Episiotomy or tear naturally?

[Thriving30]

I feel so confused on this topic and would like some clarity. If faced with the possibility of a 3rd/4th degree tear is it best to tear naturally or have an episiotomy?

The answer seemed obvious to me at first (make a cut, so the tearing can be controlled) but then I've read online that the recovery is alot worse and can cause incontinence and other pelvic floor issues?

Thanks for advice

I had an episiotomy with my first. Wasn't really clued up on them at the time if I'm honest but seemed to recover within a few weeks.

Obviously the best option would he neither

I had an episiotomy and forceps, which led to a third degree tear. If you have one with the goal to prevent further tearing, you need to push very, very slowly to prevent it extending. If you're numb, that's obviously much easier to do. I was told to do a big push by the medical staff (consultant or midwife, no idea) but I've since found out that was the wrong guidance.

I wouldn't have one again, but it allowed me to avoid a c section.

I have had an episiotomy with forceps and a natural delivery with a 3rd degree tear.
To me neither were worse than the other!

I had an episiotomy and forceps and was left with stress incontinence and a non existent pelvic floor however I have been having rehab with a female physio. I am nearly 6 months postpartum and still experience some pain/discomfort where I had the cut. It took me a good 4 months to feel better. Luckily I was prescribed good pain relief both in hospital and when I was discharged and my GP further continued this. I think there really isn’t a better option.

I had an episiotomy with forceps. My stitches dissolved too quickly & im still healing internally nearly 8 months later,
although the outside has healed fine & pain free.
I guess it all depends on the degree of the tear & where it is as to how quickly it will heal.

I have had both, I would say the tear seemed to heal better. I didn’t actually feel the tear due to having a water birth.

I had an episiotomy with forceps. That healed nice and quickly within about six weeks.

Second baby, I insisted I didn't want an episiotomy. I regretted that decision as I tore rather badly (don't know the degree, we weren't told back then) and it took much longer to heal. The midwives wouldn't let me give birth upright but got me to turn round and be propped up on the bed, and I'm sure that made it more likely to tear. The stitching was bloody awful too, much more painful than the birth itself.

Third baby, I didn't tear at all - well, maybe a slight graze but it didn't need stitching. The difference was I gave birth in an upright position which gave baby plenty of room. It was a quick delivery, too.

If I was to give birth again (I won't) I'd opt for an episiotomy instead of risking a tear.

I was always told tearing is preferable as it heals quicker because of the jaggedy edges 🤦‍♀️ don’t know how true that is?

I didn't really know much about episiotomies, but I had one. I think in preparation for foreceps that were not needed in the end. It healed perfectly in a couple of weeks. No incontinence or anything. The midwife did make sure she took her time stitching.

I'm a midwife. On the whole, tears tend to heal better as they have natural edges and tend to avoid going through bigger vessels. Episiotomies cut through tissues and vessels. I've seen many more episiotomy repairs breakdown postnatally than tears.

That being said, you have specifically mentioned 3rd and 4th degree tears. These can obviously have longer term consequences and should be avoided where possible. The vast majority of tears are 1st and 2nd degree, but you should discuss with your midwife/doctor if you are specifically at a higher risk of a 3rd/4th.

For what it's worth, I had a 3b tear with my first. It healed perfectly and went on to have another normal birth with a small 2nd degree with my second. No ongoing problems.

I didn't know it was a choice? I have 3 DC and have had 3 episiotomies, each varying sizes because when I was giving birth I was told that I needed one and they did it. I was in zero position to even think about it at the time, much less argue about it if we had varying opinions!

I had both - I don’t know which happened first. Perhaps at the same time but either way recovery was long but ok and I don’t have any issues now. If I remember correctly it wasn’t a decision either, they pulled the emergency cord and then did the episiotomy and I was a bit out of it so it felt like it wasn’t a choice. My pelvic floor is weak but that can be worked on.

I had an episiotomy first birth and perineal tear naturally second birth..

Episiotomy i recovered quite quick..

My natural tear has been awful, over two weeks and throbbing, itching, discharge. (Its not infection had swab as it was so different i thought it was) everytime i do too much lifting walking, it just throbs 😂

But i think it will all vary on how the episiotomy is done, any complications ect. I think i had more time to rest with my first as she was in nicu for a few weeks. Whereas with a baby and toddler from 4 hours after birth i was back on it..so that probably hampered recovery 😅

I had two 3a tears, no ongoing issues. Gave birth in pool both times.

Another difference is that a 3rd or 4th degree tear requires a surgical repair, this involved transfer to a hospital for me as I gave birth in a midwife led unit. 1st I had to have a general anaesthetic as the spinal block didn’t work, second just a spinal block, catheter both times I think.

I tore twice, both times healed ok and no ongoing issues.

First time out I had an episiotomy, very unpleasant being stitched up but it healed well afterwards.

Second time out, as I was birthing my dd, my midwife held my legs in position as I was on my back (too tired to go on all fours) to minimise tearing- and I came away without a scratch. No idea how she knew to do that, but she held my legs in a position and told me to breathe very deeply and slowly and it seemed to work.

I'm not saying of course that all births can be like that, but she told me that's why she was doing this and it did help.

I still think fondly of that midwife, she was ace!

Whatever the outcome a good pelvic floor physio is worth their weight in gold. If you have an episiotomy speak to them about scar massage. It can heal well on the outside but internal scar tissue can cause pain and discomfort. If you book yourself in before the birth they can go over perenium massage to reduce tearing and scar massage for post birth. As well as all the pelvic floor strengthening stuff to help with incontinence issues. I’ve put in a lot of work with one and it’s been very beneficial to my overall pelvic floor health.

I was told to have an episiotomy, I refused consent, and didn't even tear! Anecdotally I'd heard tears heal better but I ended up in the ideal situation of neither, because of a fairly slow pushing stage.

I had a 3rd degree tear with first child (epidural & induction so fast transition, and he shot out like a cannonball). Episiotomy for my 2nd, less stitches but cut through scar tissue from no 1.

Total healing times were about the same if I’m honest, just more stitches with the first (and more internal stitches).