Episiotomy - why is no anaesthetic given???

[liznay]

Apologies to anyone that I might inadvertantly scare during this post, but 2 of my closest friends have told me that they were given an episiotomy without any pain relief because there 'simply wasn't time' and the doctors just had to get the baby out.

Now, all the books say that you will be given an anaesthetic if you need to be cut, but clearly this isn't happening to everyone. I am the only that thinks that this is barbaric?
I'm a bit worried as I'm due to give birth in 5 weeks and am adding this to a long list of things i'm worrying about.

Has anyone else had experience of this and how can I prevent it happening to me? (assuming I haven't had an epidural which I guess would prevent you feeling any pain down there anyway)

And they hadn't had any epidural?

Are they sure they hadn't had any anaesthetic?

I tore all three times, all without anaesthetic.

Think you need to talk to your mw/put it in your birth plan -tbh I've not heard of anyone who had one without so just trying to put your worries in perspective.

i had one and there wasnt time for anesthetic, to be honest i didnt feel the pain at the time, i did feel the cold sharp sissors but it didnt feel like someone was cutting me, they do it at the height of the contraction and i was in that much pain anyway i didnt notice.

no idea how to prevent it, sorry.

I didn't have an anaesthetic. I can barely remember tbh, but I think it just stung really. There's a whole lot else going on for you to think about at the time

They did it at the height of a contraction and my perineum was paper thin anyway.

if an episiotomy is given as teh tissues are really stretched, the area is self anesthatisd to an extent. not everyone tears and not everyone needs an episiotomy

Many women are able to have a local anaesthetic. And many, many episiotimies (the majority? I think probably so...) are performed on women who have had epidurals anyway.
In my experience, the few women I know who have had episiotomies without anesthesia didn't feel a thing because the area was so stretched and sore anyway. A couple said they didn't even realise it had been performed and were still 'waiting for the pain' when they were told it had already been done.

Be interested to hear what others say, though.

I think the head is pushing against the perineum, causing the are to thin, and this stops the pain and bleeding.

area not are

belgo yes neither of them had an epidural, and both said they were not given any pain relief. Friend A said that they were trying to dab on the anaesthetic as they were cutting her, but in reality they were more concerned with getting the forceps in and the baby out. Friend B said that they didn't want her to tear as badly as last time on DD2 (she'd had 52 stitches previously) so they just cut her at the height of a contraction but she felt everything..
poppy - I have put it in my birth plan - its getting longer by the day but I know that in reality, its not likely to make much difference if something goes wrong and they want to get baby out quickly.

I'm just wondering why women are not routinely given a pudenal block (which numbs the vagina/perineum) in advance if they have not had an epidural in case they need to do an episiotomy at some stage, it would make sense to me...

I had one with no anaesthetic, but tbh, in the middle of pushing out a 10lb 4oz baby, they could have sliced me in two with a bread knife and I wouldn't have noticed. There comes a point when you just can't FEEL any more pain...

and now I have just read your post properly and realise you are about to give birth for the first time. nice one hecate.

I went back and had a 2nd child, so that tells you that it all gets forgotten.

Giving someone a pudendal block just in case they needed an episiotomy later would be a bit mad and ott though. Would you not need an anaesthetist to do it? And in any case many women don't want any kind of block because they don't want interventions of any kind.

You might not need an episiotomy. You might not tear. You might need no interventions. You might decide to go for an epidural. Stay optimistic but open minded would be my advice.

I tore both times (2nd time with no epidural) and didn't feel it at all in the midst of everything else.

I had an episiotomy without any local anaesthaetic or epidural. I think the whole area was pretty numb with shock and trauma by that stage anyway. I certainly don't remember the actual cutting as being painful, although I watched the mw do it.

I was given local anaesthetic for the stitches in the episiotomy afterwards though (but not for all the tears).

TBH, by the time you need an episiotomy everything down there is so stretched and so much is happening you really don't notice any extra sensation - even cutting/tearing.

I tore with all 3 of mine as their heads delivered and didn't realise til afterwards when the midwife said I'd need stitches.

It does seem barbaric when you've never given birth but tbh, when you're on the brink of giving birth, in the maelstrom of everything that's going on, you honestly wouldn't really notice. They cut at the peak of a contraction anyway, when you'll be completely focussed on the contraction pain and will notice it less.

The other thing to remember is that episiotomies are only done if they absolutely have to be and that decision is usually taken as an emergency or coupled with a decision to use forceps or ventouse. Like your friends say, there often isn't time to administer anaesthetic, wait for it to take effect then cut. If you need an epi you are likely to need it there and then. If it came to a choice between a possible problem with the baby or having a quick, tiny snip to get it out asap I know which one I'd go for everytime.

The other thing I'd add is that often by the time you get to the pushing stage the epidural will have been allowed to wear off slightly. It's very, very hard to push under full epidural as you can't feel where to push and therefore can't push effectively. Pushing with full epidural quite drastically increases your risk of having an assisted delivery.

I remember very well the panic I had before I gave birth each time but you really just have to try and relax and not stress over it. If you are relaxed and open minded over what is going to happen you are more likely to have a positive experience.

Good luck!

liznay - as I said in another post, I tore in each birth, but it really wasn't that bad. It was a very breif burning sensation. The last hours of contractions were far worse.

Usually there is plenty of time to give aneasthetic before an episiostomy. Try not to worry too much about it, you may have the easiest births ever.

If you want to try and help prevent tearing, look up perineal massage, and also think about labouring in warm water, and think about birthing positions that are less likely to result in tearing - ie. not lying on your back.

hecate don't worry your post made me laugh I like to hear it as it is. I know what you ladies mean about areas going numb, I imagine its like when you go for a brazillian wax and after they've torn off the first few strips of hair, the area is so inflamed and painful anyway that you are not sure if they could do anything more painful to you (except make you deliver a baby through there! )

I had 2 episiotomies, both in a hurry and both without anaesthetics. It sounds horrific in the cold light of day but at the time an episiotomy is very minor considering all that is going on. I was told that the skin is so stretched that there are few nerve endings and personally did not notice any increased pain at all. The first I had been given pethidene so might have masked any extra pain, the second I had only gas and air and still did not notice.

Honestly, in the heat of the moment, only minutes before the birth of your child, if you are struggling, in pain and they tell you that this little cut will help prevent long term damage, it is not something that is even questioned. To think of the hours of worry I put in before birth and thinking through all my options! What a laugh - when it came to the nitty gritty, all of that careful thought and concerns were totally irrelevant.

Don?t forget - you might not need it anyway and they will only consider it for your benefit

it's not as bad as a brazilian, if that's any comfort.

As for prevention - as others have said, there is the old chestnut of perineal massage (I am cynical about this). Personally I think it is a bit like stretch marks - some people?s skin is more prone to this than others. If you try to adopt a good birthing position and try to stay as calm, slow and as relaxed as position, they say this helps avoid a rushed final stage and tearing. It is also often commented that fewer medical interventions can lead to fewer tears (waters broken etc can bring on fast labour leading to less time for your body to stretch and prepare for birth). I have also read that fewer women tear during water births thanks to being more relaxed and in a better birthing position - squatting or on all fours. But that is stuff I have read so not necessarily gospel truth.