episiotomies

jennakg

Wondering...

Why would a care provider choose to do an episiotomy over letting the mother tear naturally?  Aren't episiotomies more difficult to heal than natural tearing? 

pinksweetpea2

Because it is easier for them to stitch up. 

jennakg

pinksweetpea2:

Because it is easier for them to stitch up. 

That makes sense, but is that the only reason?  

honkytonk_kid

jennakg:

pinksweetpea2:

Because it is easier for them to stitch up. 

That makes sense, but is that the only reason?  

That, and just not being up to date on research. The thought used to be that a clean cut was easier to repair, easier to heal, caused less damage- but research has since proved otherwise.

CurbsideProphet

If you need to get the baby out quickly, it could be necessary.

judahsmommy1

CurbsideProphet:

If you need to get the baby out quickly, it could be necessary.

This. If the tissues aren't stretching the way that they need to and the baby needs to come out ASAP then cutting is faster than tearing.

BransonsBecca

My OB assured me that he would let me tear naturally. However, if I start tearing towards the front, close to "my button", that he would step in and have to do something, as the front area is a little bit more important than the back.

My OB is also ok with doing warm compresses during delivery to help stretch things out to help prevent an epi. Most days they are not routine.

lupineaura

Echoing PPs- it can be medically necessary in an emergency situation and the baby needs OUT. I also had a nurse/doula say if the doctors think a really bad tear is coming (I forget exactly how they can tell), they might prefer a small cut.

pixieprincss

lupineaura:

Echoing PPs- it can be medically necessary in an emergency situation and the baby needs OUT. I also had a nurse/doula say if the doctors think a really bad tear is coming (I forget exactly how they can tell), they might prefer a small cut.

This reason is one I, personally, would speak up against ahead of time.  No matter what a provider thinks is going to happen, the one surefire way to have things NOT stay intact is by cutting, and there is no guarantee that a small cut will stay small. I don't know if you've heard the fabric-tearing analogy, but a small cut can turn into a large tear much more easily an if things stay intact, even if the chance of staying intact is slim. An emergency cut is one thing, cutting as any sort of prevention is entirely another in my book.

tokenhoser

The two real reasons I've heard are a serious emergency (like, life or death time) and tearing forward instead of back (but that is really very very rare).

If there are OBs doing them for an easier time stitching, they've probably got very grey hair.

maddiemoon43

After 2 1/2 hours of pushing and not really getting beyond seeing "this much" of his head and NO tearing my MW said she may have to cut if changing positions again didn't help.  It was the best thing I'd ever heard at that point.  DS has a large head and I did. not. tear.  My contractions were slowing down, and I was just done.  2 contractions later DS was born.  My MW apologized right up until our 6 week PP appt., but I didn't blame her for resorting to it - I had been starting to run through some possible options of getting the darn kid out myself, and this was probably the most appealing out of them.  

LaurelBee

My Dr said I was going to "rip from my vagina to my clitoris" if I didn't get the episiotomy. I consented to it, but I will never again unless I or my baby were in danger. My recovery was horrible and my post baby sex life was non exisistent for months after bc of the pain. Just be prepared that saying "no" might not be enough. 

mrstorrestobe

My OB told me with DD that the only way he'd do an episiotomy is if her head was coming out at an angled direction and toward the rectum......I THINK that's how he described it.  Kind of hard to imagine, but he said it would be extremely unlikely.  At least at the hospital I work at, episiotomies are the VERY UNpreferred method, for all the OB's that deliver there.

Soxgirl07

I was cut with DS because my CNMW said there was scar tissue. His head is big and the scar tissue was making a natural tear difficult, I guess. I don't really understand how there was already scar tissue... he was my first and I've never had any vaginal trauma. Anyway, I think he came out pretty quickly after that. My recovery wasn't horrible, but I have nothing to compare it to, so I don't really know.

dpraseutsinh

honestly, an episiotomy would be less painful and easier/faster to heal because it's a clean cut while a tear is... a tear lol. it's easier to clean and stitch up and take care of. 

runrinserepeat

dpraseutsinh:

honestly, an episiotomy would be less painful and easier/faster to heal because it's a clean cut while a tear is... a tear lol. it's easier to clean and stitch up and take care of. 

Just no. A tear heals much better than a cut.

My OB said she would cut to prevent a "starburst" tear, but that her epis rate was about 3%.  

mrstorrestobe

kleMcK:

dpraseutsinh:

honestly, an episiotomy would be less painful and easier/faster to heal because it's a clean cut while a tear is... a tear lol. it's easier to clean and stitch up and take care of. 

Just no. A tear heals much better than a cut.

My OB said she would cut to prevent a "starburst" tear, but that her epis rate was about 3%.  

This.  All recent research shows tears heal much better than cuts.

5dogs

My OB chose to do one when my daughter's heart rate began to decline as I was crowning and they realized her cord was wrapped around her neck - it allowed her to take some of the pressure off of DD and get her out without any additional tearing. It was quick and she apologized when she did it (as she was explaining why).

NADA-H

who would normally stitch episiotomies or tears? a MW or an OB?

wintersong

Both can stitch you up--I'm not sure how a person could be a licensed attendant of a birth and NOT be able to stitch you up, at least in VA.

Episiotomies are still disturbingly common as a standard protocol, depending on the area you are in. :-( I had a friend who works as an L&D nurse recently try to convince me that every woman should get an episiotomy because it is easier to repair than a tear. She even brought the subject up later at a different time because she felt so strongly about it. (She is only 26, so its not an old-school thing.) But I know that ACOG doesn't recommend episiotomies for everyone, so this is just the mindset of the hospital staff at one of the local hospitals.

Sannika

I had 2 kids, had episiotomies both times. Healing wasn't bad at all, the stitches were fully dissolved well before my 6 week check up. Comparing mine to my SIL, where the staff was against doing episiotomies, she ended up with a stage 3 tear and took about 10 weeks to heal. I don't see how a clean cut wouldn't heal just as fast as a tear.

Yogakitten

My mother (an OB) laughed at the thought of cutting a women just because it's easier to repair. She's a skilled surgeon, so stitches are not only pretty easy for her, she also takes a lot of pride in the quality of her work. She said that routine episiotomies aren't really done anymore, so they should only be used if (1) the baby needs to come out quickly or (2) rarely, if the patient is going to tear in multiple directions. She also mentioned that a really bad tear won't necessarily heal as well as a clean cut (no matter how carefully one stitches), but it's tough to tell in advance if an episiotomy will prevent the tear in the first place. She also had an episiotomy done on her while in labor with me, and she's still pissed about it -- so she hates doing them. Obviously I'm biased, but seriously, OBs aren't monsters. Jesus.

jennakg

Well this post came back to life! With ds I had an ob who did not perform episiotomies. I had a 2nd degree tear and healed just fine. Now I'm expecting #2 and seeing a mw. I haven't talked to her about episiotomies yet, but I think it's pretty rare for them to be routine these days. But it's great that they can be done when absolutely necessary.

dmhrn13

How about, the kids heart rate is in the crapper?? If the baby needs to be born because its heart rate is 60, it is probably not wise to let your tissues stretch for another 10 minutes. Birth is about 2 people.