really didn't want to be cut, but the midwife thought there was going to be 'uncontrolled tearing' , and so I said yes. I'm glad I did. It was fine. A good midwife will not cut unless its for the best. That said, there is no harm in putting it in your birth plan that you would rather no episiotomy unless its absolutely nessesary.

Also, a good midwife will encourage you to birth actively, but by all means you should put it in your birth plan too.
Good luck Try not to worry

Not read all messages and don't have much time...

had an emCS first time

had a spinal, epi and forceps second time as I was unwitting recipient of time limit on my VBAC

if there's a next I'm staying at home so they can't cut me again,

not happy with instrumental birth almost as much as CS, had not really looked into it before my VBAC so had not thought about options if it came to it. Hindsight means that I'd have a hellavu lot to say about it next time.

But that's maybe more because I'm a VBACer through and through. You cut me in half and there's VBACtivist running through me. And the not feeling my VBAC and having my flesh cut a second time was just as disappointing

I won't understand anyone planning an elCS without very good medical reasons but I'd support you to the death if that's your informed decision, cos it is your decision and making your own informed decision goes a long way to preserving mental health, which is also incredibly important to me.

So I reckon that if you chose to go to CS rather than have instrumental delivery that's your prerogative. In fact, I'd expect that your cons should take your concerns seriously and discuss all options so that you can make your informed choice. After all just as they have to get your permission to do a CS, they also have to get your permission to cut you and do instrumental delivery.

It's your baby, your body and your birth. End of.

Thanks for all the responses. I saw consultant today and he has booked me for induction next Friday so I'm not too hopeful of avoiding either a CS or instruments but will try! Just want a healthy baby at the end of it so will be focussing on that from here (that and trying all the natural induction methods under the sun!)

how over will you be?

10 days

I know I could probably push for 42 weeks but I am just so fed up at the moment and finding my whole existence so depressing that I might just go for it if she doesn't appear in the meantime. They are monitoring me on Tue and Thu on the CTG which is good.

have you tried a sweep to get you going on your own. I had two and started labour without induction as really didn't want to ahve to be in hospital fromt eh beginning.

At my appointment yesterday my cervix was so closed that he couldn't do a sweep! Hoping it might be a bit more favourable next week and can fit a couple in before the Thurs afternoon

good luck. Blinkin pesky cervixes (or should it be cervii??), I do feel for you, it's horrible waiting and waiting. Ds was finally born on the 13th day after his due date and I think I'd cried every day in between
Have lots of rest though this week. Everyone says it but it really is true that you need to sleep and chill out as much as you can before your lo appears.

Missingmyheals, alot can happen in 4 days. cyber hugs. sending positive vibes

Mw could barely reach my cervix on the Monday and didn't get a sweep done. On the Wednesday registrar found me to be 2cm with a Bishops Score of 8, I had dd the next day!

You could be dilating as we speak!!

My experience with three births - the only time I needed an episiotomy, I was lying on my back. The other times I was kneeling upright, and only grazed slightly. Having said that, the episiotomy was actually the quickest and least painful to heal.

Try and give birth on all fours. The bones on the pelvis open up better and it's much less likely that you'll tear.

gravity will help speed things up a little, hopefully!