June 2012 Moms

Let's talk episiotomy's...

So an episiotomy is when they clip your vagina to make a larger opening for the baby right? I've read somewhere that 90% of vaginal deliveries get this, does that sound right? Wouldn't it be better for women to tear on their own if they're going to? I've heard some women don't tear at all...is this something I can ask them not to do in my birth plan? Is there a reason for it for the mom? I'm thinking it would just make the docs life easier and delivery a little quicker.

Sorry for my ignorance FTM here!

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Re: Let's talk episiotomy's...

  • It can be harder to stitch up a tear.  Imagine taping together paper that you cut versus paper that you tore randomly.  I don't know if 90% is right for an episiotomy, but maybe if it's tears and episiotomies I could see that.  You can ask them not to if you want.
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  • Some doctor's think that an episiotomy is better than a tear because they can control the direction of it rather than risk a tear. 

    Most studies now indicate that it's better to have a tear than an episiotomy as healing time tends to be faster and episiotomies can lead to larger tears in the end (no pun intended).

    There's other methods to help reduce the risk of a tear or need for an episiotomy such as counter pressure during labour and perineal massage before labour and during labour.  Helping the vagina stretch to lessen the risk of a tear.

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  • I've heard that a lot of doctors are moving away from this practice in the last few years. I'm going to ask my OB to only do this if I am starting to tear.

    If a tear starts it can rip through to the anus and make healing and the risk of infection worse. That's the rationale. Cutting it cleanly makes it heal faster and cutting on a transverse avoids the anus issue.

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  • I wouldn't say 90%. You can request it be used as a last resort. Basically the only time you need one is if you are a) tearing in the wrong direction (towards the front not the back) or if you have t stretched enough and your body won't tear I it's own. Some doctors do just do it because it's easier but if you talk with your doctor about it ahead of time you'll know where they stand. With my first delivery my doctor attempted to tear me but I couldn't tear on my own so he had to cut. With DS I only had a 1 cm tear which didn't require stitches or anything. 
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  • Is there a way the doctor can tell if we need this done lol .... i mean can the doctor look or something
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  • image chouli77:

    If a tear starts it can rip through to the anus and make healing and the risk of infection worse. 

     

    I'm on a mac so I can't make the omg emoticon...but OMG! The more I learn, the more I'm getting nervous about delivery. lol I should just stay in the dark about these things and let them happen. I had no worries about delivery pre-pregnancy.

     

    Thanks so much for all the info ladies! 

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  • My doctors with DS very rarely perform episiotomies.  They would rather you tear.

    I had a 2nd degree tear (I had an epi and didn't feel it tear, and I barely felt the stiches until the end because a nurse turned the epi off too soon).  My only issues postpartem was the blood loss and passing out when I stood up.  I never had any discomfort urinating, no hemmerhoids, and was pretty comfortable.  I healed easily and quickly without problems.  

    I think a lot of things that you read about with delivery are so much worse to just read about.  When you're in the moment a lot of those things are the last thing you're worried about. All that matters is getting that watermelon out the 10cm hole.

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  • Oh goodness... I really hope I don't have to have an episiotomy! Now, I'm scared! LOL! I was reading about them today and I think I read it's around 10% or births have an episiotomy.
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  • I had to have one because DD had to be delivered with forceps. Unfortunately, I tore beyond the episiotomy and ended up with a 3rd degree tear. Not fun. This time, I will request that my dr. NOT cut me. I'm also planning to start massaging that area well in advance. My cut/tear did heal cleanly, but I can't help but wonder if it would have been as bad if she had just let me tear naturally.
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  • I had one because my daughter was a posterior baby which causes back labor and makes it difficult to push her out. After three and a half hours of pushing, a vacuum had to be used and I had third degree lacerations and an episiotomy.  Apparently, it is pretty rare for that to happen. Vacuums aren't common anymore. In fact, I am go to a fairly large practice and saw a dr that didn't deliver dd and she mentioned the fact they had to use it in my first labor.
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  • How would counter pressure work during labor? For massaging it would you just do what I think? 
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  • I had one with my first and with my second I was so worried and made it clear how much I did not want one nurse was awesome and did a perineal massage and I did not get one. 
  • After having a 4 degree tear I am making sure my doctor tries to prevent that again. I tore inside and outside front to back that was worst then labor! The doctor lost count after 130 stitches!
  • image Mycrimsonheart:
    How would counter pressure work during labor? For massaging it would you just do what I think? 

    You can look up videos and information on how to do perineal massage.  It's something you and/or YH can do prior to labour to help 'work out' the area. 

    My OB with DD1 used counter pressure as she was crowning - basically applying a little pressure back against baby's force to help ease her out more gently.

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  • image Junebaby2:
    After having a 4 degree tear I am making sure my doctor tries to prevent that again. I tore inside and outside front to back that was worst then labor! The doctor lost count after 130 stitches!
    Oh.good.Lord. I have no words, except ouch!! I'm currently terrified to give birth and I am now in full blown panic mode. What about in the movie Baby Mamma where they discuss using olive oil and cooking oil!? Starting to sound like a great idea....
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  • I figured I was the only person thinking about this so early in the pregnancy but I guess not. It's so nice to hear some stories just to have an idea as to what might happen. Everytime I look at my husband I feel like calling his mom and asking if she had one. My coworkers looked at me about a week ago and said you better get an ED if it has a head like daddy's. I'm so freaking out now. I was thinking about going natural and now I'm thinking ummmm that might hurt a little more than I'm prepared to handle. We'll see what happens I guess.
  • It's more about how the MD was trained. Younger ones tend to control pushing to help stretch the perineum while older ones are like get me the scissors. I would definitely recommend perineal massage and again the controlled pushing. 

    Mad you crown you give shorter burst of pushing more frequently. This helps stretch the tissue as the doc/mw supports the perineum. It takes alot more concentration because you are fighting the urge to just get the baby out. Yet it's so worth it. When we have pt's who do it they tend to only get 1 and 2 degree tears.

     

    Side note the scar tissue after an episode is weak tissue and you will tend to tear along that are with the following deliveries so just be aware.  

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  • image Brooke 0617:
    I had one because my daughter was a posterior baby which causes back labor and makes it difficult to push her out. After three and a half hours of pushing, a vacuum had to be used and I had third degree lacerations and an episiotomy.  Apparently, it is pretty rare for that to happen. Vacuums aren't common anymore. In fact, I am go to a fairly large practice and saw a dr that didn't deliver dd and she mentioned the fact they had to use it in my first labor.

    My story is similar to yours - I had a sideways baby (head at 2:00), back labor, pushed for 3.5 hours and delivered with the assistance of forceps.  I also had a 3rd degree tear, but no episiotomy.  The recovery from the tear was really not that bad. 

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  • No, episiotomies are NOT that common anymore. A lot of doctors are moving away from them as evidence shows that tearing is usually better for mom. It may be harder to stitch, but it heals faster and has less chance of tearing more.

    Think about trying to rip the neckline of a t-shirt. It would be pretty tough to rip it on your own, but if you gave it a cut first, you could probably tear it further pretty easily. Often the really bad (4th degree, to the anus) tears are started by an episiotomy. 

    You should talk to you doctor about their policy re:episiotomies, and you could certainly request that they don't perform one. I think the most common instance they're performed in now is if the doctor used a vacuum or forceps.  

    FWIW, I've had two natural, vaginal births, and only teared a tiny amount (1 stitch) with DS and none with DD.  

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  • It really depends on your situation and your doctor.  My doctor said the older you are the more likely you are to tear (like with most of our body the elasticity goes away as we age), although in most situations she only likes to do them as a last resort. I knew I was going to have one before I had my daughter because my OB did not want me to risk tearing due to having Crohns disease.  She had a conversation with me about this before I was even close to labor.  She had a Crohns patient once that tore to her anus and it caused a fistula which caused her disease to go her crazy.  She said from there on out she recommends doing them for patients with Crohns and Colitis to avoid that type of tear of couse if I said no she would have respected my wishes.  My OB was great and I trusted her so I went with her recommendation and I only had a stitch or two.  

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  • My OB used olive oil to massage the perineum to help the skin stretch.  I ended up with a tiny episiotomy (he arrived pretty fast - not enough time to fully stretch) but it was not a big deal...only a couple of stitches.
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  • OMG is all I can say to this. Tearing and cutting....ahhhh. I probably won't care at that point, just get it out!!! But right now the thought completely freaks me out.

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  • I've had two posterior babies and two episiotomies (both 2nd degree).  Even with massage both times, I needed more room.  Here's hoping this baby isn't sunny side up so I can avoid it this time, but it really wasn't that bad as far as healing and pain after the fact.
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  • image Missy0483:

    OMG is all I can say to this. Tearing and cutting....ahhhh. I probably won't care at that point, just get it out!!! But right now the thought completely freaks me out.

    Ditto!!!  I can't seem to let myself un-cross my legs after reading these posts LOL.  But all good to know info, nonetheless!!!!  

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    Married 5/2006 ~ MMC 5/2011 ~ DD born 6/2012 ~ Baby #2 EDD 12/21/2014








  • Okay, so now I'm just like horrified. Haha! What stretches and things can I do to "help" myself with all of this????
    *~~Danie~~*
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