Tore with #1. Episiotomy with #2? Wwyd?

JessaPrimate · December 2013

With DD I opted not to get an episiotomy and I wound up with a significant tear. I was never told the degree, but I got a lot of stitches. The tear apparently went the opposite direction they normally do into my labia.

I have heard you tend to retear already weakened tissue. While it wasn't the worst thing in the world, I'm concerned it will go up even farther.

Anyone have any thoughts/experiences?

Thanks!

barista411 · December 2013

I actually just went through a similar situation. With my first I had a 4th degree tear, episiotomy, and labial hematoma. I was terrified to have another vaginal delivery but was determined to have another natural birth my second. I did lots of reading and research before my second and was able to have another natural delivery with only a very minor 1st degree tear. The things I found that helped decrease the tearing were doing the exercise from spinningbabies.com to help baby get into the optimal fetal position, reciting positive labor affirmations all through out pregnancy, trying other pushing positions (side lying worked best for me), counter-pressure on labia and perineum during pushing, slowing down while pushing and allowing my body to slowly push the head out.

I hope some of those suggestions help. I know how scary it is thinking about going through that pain and recovery again. Labor is so much of a mental game. Mentally preparing myself and trying to stay positive that my body is fully capable opening up and birthing LO made a huge difference for me.

rooftop · December 2013

I was always told its less likely to tear again since scar tissue was harder than normal tissue. That's why it's more common for FTMs to tear than it is for STMs. Maybe I'm wrong? Have you talked to your doctor about this? They might have suggestions to help.

JessaPrimate · December 2013

I had heard the weakened tissue in regards to episiotomies, not sure how it applies to natural tears.

I haven't had my first ob appt yet (it's Jan 3). Can you tell I'm a planner? I just have the suspicion that my ob will say "get an episiotomy what's the big deal?" And it's not a huge deal to me, just the gears turning in my brain.

oliversmommy32912 · December 2013

I have heard many stories of women who have significant tears with first babies and minimal to no tearing with subsequent babies. I myself am holding on hope on that matter! I had a very large tear that took several months to recover from. I would do almost anything to prevent it from happening again.

I understand considering an episiotomy to direct the tearing toward your perineum instead of labia/urethra should tearing occur again. If it was me honestly I would wait until pushing. If it looks like you are going to tear I would consider the episiotomy to direct the tear to a more "desirable" location. I wouldn't ask for one unless it is clear it is needed. Hopefully it won't even be an issue.

PepperBug · December 2013

I had a third degree tear and two very painful internal sulcus tears with my first My second was born naturally with only the tiniest tear that the doctor only put one stitch in for cosmetic reasons.

I would ask your doctor about it at your appointment, and get a second opinion if you're not comfortable with what the first doctor says. That's what I did. The doctor I ultimately went with told me that I deserved a better birth this time around and helped me formulate a plan I was comfortable with. I was terrified of re-tearing and the potential consequences of that. She said we could schedule a c-section if that's what I wanted. Or we could attempt a vaginal birth and she would keep a close watch on the tearing situation and they could do an emergency c-section if it looked like a severe tear was unavoidable. But she didn't think it would be necessary. And it turned out not to be.

headgear03 · December 2013

I had a horrific tear with my first ( 3 rd degree) My tear was due to me pushing passed the end of my contractions , me being on my back during pushing and how my daughter crowned . With my second I decided to birth on my hands an knees and controlled my pushing ,I only tore a tiny bit not even enough to stitch. With my third and fourth I didnt tear at all and both were born with me on my hands an knees. It think your position and control will have allot to do with if you tear or not.

Nikgoss11 · December 2013

I tore really bad with my first and took forever to heal properly and it still didn't heal right. Didn't even get a scrape with my second and hope not to get anything with this LO either.

shiway · January 2014

There is no evidence that epesiotomys help in any way. Natural tears not only heal better but you could potentially my tear in the first place. I did not tear with my first. You can do something to help avoid tears. Use and oil on your perineum during pushing. When your baby crowns take a couple contractions and don't push but let the skin stretch. Don't be in a complete squat at crowning. Too much pressure. Push slowly. Warm compresses On perineum.

JessaPrimate · January 2014

Well this all may be moot because I found out Friday I'm expecting twins. I will be lobbying hard for a natural birth, but I know the odds are against me.

wintersong · January 2014

Congratulations, @JessaPrimate!

HNRomance · January 2014

Congratulations on your twins!! Natural is completely possible with twins if you have a supportive, experienced provider. I have no personal experience but my mom had a 4th degree tear with me because a resident saw me crowning and started screaming at her to PUSH!!! before she was ready. The OB tried to stop her but it was too late, i was out. She had no tearing with my two sisters after me.

ah625 · January 2014

Tearing previously does not doom you to equal tearing!

Position makes a big difference. You want as little stretching of your perineum as possible (unrelated to crowning). For example, being on your back with your legs hiked up is BAD. Kneeling on all fours or half-kneeling across the top of the bed is GOOD. If your perineum is already stretched, then the baby stretches it more with delivery you're in for a bad time.

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