- Pregnancy
- Baby & Toddler
- Parents
- Getting Pregnant
- Baby Names
- Product Reviews
-
Registry
- Community
-
More
Want a personalized experience?
Download the free app
Natural Birth
mrshall10210
member
Let's talk about episiotomies and tearing...
mrshall10210
member
I've read various opinions on this subject with differing opinions and outcomes. So I would like to know about your own personal experience with this, and your opinions.
Although this will be my first birth experience, I am confident that as long as my healthcare professionals cooperate with my wishes, I can have a natural birth, and I am not afraid at all.. mostly thanks to all of the great information and support on this forum. My one fear, I think, is tearing/having an episiotomy, and even worse, requiring stitches to repair it.
Most natural birth books/articles I've read seem to lean towards allowing yourself to tear. I understand that the tear often heals better than the cut? It is also my understanding that many women will experience only a small tear, whereas the episiotomy incision would be longer. Is this true in most cases?
At what point would you consider allowing the episiotomy? I will be giving birth in a hospital, so I expect to be pressured for the episiotomy. If I'm being told that I am "definitely about to tear", should I allow them to cut? What if they tell me I'm going to tear in multiple directions? Does perineal massage work well, in your experience, to reduce the likelihood of tearing? Does this need to be done only during labor, or is there any benefit to having it done in the last weeks of pregnancy? I don't know if this is possible to control or not, and maybe I read it somewhere, but if you take your time with pushing, are you less likely to tear? One more... best pushing position for minimizing tears... squatting, or on all fours?
Thanks in advance! 
Warning
No formatter is installed for the format bbhtml
This discussion has been closed.
Re: Let's talk about episiotomies and tearing...
I've had three vaginal births (two posterior) and have never torn. For my first two births I pushed flat on my back and with #3 I had a waterbirth and delivered her squatting in the tub. So, positioning didn't seem to make a difference for me.
I never did perineal massage with any pregnancy. The only thing that was done (only with #1 and #2) was my MW guiding my pushing and helping me to stretch.
If tearing is a serious fear of yours you should consider a waterbirth. It is supposed to reduce the likelihood of it happening.
I didn't want an episiotomy, but ended up having one.
My friend who was there with me knew that I didn't want to be cut, was my 'advocate' with the Dr.. When he said he was going to have to cut me she stepped in and told him no, but he explained to both of us, and showed her that I was about to tear in 5 different spots.. 2 on bottom and 3 on top.. I hadn't had sex since the week I got pregnant, and didn't do any peri massage, so I'm thinking that made me more likely to be small/more at risk to tear.
We went ahead and agreed to let the Dr do the episiotomy... he did a small one & I avoided multiple tears...
I want to fore warn you though, that in the heat of the moment, especialy if you are doing all natural- You need someone there who will help be an advocate because in the middle of it, it's hard to be able to focus or think about things like that.
I have had two natural births in a hospital with a CNM. It's a very natural birth friendly hospital, so no one ever even spoke the word episiotomy to me. If you can, I would talk to others who have delivered at the same hospital you plan to and see what their experiences have been.
Both times I sustained a second degree tear. And both times I can honestly tell you I was not aware of it as it was happening. I had to ask the midwife after if I tore. I have a friend who had two natural hospital births and she did not tear either time. So, I would not opt for a routine episiotomy because you might not tear at all and even if you do, in my experience I did not think the recovery was all that bad. Sure, stitches weren't fun, but it doesn't take that long and by that point you have your baby on your chest so it's a great distraction. I asked for a local anasthetic down there soon after delivery, and they can give you pain meds that are safe for breastfeeding. The midwives told me to pour a little castor oil onto a pad each time you change it during your recovery, the castor oil is supposed to promote healing.
I could only imagine consenting to an episiotomy if I was having some kind of real trouble pushing the baby out and if the baby seemed to be in distress. Honestly, I question whether they can really tell you that you're "definitely going to tear" or that they can tell how and where you're going to tear. I've never heard that. I pushed nearly three hours with my first and only 5 or 6 times with my second, and I had the same tear each time so I don't know to what extent you can really control this.
Tearing is a normal and understandable fear, but try not to psych yourself out and let it paralyze you. Sure, I would rather have not torn at all, but for me in the grand scheme of things it was really no big deal.
Good Luck to you!
I will preface this with saying that my experience is NOT the norm. I know plenty of moms who have had first vaginal births no tearing or tearing so minor that it only required a stitch or two. As scary as it is to think about it was not scary when it was happening...in fact, I didn't care one bit. The recovery was difficult but not unbearable.
I had a pretty extensive second degree tear with DS (They were stitching me up for over an hour). I hope to avoid it next time since my recovery time was so long (still uncomfortable to squat down or sit on hard surfaces for long at 9 mos PP) There was a thread on tearing the other day with some good info from posters so you may want to check that out.
I understand that the tear often heals better than the cut? This is my understanding also. With that being said, I still had open wounds/stitches at my checkup at 8 weeks PP while my SIL who had an episiotomy didn't feel it at all after about a week. It is also my understanding that many women will experience only a small tear, whereas the episiotomy incision would be longer. Is this true in most cases? An episiotomy is automatically a second degree tear. I think it really depends on the situation.
At what point would you consider allowing the episiotomy? If I was about to tear the wrong way. A tear up to the urethra is more painful and it is my understanding that it takes longer to heal than a tear to your perineum. Another example: my SIL's midwife did one on her (she had only done a few in the past) because she looked like she was about to "starburst tear". I will be giving birth in a hospital, so I expect to be pressured for the episiotomy. If I'm being told that I am "definitely about to tear", should I allow them to cut? I delivered in a hospital and not once did they offer me an episiotomy, even when I was about to tear and started to tear. It was in my birth plan that I didn't want one. I did have a CNM, so maybe that would be different with an MD. What if they tell me I'm going to tear in multiple directions? Personally, going through the recovery I did, I would get it in this situation. Does perineal massage work well, in your experience, to reduce the likelihood of tearing? We did not do this but definitely will during pregnancy the next time around. Does this need to be done only during labor, or is there any benefit to having it done in the last weeks of pregnancy? Again I'm not sure. They didn't have time for massage when I was pushing (or if they did it I didn't notice...I know she did try to compress my perineum during crowning). I don't know if this is possible to control or not, and maybe I read it somewhere, but if you take your time with pushing, are you less likely to tear? This is one I really really believe in. I pushed DS out in 15 minutes. It took about two minutes from the time we could see his head until the time he came out. He came all the way out in one push. I feel the hospital is partially responsible for this...they kept urging me to "push harder, push harder, push harder!" so I did. Next time I will be clear that I want to direct the pushing and I will try by best to take my time so the skin can stretch a bit. One more... best pushing position for minimizing tears... squatting, or on all fours? Having only had one child, I can not say what the best position is, but I will say I was pushing flat on my back in bed. They had me kind of squatting/on all fours to start the pushing but the baby had heart rate decels so they had me move to my back with a pillow under my left side. Next time I will try different positions. (hoping for a water birth).
If you are allowed to tear naturally, it usually isn't as bad as if you are given an episiotomy. Think about it: if you try to rip a piece of fabric, it's really hard. However, if you make a little snip and then pull on it, it will easily tear further. It's the same concept with the skin of your perineum. Also, the more surface area involved, the faster an incision will heal, so a jagged tear heals faster than a straight episiotomy. That all said, here is my personal experience. With DD#1, both my OB and I were very anti-episiotomy and she did all of the warm compresses/olive oil tricks while I was pushing. However, at the very end with DD "right there", her heart rate dropped down very low and wasn't recovering. She needed to come out quickly, so it was either crash c-section or massive episiotomy and pushing like life (literally) depended on it. My OB did a 2nd degree episiotomy and thankfully I was able to get DD out quickly and she was fine. Within 2 hours I was sitting cross-legged and had a super easy recovery. No healing complications and I felt great getting up and around within a few hours. I did have an epidural with DD#1, so I can't attest to pain from the episiotomy or repair immediately afterwards. With DD#2, I went natural and tore right along my episiotomy scar. I couldn't even feel the tearing when it happened, but getting stitched afterwards hurt quite a bit. They did give me local, but it was still painful. Definitely manageable, but unpleasant. Healing this time was also quick and easy, probably a bit faster than with DD#1.
Honestly, I think most of the pain issues post-delivery come from swelling if you have to push for a long time. I would suggest laboring down as long as possible to let your body get your baby low before you start actively pushing. Also, most OB's are moving away from episiotomies, so I wouldn't be too worried about being pressured for one...usually it's only done when the baby's life depends on it.
Thanks for all the replies... I plan on having my mom, who knows little about natural childbirth and isn't much of a believer, but hopefully knows to leave me be, and DH who is a nurse, and agrees with my wishes for minimal interventions, and who I expect will be awesome at advocating and supporting me.
I'm glad to know having an episiotomy isn't as routine as I thought. I see a CNM at most of my visits but I also see a few different OB's, and it's hard to say who will be on call when I deliver. I'm okay with this, as long as they're allowing me to do my thing. If I'm going to tear upwards, then I'll definitely allow them to cut me if that becomes an issue. Otherwise, I will definitely avoid it unless LO is in trouble. If I get brave, maybe I will try to look up the technique for perineal massage for the weeks leading up to my due date... that should be an interesting google.
Good to know, also, that tearing and stitching is not as big of a deal when you're in the moment. I never even thought about them numbing it first!
I had an episiotomy with DS1 and tore with DS2. Healing was MUCH easier with the tear for me. I did feel it tearing a little, and getting stitches wasn't fun, but once that was over I barely felt any pain. With the episiotomy, I was in quite a bit of pain for a good week after birth.
I delievered DS2 in a hospital with an OB. No one pushed me to get an episiotomy. Once I put it in my birth plan that I wanted to tear unless it was an emergency, they respected my wishes. I did discuss this with my OB beforehand to be sure she was on board.
Lurker here...
I have nothing to add, but the information in this thread is really helpful. Thanks for asking all this OP, and thanks ladies for taking the time to write such detailed, helpful responses.
I didn't have a natural birth, although I wanted one. I didn't have the knowledge to advocate for myself... which is why I'm here.
With DD, I had an epidural that wore off by the time I started pushing. After I had been pushing for around 3 hours my OB was beginning to get worried. She tried using vacuum assistance to no avail and at that point she said that baby needs to come out now. She absolutely did not want to give me an episiotomy and even apologized for it. After she made the cut, DD's whole head & body came out in one push. She had a very big head at 14.5 inches and was swollen from being in the birth canal so long.
All of that to say, I think the episiotomy could have been avoided with a different pushing position. I had also been in labor since 5pm the previous evening (she was born at 5am) so I'm not sure how effectively I was pushing after 9 hours of labor and 3 hours of pushing and no sleep. I do feel like the episiotomy probably saved me from a c-section and for that I am grateful.
I had a second degree tear that required 5 stitches, and honestly - it wasn't a big deal. I didn't feel the tear at all and I had the stitched done without novocaine or numbing meds. The pressure of pushing out the baby didn't let me feel the tear and once I had baby on my chest, nothing else mattered.
Like PPs have said, the only reasons I would feel ok with an episiotomy is if I was at risk of tearing upward towards the clitoris or in a serious emergency requiring the vacuum or forceps to deliver.
I had some perineal massage during the early pushing stages, but I can't really say if it helped or if prenatal massage would have helped more --- but it certainly can't hurt!
I think that if you were able to go slow and steady with pushing, you might be less likely to tear. In my experience however, going slow was the last thing on my mind during the pushing phase. I wanted the baby OUT. NOW. If you had a really good nurse, support person or OB/MV who really encouraged you to take it slowly that would probably help, but sometimes your body just takes over.
As far as positions for reducing the likelihood of tearing, I'm not positive - I would be curious what Ina May says on the subject. But, squatting and all fours are great for pushing in general - you have more leverage and gravity to help you and your pelvis opens more in these positions.
I can only speak for myself, but tearing, the repair and subsequent recovery were a tiny blip on my radar. There is so much more going on during labor and the best part is that at the end of everything you get your precious treasure to snuggle and that really does erase any pain. GL, you will do great!
The only time I would entertain the idea of an episiotomy is if I was not tearing on my own and the opening was not allowing LO through, and we were hitting issues with LO being in distress. I wouldn't if I was going to tear anyway, since I do think that nature does a better job than the scalpel in this case. But I've heard of very rare cases of this happening, and I kept myself open to the option in case of true distress.
Here's an article with some stats on massage and tearing: https://www.scienceandsensibility.org/?p=5899
Also--I think too much fear can hold you back and keep you from seeing the big picture. If you tear, you tear. If you need stitches, you need stitches. They'll numb the area so it won't be painful (much) and though healing isn't fun, it's not awful. I promise in that moment of holding your LO for the first time, the repair work on your lower half is going to be furthest thing from your mind.
I did everything "right"--massaged leading up to due date, self-directed pushing, we took a long time pushing--and I still had a kinda nasty 2nd degree tear. I couldn't have cared less at that point! I was numbed to repair, was nursing my baby by then, and didn't even notice my MW down there
It was sore for a couple of weeks but I've almost forgotten three months later! So in the big scheme of things, it's all ok.
I will go check out that article!
Your daughter is precious, btw.
Thank you for this article! I was planning on doing perineal massage for my next baby but now I know I need to look into it more.
I tore with both my kids. Lots of stitches. Getting the stitches was NBD at all, and they dissolve over a couple of weeks so again, NBD. Swelling was much more difficult to manage, esp. the first time.
I'd likely have consented to an episiotomy if it had been recommended during pushing, I'd have consented to just about anything to get babe out at that point, lol. But it never came up.
I pushed 2 hours with my first, and tore right at the end, according to my doc. I did not notice that I was tearing.
Don't know when I tore with DS2, but he was out in 3 quick pushes.
I pushed in all kinds of positions with DS1, most productively while squatting. DS2 I leaned on my right hip more or less but was essentially on my back.
DS #1 born 05/25/2012
BFP#2: 06/12/2013 ---- loss
DS #2 born 4/08/2014
BPF#4: 2/1/2016 --- 2/23/2016 suspected molar pregnancy--- 3/15/2016 D&E - diagnosis MM
BFP#5 - 9/22/2016
* formally bornmommy
I don't know the answers to all of your questions, but I'll help with what I can. In my opinion, it's best to tear naturally. It is true that sometimes the tears are smaller than what the episiotomy would have been. Some women don't tear at all. My midwives rubbed oil and massaged the area all through labor, and I really feel like that helped. I only had a very small tear, and that was because my daughter came out with her hand next to her face. It was such a small tear that my midwife said it didn't need stitches. If I had been in a hospital they probably would have just stitched it anyway. I have no idea if using oil and massage before labor would help, but I don't really think it would. I have also heard that water birth reduces the risk of tearing. I hope to do a water birth this time around.
I hope this helped a little!
Lots of good responses, just wanted to share a detailed midwife blog post on the subject of tearing:
https://midwifethinking.com/2010/08/07/perineal-protectors/
Notable quotes:
"It is also important for women to know that it is normal for the perineum to tear, and that if it does they have not ?failed?."
"Telling a woman to stop pushing, pant or ?give little pushes? distracts her at a crucial moment and suggests that you are the expert in her birth, which you are not. She is the one with a baby?s head in her vagina ? leave it to her."
"In summary There is very little midwives can do to protect women?s perineums so we need to stop taking the credit and the blame for perineal outcome. Instead we need to encourage women to trust that their body has an innate ability to birth their baby; that perineal tearing is a normal part of birth; and that the body will heal itself."
Personally, I will also choose to tear just so that there's a possibility that I won't.
Tearing was my single fear about giving birth to DS1. I wasn't afraid of labor pain, I was afraid that I would tear and that my vagina would never be the same again. Well, I did tear and my vagina will never be the same but that's because of a family issue with vaginal prolapse and not because of the tear. I can't even tell there ever was a tear. It was hella sore for a couple weeks, tender for a couple months, and sex was slow going for a while because I was so nervous. But it wasn't bad and this time around I'm not the slightest bit concerned about it, not knowing what to expect was so much scarier than the reality of giving my body time to heal afterward.
I had a natural birth, and, in my birth plan, it stated that I didn't want an episiotomy and would tear naturally if necessary. My son decided to mess that all up when he showed up 14 weeks early, though. :-) I had to have an episiotomy because they needed to do whatever they could to reduce pressure on his head (preemies are susceptible to brain bleeds). It worked, and my son's head was fine.
My recovery from the tear was no big deal. I had a few stitches, but I didn't have any lingering pain or anything. So, if you DO have to have one in an emergency, it will likely be manageable. Tearing naturally is supposed to be better, but it isn't always possible.