Is is better to have an episiotomy than to tear?

[nikkisbump]

I'm writing down a few 'wishes' for my birth ( rather than a birth 'plan') and noticed on some of the birth plan drafts online that you can say which you would prefer. Now, in my mind, a neat controlled cut would be far preferable to tearing naturally but am I missing something? I'm a completely clueless first timer!

I tore both times with my big whopper babies and I didn't even know until the midwife told me afterwards. I don't have any experience of epis but just wanted to say (in my experience at least), tearing is not as horrific as it sounds. You can always massage your perineum beforehand to try and prevent it, if you've got the time and the inclination . Good luck with your labour!

According to the NICE guidelines, episiotomies should not be given routinely, only if necessary, because tears heal much more quickly and cleanly.

I had put in my birth plan of ds1 that I wanted to tear, but was talking into been cut by the midwife, which I regretted.
I had the episiotomie with ds1, it was awful, the midwife made a right mess and didn't stich me properly. She kept telling me it was my fault as I couldn't open my legs wide enough for her to stich me (I had SPD and I'd managed to give birth for god sakes!)and that I was too hairy! (now I know it wasn't perfect down there, but it wasn't a sodden great bush!)
She basically left a hole at one end of the cut. I was left in loads of pain and got an infection. The mid wife who came to see me at home was horrified when she saw it.
The second time, I had a small tear, which i didn't even know had happned, which also needed stiching. Mid wife was fantasic and I never had any problems.
Also with the cut they numbed the area when they stiched me whuch also hurt like hell, with the tear i just had gas and air which was much better.
I would never have a cut again. What ever you decide, don't be pushed into changing your mind.

If there's a risk that you might get a big tear, a neatly made incision, made at the right time (when the skin is already stretched, not before) and properly stitched, will heal better than a big ragged tear (harder to stitch up very well).

But if you might only get a little tear, that's less healing needed than a big cut.

At uni, I lived with 5 medical students who happened to do their Obs & Gynae placements whilst I was there - their opinion was 'tear, every time'. As beanlet says - they heal quicker and better, and, if you think about it, it'll only ever be as big as it needs to be, whereas if someone cuts you open, they might make it bigger than it needs to be!
(Although - I'm lucky enough to never have had either of these problems as I've had 3, soon to be 4, elective sections. Sorry!)

I had an episiotomy as DD was delivered by forceps, at the point I was asked I was past caring what anyone did and just wanted the baby out, having read my birthing notes since it appears I tore as well. No idea if it was better or worse but I don't think it caused me any issues and I presume there was little choice at the time if forceps are being used.

I've had both: an episiotomy with my first birth that healed with no problems at all, and two tears with my second. The larger of the two tears did not heal properly, although birth was only 3 months ago so there may be time for improvement yet.

Obviously my experiences with the healing may have nothing to do with whether I was cut or tore but if I were to have another baby I'd go for an episiotomy again even though I know it's an uncommon choice nowadays.

My episiotomy healed within two weeks. It wasn't my preference but in some situations they do them anyway so don't worry about it too much if you do need one.

to try and prevent either massage with almond oil
and arnica pills at and of pregnancy to minimise bruising
worth a try, worked for me

end of pregnancy, even

The research suggests that tears heal better then epis and cause less long term problems as the tissue meshes together better. Also if you have epi can tear as well.

I had a 2nd degree tear with DD that healed very well never had any probs with it and within 2 weeks it was as if it hadn't happened. My SIL had ongoing probs with her epis months and months later.

Also an epis is, IIRC, a risk factor for a third degree tear. And that, trust me, you do not want.

FWIW, I would not permit a mw to suture of even assess my perineum (nor an SHO for that matter). Reg/SpR/Consultant only.

I had 2 epis which healed ok
then 1 tear which seemed to heal ok but I ended up v ill with septicaemia. Probably not linked though. If I had to do it all again I would ask for an epis.

Also recommend massage and arnica. However just to say, my experience of an epi was fine. I had said in my plan that i would prefer to tear- however babys heartrate dropped and as i was at home the midwife did not have the time to wait for me to tear and i gave permission for her to cut. It was a small and necessary cut. And she stitched afterwards (which is the worst part of the whole experience) but i healed completely and quickly. I think in the end, if you trust the people with you- your midwifes and docs etc and hopefully you do- then either way, tear or epi, you will heal and it will have been worth it.

As LittleSilver says, we now have research evidence that women who have episiotemies are MORE likely to have a major tear than women who don't.

Anyone training in Obs/Gynae or Midwiffery now (of whom I know a suprising number by sheer chance!) is being taught NOT to cut unless absolutely necessary (e.g. for forceps).

The midwife said she was going to cut me, after pushing for nearly 2 hrs, and injected something into each side of my fanjo -anesthetic I presume?
She didn't ask, just did it.
When I saw the size of the sissors, I pushed like mad, and gave birth naturaly.
I hadn't taken any pain relief during labour, as left it too late, and was a bit scared of the thought of being cut!
Anyway, I ended up without any tears or stitches !!