Episiotomy vs. Tearing

lyzp07 · November 2010

I'm getting extra confused with this choice on my birth plan. Last night in child birth class they said episiotomys (?) are easier to heal and stuff, but then i have friends who are nurses and they say that tearing is better because its natural. Then I'm looking for opinions everywhere else and its coming out 50/50, so I'd really like to hear everyones thoughts. I can see both sides of the argument. Right now I'm about to tell my doctor I'm going to wing it haha.[Poll]

utlawgirl · November 2010

Hmmm... That sounds like outdated info. Most doctors don't do episiotomies routinely any more (thank goodness). A straight cut is easier to repair, sure, but that doesn't make it easier to heal. My midwives (and the OB that practices with them) have all said it's almost always better to tear naturally than to be cut. Ask your provider what his practice is, but personally I don't want an episiotomy unless it's really necessary (i.e. to prevent a worse tear).

kpmd1 · November 2010

The nurses I've spoken to have equated a tear with a bad rug burn, and an episiotomy obviously is surgical, so you have stitches to contend with. I also have been told that Drs. do not do episiotomies anymore unless the baby truly is too big to get through otherwise. I think generally there is not a choice anymore. You tear unless there are extenuating circumstances. BUT, a lot of women don't even tear.

danssugahbugah · November 2010

Tears actually heal much better than cuts. The jagged edges of a tear connect and heal back together much like a puzzle piece rather than a cut which has two straight lines. I'd rather tear than be cut, but that's just my opinion!

EmjayTheHunted · November 2010

Alright... I don't know what nurse equated a perineal tear with a rug burn, but that's BS.

It's simple really. If you have something that tears in a jagged line and uneven, it's harder to repair. And yes, it still has to be repaired. They don't leave it there unless it's super tiny. But a tear usually isn't.

Some edges are pulled tighter than others, and it results in a lot of pain when sitting, standing, doing anything.

An episiotomy is done with a pair of sterile surgical scissors, it's a controlled cut and it very simple to repair. The edges line up better, there is less tugging on the wound. Heals much better.

Soap1 · November 2010

You get stitches whether you get an episiotomy or tear. My doctor gave me an episiotomy (2nd degree) because he was concerned I was going to tear 4th degree if he didn't do it.

I think tearing sucks and an episiotomy sucks. Either way you won't be sitting right for a week or two. I personally don't think it matters in the end!

EmjayTheHunted · November 2010

danssugahbugah:
Tears actually heal much better than cuts. The jagged edges of a tear connect and heal back together much like a puzzle piece rather than a cut which has two straight lines. I'd rather tear than be cut, but that's just my opinion!

Seriously?? How would jagged edges line up better than 2 straight lines?? That doesn't even add up.

Mama_SAS · November 2010

It depends on how severe the tear is. Normal minor tears heal better but extremely severe tears will be worse than a controlled episiotomy.

Just have a c-section and avoid it all. That's what I'm doing. Stick out tongue

(Before anyone jumps down my throat - repeat c-section, not a VBAC candidate.)

kknapp25 · November 2010

honestly couldn't tell you which method is better, i would think it depends on the person. when we went to our birthing class the nurse told us our hospital is actually against epoisiotomies, they feel it's a guarantee that you will need stitches, healing time, etc. where if they let you deliver without an episiotomy you could do it without tearing at all. if the dr feels you're in jeopardy of tearing they'll try a few techniques to try to avoid it, if that still doesn't work we'll have the option of "seeing what happens" or having an episiotomy (if this is done there's more control over where pressure is relieved, how they'll mend you afterwards, etc, vs. a tear that could spread anywhere!

andrea922 · November 2010

EmjayTheHunted:
danssugahbugah:
Tears actually heal much better than cuts. The jagged edges of a tear connect and heal back together much like a puzzle piece rather than a cut which has two straight lines. I'd rather tear than be cut, but that's just my opinion!
Seriously?? How would jagged edges line up better than 2 straight lines?? That doesn't even add up.

This just shows how conflicting the information is. A nurse is on here saying an episiotomy is better but in reality most doctors no longer do them routinely because they have found tears actually do heal better. A tear is also natural in the sense that you will only tear the amount you need to. If you are cut you run a higher risk of tearing on top of that and ending up with a 4th degree tear. I would never, ever let my dr do an episiotomy. And, fwiw, I didn't tear at all when I had my son, so it is possible you won't tear, not everyone does.

ToBeWedJuly07 · November 2010

This is such a great question/discussion... thx for posting.

My sister in law had an episiotomy b/c her dr. thought she would tear and she said that the sewing part of it was the worst b/c she didn't have any medication when they sewed it together. She said it was worse than the labor/delivery itself as she had an epidural but it wore off by the time it was to sew her up. So if anyone does get one, make sure they give you anesthetic before they sew you up.

I say its one of those things that are hard to tell b/c we all don't know if we will tear or not... so its hard to say to anyone what to do. I think if you're baby will be big during your delivery time, then your chances of tearing will be greater. If you are oppose to an episiotomy then most OB's will tell you how to massage that area so the chances of tearing will decrease. I don't want either one done like I'm sure everyone wants, but I rather tell the dr. delivering to do it if he/she feels that I really would tear as I rather have it controlled than chance it to have it tear as it could tear big and be harder to sew together.... just my opinion. good luck!!!!!!!!

JenSaidYes · November 2010

this is what my doctor said to me when i asked him about it. Think of your skin as fabric. it doesn't tear easily until you put a small cut in it, then you can rip it completely apart.

His concern with cutting is that the cut can then tear and be even worse than it would have been in the first place. he said that a natural tear is much better for me.

midnight*sun · November 2010

There have been quite a few studies done on this matter and they are finding now that an episiotomy can actually increase your likelihood of having a serious tear and there is no medical research that shows increased healing time over a tear. In the book "Pushed" by Jennifer Block numerous scientific studies are referenced but for internet purposes you can find more info at babycenter. There are some instances where an episiotomy is needed, but very rarely and the ACOG states that episiotomies should not be done routinely and reccommends restricted use.

iris427 · November 2010

Routine episiotomy seems to be falling out of favor because of all the medical studies that have come out finding that it does not improve outcomes for mothers. There are certainly cases where episiotomy is warranted but using episiotomy on a case by case basis seems to be a better approach than just cutting everyone.

Some women won't tear at all and those who do will often have only 1st or 2nd degree tears. An episiotomy is a guarantee that you will have at least 2nd degree perineal damage. And a midline episiotomy is more likely to extend into the anus or rectum than a natural tear.

There are also a bunch of studies finding episiotomy is associated with more postpartum pain, more sexual and pelvic floor dysfunction, higher blood loss and higher rates of infection than natural tears. With medical studies it seems like there are always going to be other studies that come out and contradict that. But the studies showing that routine episiotomy is harmful date back several decades and I think overall they make a good argument for episiotomy to be performed as needed instead of on the majority of women.

ACOG does not support the use of routine episiotomy:

https://www.acog.org/from_home/publications/press_releases/nr03-31-06-2.cfm

Here's a meta-analysis of studies looking at routine vs. restrictive episiotomy:

https://jama.ama-assn.org/cgi/content/abstract/293/17/2141

HoonFan · November 2010

I'm no doctor so I don't know for a fact. But, I can tell you from experience that with my first, I had a 3rd degree tear and the only reason I know is because my doc told me!! Otherwise, I would have never known.

WannaBeCrunchyMama · November 2010

The only time an episiotomy should be "required" is if the baby is in danger and needs to get out ASAP.

The doctor/midwife/whatever will then perform an episiotomy to help the baby come out faster.

A doctor who routinely performs episiotomys is behind the times and needs an update on what is considered "standard" these days.

monicarosega · November 2010

I am lurking from second tri...

In my opinion, as someone who has been through this before, I would much prefer to have the chance to tear and not get a preemptive episiotomy.

I did NOT tear at all and alot of women don't. I was very adamant that my doctor not cut me and I am so happy that he didn't. The recovery would have been so much longer and harder had he cut me since I did not tear at all on my own.

HappyMommy28 · November 2010

EmjayTheHunted:
danssugahbugah:
Tears actually heal much better than cuts. The jagged edges of a tear connect and heal back together much like a puzzle piece rather than a cut which has two straight lines. I'd rather tear than be cut, but that's just my opinion!
Seriously?? How would jagged edges line up better than 2 straight lines?? That doesn't even add up.

Actually I was told by two separate MW's that tears do heal better than cuts. Often times if you tear naturally it also wont be as bad. In fact, many doctors don't even perform episiotomies much anymore due to the fact that they really aren't necessary and can cause more pain and discomfort than tearing naturally. My sister's OB told her the same thing when she delivered. She did not have an episiotomy but tore naturally.

ncbelle · November 2010

EmjayTheHunted:
Alright... I don't know what nurse equated a perineal tear with a rug burn, but that's BS.
It's simple really. If you have something that tears in a jagged line and uneven, it's harder to repair. And yes, it still has to be repaired. They don't leave it there unless it's super tiny. But a tear usually isn't.
Some edges are pulled tighter than others, and it results in a lot of pain when sitting, standing, doing anything.
An episiotomy is done with a pair of sterile surgical scissors, it's a controlled cut and it very simple to repair. The edges line up better, there is less tugging on the wound. Heals much better.

Then why, pray tell, does the ACOG recommend against routine episiotomy? Oh, must be because medical RESEARCH has shown that it's not as effective as allowing for natural tearing.

OP - to answer your question, I'd never opt for an episiotomy. I had a super minor (not even 1st degree tear) with kiddo (and his 95th percentile head) - I credit the perineal massage my midwife did while I was in labor with helping with that. Of course there's no way to know what sort of tear, if any, you'll get. But the research that suggests episiotomy often leads to more extensive tearing than would have otherwise occurred is pretty convincing to me.

OregonMommy · November 2010

utlawgirl:
Hmmm... That sounds like outdated info. Most doctors don't do episiotomies routinely any more (thank goodness). A straight cut is easier to repair, sure, but that doesn't make it easier to heal. My midwives (and the OB that practices with them) have all said it's almost always better to tear naturally than to be cut. Ask your provider what his practice is, but personally I don't want an episiotomy unless it's really necessary (i.e. to prevent a worse tear).

This. My OB won't do one unless it is absolutely necessary and said she does only a handful a year.

katoflower1 · November 2010

I've been wondering the same. With my first pregnancy, my labor and delivery went so fast that my body didn't have time to stretch out so I tore...very badly! My little girl was only 6 lbs.

I was in so much pain for weeks, I would cry everytime I had to pee. I am worried that I will have to go through that again, and I would much rather labor and deliver 10 children before having to go through the pain of healing again.

I know this isn't much help to you but I would have to think that an episiotomy would be much easier if either had to be done. I can't imagine that it would be worse...

kaulmer · November 2010

When I had my first child 15 years ago, I opted to tear. This was at a time it was routine to do an episitomy. I chose to tear because it is natural and my friend suffered from her episiotomy and had to sit on a donut device due to the pain because they cut towards the anal area. When you tear, it is usually away from that area making it easier to sit down after the birth without severe pain. Although my doctor did let me tear, it was a severe tear and I almost needed a catheter. I still needed stiches even though it tore naturally but I am opting again to tear if they let me because it does make a difference on how you feel after.

alliecarrie41 · November 2010

episiotomy is a controlled and repairable cut. tearing could be anything. i am hoping to not have either of course, but i am not closed-minded to accepting an episiotomy if my doctor feels like i will otherwise tear.

andrea922 · November 2010

alliecarrie41:
episiotomy is a controlled and repairable cut. tearing could be anything. i am hoping to not have either of course, but i am not closed-minded to accepting an episiotomy if my doctor feels like i will otherwise tear.

A tear is repairable as well. Clearly you didn't read anything anyone else posted in here that discusses why a tear is actually preferred over an episiotomy by most OBs and midwives these days.

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