Irrational fear about repeat episiotomy

[addictedtoharibo]

I am 25 weeks pregnant with number two and had to have an episiotomy last time, not because he wasnt fitting out so to speak but because he was distressed and the cord all wrapped up and they wanted to get him out quickly.

Am quite ambivalent about the whole labour bit - realise it will hurt etc but feel I can cope with that as its my body doing it rather than somebody else doing it to me if that makes sense. But I am petrified to the point of tears a few times a week (already) at the thought of another episiotomy/tearing badly and I have no real idea why.

Yes it hurt a lot (no time for any anaesthetic or anything and she had to cut twice) but in the grand scheme of things the pain wasnt worse than anything else that went on and it was over pretty quickly. Recovery was pretty awful but no idea what its like to recover without. And I distinctly remember telling another mum on the postnatal ward that actually getting the baby out wasnt as bad as I had expected.

The problem is that it was that part that seemed to leave me quite traumatised. Whilst I got over the birth itself fairly quickly I seemed to end up fixated on that for weeks and months afterwards. I can still hear the sound of those scissors and just the thought of it makes me physically cringe and feel sick. My scar is starting to ache more and more as the baby gets bigger and is very tender to touch - it seems to go a long way into my bum cheek and feels hard and taught. I cant even bring myself to start doing perineal massage as dont want to touch the area.

Im not asking for reassurance it wont happen again - I know lots of mums have less tears the second time around and Im hoping for a home water birth and just more general calm. I just dont know how to psychologically beat this and to stop stressing about it as I know stressing about it is just going to make me tense up and therefore more likely to tear.

Any ideas?

haribo- big sympathies for you. Your fear doesn't sound irrational at all though, don't belittle the effect it's having on you because it sounds like it is really distressing. Don't feel silly either for not feeling at the time that the episiotomy was traumatic- it obviously is now in your memory and there was so much going on with your lovely new baby that it may not have registered at the time.

I haven't got any real practical advice or experience to give I'm afraid on how to help with dealing with your very real fear- but do know (and I don't want to scare you with this so please just take it as a "could-be-in-a-million") that Obsessive Compulsive Disorder can manifest itself in scary or worrying thoughts rather than actions, and that it is relatively common for OCD to begin during pregnancy or post natal period. I mention this as both my lovely SIL and BF suffered terribly from baby-related OCD and would want anyone else potentially suffering similar symptoms to identify them as soon as possible.

Maybe talk to your midwife or GP (or even your health visitor if she's a nice one- they are normally more tuned in to mental health issues IME) and let them know just how distressing this is for your- I really hope you manage to get some practical advice from them.

Hope this hasn't scared you, it could be something entirely different that is going on of course but really wish you well as it souds like this is affecting your life quite dramatically. Good luck x

Message withdrawn

Talk to your midwife - I had an episiotomy 2 years ago to get DS out with forceps. I have just had DD and labour progressed much more quickly and there was no need for instruments etc. She came out and tore my old episiotomy open. This meant the tear was a clean tear and easy to stitch. Scar tissue is weaker, that's why the episiotomy tore. I don't mean to scare you, but I am trying to say, talk to your midwife to see what you should do. Maybe you could have an epidural, that way, nothing hurts (I had epidural for DS and just gas and air for my DD - it was much better with the epidural!). Then have an episiotomy in a controlled environment so that you won't tear. I hope I haven't added to your fear, but I wanted to tell you that mine tore, because I don't think it is unusual and it could have been avoided by having another epis (I think).

Just to offer you lots of support xxx

Hi there

I know what you're going through as I had a episiotomy with my first baby then had to have TWO further operations to have it refashioned so when baby two was on the way I felt just like you do now however I explained to the midwife my anxieties (who was really great and understanding) and I went on to have a perfect normal delivery without any episiotomy.... I really don't think that you're going through any abnormal emotions lets face it first time round it's unknown territory second time well you know what you're in for but the great news is like every pregnancy, delivery, baby - no one is ever the same so positive thinking may help and if it happens second time round you can get some cooling gel pads from Boots that will help to soothe any discomfort whilst you're happy holding your new bundle of joy - good luck from someone that's been there and got through without any further interventions X

I felt taumatised after my first delivery-for other reasons-but the thing that helped the most second time was talking this through with the consultant,having the same midwives all the way through the pregnancy and (the best thing)a wonderful doula who was completely supportive.still ended up with another dreaded c-section but it was all brilliant,totally different .

Haribo, IMO you remeber/expect worse case scenario.

The worst you experiend was the episiotomy (I know it's horrible!) but it isn't the worst thing in the world.

Try, as hard as it may seem, to just remember the good things of your previous experience. I think it is only natural to focus on the worst case scenario (as who know it) but you can manage.

As a child-bearing woman you have to contend with many crap things, but YOU CAN! It is worth it in the end. xx

Oh dear I feel you pain...I had an episiotomy for my first, it was a very quick decision to do a forceps delivery and no time for any more pain relief than I was already using...just gas and air, I felt the whole thing and I felt myself tear (2nd degree)as they pulled the baby out.

Is there anyone you can talk to about it, during my second pregnancy I was very scared of the same thing happening, I could still remeber the exact feelings of pain...and talking ti my midwife did help, it didn't make me forget but the memories somehow had less power over me and although it still made me shudder to think of it I could look forward to my second birth without automatically thinking it would happen again.

FWIW episiotomies only tend to be done these days for exceptional reasons - instrumentals and sudden distress (as in your case) .Every birth is different and there's no reason to think that the same set of circumstances will happen again . However, if you are very distressed by the idea of it happening again, put it in your birth plan that you would prefer to avoid an episiotomy unless it is absolutely necessary to get the baby out - it's worth knowing that it'a possible to do a ventouse without one so put that in as well. Saying that there's worse things isn't helpful, for a lot of women the idea of having their vagina mutilated is worse than the thought of having a C/S and can be more harmful in the long term. I think the op is perfectly entitled to feel as she does, given that it sounds as though the epis extended and she has considerable scarring and discomfort from it - I think most of us would be scared if we had a constant reminder of a frightening and painful event.

I have had two (very different, with extremely different labours) ventouse births - the first one with episiotomy, the second one with a second degree tear that tbh I didn't actually feel (no pain relief whatsoever) and recovered very quickly from, despite stitches.

Will you have a doula? i think one (or maybe an independent MW) could be invaluable in supporting and calming you prenatally and during the birth.

FWIW, I had an episiotomy - which i did not want, with DS1. I really feel for you - i felt that it was the thing that 'bugged' me far too much continued to do so until DD (DC3) was born.
With DS2 and DD's two subsequent births were both really easy and no repeat episiotomy, mainly because i had no epidural - well should i say no pain relief at all . Got lots of minor scratches and cuts with DS2, but most importantly to me no episiotomy and it just tore very slightly as he was born very (too) quickly.
I think the key to the whole thing is to relax and just let your body do what it needs to. During my third labour, the wonderful mw told me not to make any conscious effort to push, just go with my body. It was an absolute dream birth.
wishing you lots of luck and relaxed vibes...

Thank you everyone. I do feel quite a bit better just getting this out and talking to people about it. The thing is I realise its not the worst thing in the world - its only a few seconds (minus recovery) but its the thing that has stuck in mymind (and yes very possibly been exagerated in my mind thinking about it on and off for the last two years).

I do have a lovely doula but havent got round to talking to her about it yet. Midwives I have given up on - have only seen one three times and a different one every time who seems to want me in and out in record speed.

I think the control issue is very important - I was made to lie on my back to push and every time I tried to sit up or lift my body up with my arms (insinctually probably to give baby more room) I was pushed back down again and got told to concentrate on pushing. I have looked into things and water seems to be a good way of reducing risk as well as different positions so with more confidence this time (and lovely doula) I will be arguing back I think!

Am also thinking that maybe this isnt all about the episiotomy - more the episiotomy has become the focus of all my worries as that was a part I can visually remember if that makes sense. I had an awful pregnancy with hyperemesis for 40 weeks, blood pressure problems, placenta problems, in and out of hospital etc followed by a long early labour as he was back to back then a very quick active labour where I was left alone and treated like a nuisance. Awful hospital experience afterwards then turned into a recluse at home- DH straight back to work, no one came to visit etc etc. Unsurprisingly I had bad pnd and the HV thought some form of post birth trauma. All of which I am keen to avoid again. So perhaps I am focusing everything onto the episiotomy when in fact its a big fear of everything in general. Maybe, maybe not.

I will have a chat to both midwife and doula about it as Im not sure its really a pain issue - the idea of tearing doesnt scare me anywhere near as much (still not a pleasant thought naturally lol) but if I tear its my body doing it and Im more in control not them if that makes sense.

Wow - this is a really long post - Im sorry! I am so so grateful for your responses though. I am surrounded by people who either had easy births or dont have children and they have no understanding of what its like to have bad memories.

Thanks again xxxx

Would like to add, I think your decision to go for a waterbirth this time around is VERY smart. Only a small minority of first time get through labour without a tear or a cut, and almost all the FIRST time mums I know who've got through birth without a tear or a cut have birthed in water.

Re: how you approach the next labour - I would write birth plan that looks something like this: (in letters two inches high) I DO NOT WANT AN EPISIOTOMY OR A TEAR - PLEASE DO YOUR BEST TO HELP ME GET THROUGH MY BIRTH WITHOUT ONE. Give it to the midwife and tell her to use all her skill to get you through the birth safely with an intact perineum.

I know that seems like an odd thing to suggest - surely all midwives do their best anyway to keep a mum intact, but there's research done by the NCT which shows that women who ask their midwife to help them in this way end up with less perineal damage. Some midwives really pride themselves on their ability to get a mum through birth without tears or episiotomies. I know my IM did. I'd had an epi first time around (forceps birth with 9lbs 6oz baby), second time around my IM got my 10lbs 12oz son out and I didn't need stitches (I did have a tear but it didn't need suturing and healed really well). Third time around she helped me birth my 9lbs 3oz baby with no damage at all.

Good luck to you!

I'm tempted to tell you that your post title should be "rational fear about repeat episiotomy", as I'm very nervous about it too. After all, it was a very traumatic part of labour for you, and it's aching and tender now and so reminding you constantly of that trauma.
I have had similar issues to you - I requested that I didn't have an epi, and consented to ventouse only because I knew that an epi wasn't necessary (unlike forceps). In the end, not only was I given one without my consent, but they lied to me about it, and I'm also having problems with the scar.
A waterbirth and a doula sound great to help avoid a tear/epi next time round. I've also been referred by my GP for counselling to help me talk about and (hopefully) conquer my fears.
Saying that things could be worse just isn't helpful, in my opinion. I was told by a GP that I should be grateful to have a healthy baby, and that it could be worse because I could be incontinent. So what? I still had PTSD and a painful vagina 6 months after DD was born, and those were issues that needed to be addressed.