Epidural and episiotomy - is there a strong link?

[ToniLondon]

Hi all - I'm quite new to mumsnet but would really appreciate opinions/ experiences on this subject! I'm currently 33+2 and starting to think about the birth... i want to avoid an episiotomy if at all possible and I wondered if the link between having an epidural and needing an episiotomy is a strong one in your experiences!! Has anyone had more than one birth, one with an epidural and one without? And was the need for intervention quite different in each case? I know I can probably find statistics on these things, but I'd prefer to hear honest first hand experiences! Thanks

You'll need an episotomy most if you have forceps. Having an epidural does mean you're higher risk of urther interventions, inc. forceps.

I think the reason a lot of people who have an epidural end up with an episiotomy is because there is an overall stronger link with intervention following an epidural, in part because you normally end up lying down and are far less active. That is my understanding of it, anyway. I refused to go near a bed when I was in labour because I had a bee in my bonnet, that if I were to lie down, I would end up with a million types of intervention! As it was, I delivered standing up, very quickly and did only have a small tear. However, I was 'lucky' in that it was a quick (but v intense) labour.
Have you booked any antenatal classes? They go into the pros and cons in a lot more detail. Good luck!

I had an epidural with both births - both extremely straightforward and speedy. I had an episiotomy with the first because the cord was wrapped around my daughter's neck. The outcome would have been the same with or without epidural - the great benefit of having had one was of course that I didn't feel a thing when they made the cut. I should add that like you I also dreaded having an episiotomy - the reality of it was much less horrific than I'd imagined. In my own personal experience it was a very minor procedure which I recovered from very speedily. I wouldn't worry about it too much if I were you. Good luck.

I think that there may be a link because with an epidural you can't feel as much as you would without one and so don't push at the right time?

I had an epidural for my first labour - ended with C-section. Second labour - just gas and air, but speedy delivery ended with epesiotomy, which then tore into rectum. Third delivery was elective C-section because torn bum healed so well midwife said don't risk scar tissue tearing. Recovery from no. 2 delivery was much better than others.

ToniLondon - I was like you when pregnant with DS, wanted to avoid episiotomy and believed it's less painful and easier to heal when one tears naturally. When I talked to my consultant about concerns with epidural and so-called "cascade of interventions", he recommended that the key thing is not to insert epidural too early but wait until labour fully established, i.e. at least 3cm dilated - and then risk of intervention no higher than if no epidural. Ended up having an epidural as waters had gone, labour wasn't progressing and needed to be augmented with syntocinon drip which is too painful without pain relief. Epidural was great, was fully dilated within 2 hours, could stay mobile and felt all contractions to push with them (they just didn't hurt), lay on my side not my back, and DS came out after 20 minutes of pushing, with just tiny tear that rquired a couple of stitches (and healed quickly) and no episiotomy. Would definitely consider another epidural in this pregnancy based on my experience with first.

Thanks so much for all your replies. I feel much better about it (either way!) now... I will definitely try to stay on my feet, but perhaps an episiotomy isn't so bad after all. Pinkpeony, your experience sounds great!

I had an epidural with both my births, I refused an episiotomy with both as well and suffered 2nd degree tears which healed really well and v. quickly. The midwife said that when you have an epidural you can't push as well so for that reason there is more chance of needing an episiotomy but you can always refuse (unless it's an emergency I guess), there is evidence to suggest you heal better and quicker from a natural tear