A Dreaded Topic - Episiotomy

Lyons_in_2007

Okay, so I'm trying to finalize our birth plan (I know, I'm a procrastinator - LOL); and I'm really struggling with this one.  Therefore, I'm asking for the help and expertise of you veterans out there.  I'm sure this probably isn't your favorite topic to discuss (I'm literally sitting here cringing, just thinking about it); but I can't put this off any longer and I need to weigh the options.

On one hand, I think that it is best to let nature just take it's course and hope for the best.  On the other, wouldn't it be better to leave it to a trained professional to make the call and do what is medically necessary?  I've heard horror stories, each way.  PLEASE HELP me to understand the benefits of both sides, based on your own experience.

TIA, ladies - you're the BEST! 

LoriZ

I didn't have one and I got a second-degree tear.  Personally, I didn't do a written birth plan since I figured the doctor and nurses knew a whole lot more than me about childbirth.  Also, a friend whose labor went totally against her carefully planned birth plan told me not to bother since you just end up doing what's necessary at the time.  She felt her whole experience would have been better if she hadn't had an ideal birth all planned out in her head.  I had wanted to go natural, but when pitocin became necessary, that plan went out the window, and I was (and still am) totally okay with that.  So, I guess I'm trying to say to be open to change no matter what you plan.  For what it's worth, my tear wasn't a walk in the park, but it wasn't horrible.

shawnsweetie

In my birth plan I put something to the effect of "unless medically needed no epi is to be given" blah blah blah.... also "The doctor should consult with me before giving"

I saw my sister doc give her a stage 3 epi after ONE push because he wanted to "hurry things up" He didn't even talk to her about it.

After an hour of pushing and a dropped heart rate by Rylee my doc ended up letting me know that she thought it would be best to have one... but she told me it was my call.... I told her she was the pro and if she thought it needed to be done then to do it... and she did and Rylee was born on the next push.

I did write it in my birth plan but I also told thedoc as soon as she walked in the door that I didn't want one or a c-section since I was pretty sure she had not read the plan

kel716

I did not have a birth plan.  All I wanted was a healthy baby to be delivered, and I put my faith in my OB and nurse(s).  I knew going in I wanted an epi because I'm allergic to pain.  I also knew going in that odds were my son would have a larger head as DH and I both were in the 95th+%ile our whole life.  (DH wears a 7 3/4" hat and his hats almost fit me).  So I knew that while I have some bigger bones, etc... and that I was being induced there was a chance I would have a c/s, in which case all plans would be thrown out the window. 

All that being said, I did deliver vaginally.  I did have an epi, and I was induced.  I was in labor for 15.5 hours and I went in at 3cm/75% effaced.  I wound up with a 2nd degree tear and a small episiotomy.  It has all healed pretty well (I have a ligament tear still).  My OB even said he should have made that a little bigger...  But, he had to turn DS's head just a smidge to get him to come out, which is part of why I actually pushed twice- at 1 AM and again at 3:15 AM.  DS arrived at 3:43. 

But... if you ask me again, my plan for #2 will be the same-- Bring me a healthy baby (and happy too would be good!), and I want an epidural.  When the nurses asked me if I had a birth plan and I said "happy & healthy baby" they said "oh good, we like those!" 

teacherjess

To be honest, anything down there is no walk in the park-- stitches from an episiotomy OR a tear. I had a 3rd degree episiotomy but if I hadn't the doc said I would have most likely had at least a 3rd degree tear anyway. DD came out with a big head . I chose the episiotomy because a girl I work with tore through to her rectum, which scared the crap out of me.

I ended up with 21 or 22 stitches and recovery was painful, but honestly, there was just no way around it. She had to come out somehow. I did get a prescription before leaving the hospital for prescription-strength ibuprofen and two weeks' worth of Vicodin. I took it all. 

Basically, same as Kel said-- I'll do the same thing next time around. My birth plan was to delivery a healthy baby and since I know next to nothing about medicine, I had to trust that my doctor knew what was best at the time my DD was coming out!

GL and try not to be scared. The idea of anyone down there with scissors is scary, but I didn't even know it had happened, and my epidural had mostly worn off at that point. I just remember my doc saying she was putting in stitches, and I asked why, ha!

Lyons_in_2007

Thanks so much for your responses, ladies - keep them coming!

For what it's worth, I didn't really want to write a birth plan, since (like most of you have expressed) I'm one of those people who prefer to leave the decisions in the hands of the professionals (whether it's at the salon or in the delivery room - LOL!); however, one of my MW's suggested that I write one.  Is that strange?  She said that they (she and the other MW's in the practice) prefer having one - even if it all winds up getting tossed out the window.  I respect what she is saying (wanting to know what is/is not important to DH and I regarding the birthing experience); but I'm just having a heck of a time with it!  )

Thanks, again, for all of your advice.  Reading your opinions and experiences really help me to [mentally] prepare for what is ahead.

teacherjess

Also, as far as a birth plan, it is a good idea to have one, but don't get yourself to a point where you are expecting nothing else. My labor and delivery was nothing like I imagined or wanted because I had to be induced, and I'm pretty glad I didn't end up having time to fashion up an elaborate birth plan, because I would have been hard-core disappointed! No one even asked me about my birth plan after they ascertained I was being induced.

nire99

I had an episiotomy after 3 hours of pushing with DD.  I was unmedicated and begging for anything at that point.  I didn't even notice they had done it until afterward.  I had 4-5 stitches and it never bothered me when it was healing. I was up and walking around after 30 minutes. With DS I had a 3rd degree tear and several stitches.  It hurt like a SOB and I couldn't sit down for a week. I definitely preferred the episiotomy.

hav2run

I did not have a birth plan for either of my kids.  My thought was that the best laid plans are more subject to change, and most definitely would have been thrown out the window with both of my birth experiences. 

With DS, I delivered vaginally.  32 hours of labor and 3 hours of pushing (that was 18 years ago...they usually will not let you go that long now, so don't let me scare you).  I had an episiotomy.  I also ended up with a 4th degree tear.  I don't even want to think about what that tear would have been like without having the episiotomy.  I would so much rather have a clean incision than a nasty tear.  So, I knew going in with DD that I would not fight the OB if they thought I needed the episiotomy again.  We never got to that part,  and I ended up with an emergency c.

I agree with the pps, the goal is a healthy, happy baby, and I most certainly would not hesitate to do whatever the OB thinks is necessary to reach that goal.  

adamsbabble

I don't think it's strange that your MW suggested having one.  In the event that you cannot speak for yourself, it is important for them to know what you want.  That being said, I think the term "birth plan" is sort of silly.  It's really more like birth wishes.  I think it's important to know where you stand on things so you don't end up having a doctor "hurry things up" but it's also important to be flexible.  Basically my birth plan is that I want to let everything happen naturally, with interventions there only if it is necessary to save mine or the baby's life. 

As far as episiotomy goes, my birth plan states that I would rather risk tearing naturally.   MW's will generally let it happen this way, just an FYI (the good thing is that MW's also do what they can to help you avoid this, i.e. perineal massage, etc.).  Natural tears heal better than cuts though, and like PP said, whether its a natural tear or stitches from a cut, it's not going to be a walk in the park.  Here is some food for thought - I know someone who was seeing an old school OB, who actually still did routine episiotomies (doing them routinely is pretty much an outdated practice).  However, her labor was so fast that by the time he got there, he didn't have time to perform one.  Well, it's a good thing he didn't get there until the last minute b/c she didn't end up tearing whatsover.  If he had been there earlier, she would have been cut for no reason.  Now how silly is that?  This is why I am all about letting nature take its course and using interventions only as a last resort. 

FWIW, if my MW suggested one, I would probably end up having it, only b/c I really trust their care (that's so important - I would not trust everyone out there just b/c they are a "professional") and b/c I know that they are all for letting you have everything happen naturally.  If they are suggesting intervention, I know it means it is probably the right thing to do. 

Rose.9.6.03

I didn't have a birth plan, as so much was out of my hands by having twins (had to have an epidural, fetal monitoring, delivery in the OR). 

 I did ask that my doctor do a episiotomy only if absolutely necessary.  He didn't do one.  I ended up with a 2nd degree tear - primarily from the fact that I had to have a vacuum extraction. 

I know I'm in the minority, but I didn't have any issues post partum with pain or itching down there.  I had a really easy recovery and everything healed perfectly. 

JLPT830

I had a birth plan....mostly so I had things written down to discuss with my doc at one of my last appts.  I had a copy in my hospital bag with a "thanks for being my nurse" note to give to the nurses when we got to the hospital.  But when we got settled into our room, my nurse came in with a copy from my chart and was ready to go.  It was wonderful.  I didn't have anything real crazy in there....just things like - who I wanted present when I delivered, what I wanted to try during labor, DH to cut the cord, DH to help with bath.  I also had things in there in case something happened to me - I didn't want DH faced with trying to make decisions if he was in a panic state....like whether DS should have the eye drops, immunizations, if I needed emergency c-section, etc.  I may have stolen some suggestions from a form off the bump.

As far as the episiotomy was concerned, I had already talked with my OB at an appointment and he knew, and it was in my chart, that I wanted the delivering doctor to make the call.  I ended up with just a small tear.  I don't know anything about delivering babies and I certainly have no idea what's going on down there....so I trusted their decision.

Good luck!  Either way...just remember that ICE is your best friend!  :-)

gemduncan

I just got back from my all day birthing class at Good Sam's and they prefer to just let women tear vs. episitomy.

jerseygirl81

Ditto everything Kessler said about the birth plan. She put it perfectly!

I didn't want an episiotomy, but because Baby C's heart rate kept dropping so dramatically they had to use the vacuum and he had to come out right at that moment, so I ended up with a 2nd degree cut. It healed nicely, really didn't bother me at all except when I was sitting on a hard chair for the first few days. A donut pillow is your friend

hav2run

I have never heard of a doc offering an elective c section because of a previous tear.  Anything is possible though.  No, they do not cut an episiotomy into the rectal tissue even if they suspect you might tear that far anyway.  That would be bad practice.  That said, I really think that the potential risks associated with a tear or an episiotomy are FAR less worrisome than the potential risks associated with a c section.  The recovery from a tear or episiotomy is harder IMO (I speak from experience) than recovery from the c section incision.  But, there are far more risks to the mother with the c section.

annapolis13

I had an epi and still ended up having a 4th degree tear with my son.  I'm glad my doc gave me an epi.  I can't imagine what the tear would've been like without one.  I will probably have a c-section next time due to the size of my son.  I really don't want to have surgical repair later on from having big babies.

 

424bride

I didn't plan on having one, but after 18 hours of labor and exhaustion, I ended up needing one.  It wasn't nearly as bad as I thought.

cops_wife

I would have preferred to tear on my own, and I let that be known. Everything I've read says a tear is often not as deep or as large as an episiotomy. However, my doctor cut me without discussing it with me despite my request not to because she had another birth going on that had some complications and wanted my baby out. DH even overheard her say, "Gosh, I thought that baby would slide right out after the episi." The baby did not slide right out. I had to then push for an hour after the episiotomy without an epidural and she then stitched me up without anesthetic. The rest of my labor and delivery was a piece of cake compared to that. The pain from it was so difficult that I had a hard time even focusing on holding the baby after she was born. I'm still p!ssed about that experience, and won't deliver with that doctor again. I would have MUCH preferred to tear and see what happened, only having the episiotomy if I started to tear the wrong way or really needed it.

JenRose05

I had a small episiotomy and it lead to a tear in the end I had a 4th degree tear which is the worse, it did hurt but the meds I took afterwards kept it under control

Megs&Nick

I had a third degree one due to Allie trying to come out sideways and needing to be pulled out with forceps.  I didn't think it was bad at all.  I was up walking shortly after delivery and took nothing but motrin.  I would do it again for #2 if necessary but obviously wouldn't want it if I didn't need it.  We didn't create any sort of birth plan and none of the nurses or docs asked about it.  I didn't have any strong feelings about delivery though (just figured I'd take it as it came) so it would have been a waste of time for me.

Do what you feel works for you but be ready for anything.  I'm sure you'll do great!

dec05gurl

I had my birth plan in my head, but didn't write it out bc I figured the chances of doc/nurses reading it were slim to none. ?That being said, we were really clear with everyone how we wanted labor/delivery to go. ?But pitocin totally threw us for a loop and nothing went as planned. ?I'm glad we didn't have it written out bc I think everything going not as planned would've been more upsetting for me. ?SO....with that...ended up with a vaginal delivery, but in the OR bc if forceps didn't work then immed c/s would have been done. ?As the doc was inserting the forceps he told me he had to do an episiotomy bc of forceps...at that point I said something like OK or whatever. ?I had a 3rd degree tear. ?I'm not sure how bad it was considering I have nothing to compare it to. ?Yeah, it was uncomfortable, but not terribly painful. ?The 'roid was and still is worse than the stitches : )

So after my novel, I'd write something about if the doc thinks you must have one, for him/her to explain to you before they would cut and make sure you're OK with it. ?You just don't know how things will go. ?

GL! ?I can email you my birth story if you want, it's really long that's why I never posted it here. ??

lauradreed

I didn't write out a birth plan.  It wouldn't have really made a difference if I had.  I had to have an epi because DD had to be delivered by forceps (after 2 hours of pushing and no progress).  She came out healthy and beautiful and I healed up just fine.  I don't know what degree of a cut I have.  I don't care.  I had a healthy baby and I can continue to have more.

FWIW - I had a very long labor and my mother (who had three very traumatic birthing experiences) said that my labor was a difficult one.  I didn't notice.  I never ruled out the option of an epidural but I went as long as I could handle it without one (and then eventually opted for it).  I pushed for a very long time with no progress.  The only time that it dawned on me that my labor and delivery was a difficult one was the next day when every muscle in my body was sore and I felt like all I wanted to do was sleep (I was so exhausted that I could only hold DD for short periods at a time).  Still, I thought that I had a very pleasant labor and wasn't stressed at all when I probably would have been if I had written out a plan of how I wanted it to go and it didn't.

natasha15

I let the doc do what was needed..While I was pushing she said I am going to need to cut is that okay and I said sure!! however it was wicked after the fact..I did need ice packs and stool softners for a couple of days and then I was back to normal..Thanks be to GOD!!! I can't really say there are any good things about it..regardless you get stiches and those SUCK!!!  GL in your decision..