Episiotomy?

Jan1214 · June 2014

Today I met with a different doctor during my monthly appointment. - I go to a practice that has 10 OBs. - She briefly talked to me about thinking about a birth plan. Among other things, she mentioned episiotomies, and advised against them unless necessary to get the baby out. She said some doctors still perform them routinely, so if I decide I would prefer not to have one, I should make sure the delivery doctor knows my wishes. I fully intend to ask more questions about this at future appointments, but I was wondering if any of you have had an episiotomy. Have your doctors expressed opinions about the procedure? Just curious. TIA.

dr_pr · June 2014

I had one with DD. There was meconium in the amniotic fluid, so they needed to get her out before she aspirated too much of it. They're not routinely done at my OB's practice--just in cases like mine when they want to get the baby out quickly to prevent damage. I would actually be really surprised if anyone said that their OB does them as a "just in case" measure on every delivery. After mine, it was a full week before I could walk up the stairs like a normal person, not mention pee without crying.

Celticlass6 · June 2014

I'm a FTM, so I have no personal experience, but this is what I copied from my OB's pregnancy packet regarding them: "We generally do not perform episiotomy unless you specifically request one, even when it is obvious that you will tear. Not cutting an episiotomy will minimize the risk of tearing into the rectum (having a fourth degree laceration), but will not allow us to control where or in how many places you tear. Having a slow controlled delivery is the most effective way to minimize tearing and we will give you guidance as to when to push or stop pushing. Perineal massage is fine but will not actually increase the natural elasticity of your skin. If you do not have an epidural, or if your epidural does not provide adequate pain control for laceration repair, we will use a local anesthetic. Any stitches that are needed will dissolve and do not need to be removed."

Edited to fix funky line breaks.

wallygirl · June 2014

Studies have proven natural tears are better than having an episiotomy. They used to be done frequently and it was believed they healed faster than natural tears... research shows that isn't true and that sometimes they cause increased bleeding, worse tearing and sometimes increased healing time. My dr does not routinely do them.

moroccojade · June 2014

An episiotomy is the last thing I want! Eeep!

It would have to be a very dire and desperate situation before I would consent to one.

Picture grabbing the hem of your jeans. Try and rip the fabric up the pant leg.... Any luck? No.

Ok... now grab some scissors make a one inch cut up the pant leg. Now try and rip the jeans. Success? Absolutely.

This is why I want no scalpels anywhere near my vagina. I see where the original logic for episiotomies came from. (Quicker delivery... A "nice" and "clean" cut to sew up... but geez, women ended up ripping a lot worse than they would have if they just would have let things happen on their own.

abbyful · June 2014

I had in my birth plan that I would rather tear than be cut. But my doctor gave me the choice last time (as I was loudly exclaiming "get it out! get it out!"), he said it would be about 20 more minutes probably for me to tear, or he could make a small cut. At that point, I opted for the cut, DS born was a couple pushes later. I think the sound of the scissors was worse than the actual cut.

I was totally freaked out about the idea of an episiotomy, but it ended up not being as bad as I thought. I was freaked out the first few times DH & I had sex afterwards, we took it VERY slow because I was afraid it was going to hurt or I'd rip back open or something. (Which would NOT happen, I had 6 weeks of healing already, it was just one of my unfounded fears.)

sweetbabyrahe · June 2014

I had one with DS. It wasn't routinely done, but I had troubles in delivery. I pushed for nearly four hours and cord was slightly wrapped inhibiting DS. So they had to use forceps. They did an episiotomy with 2 stitches, but I was informed at the time. They made me wait a little longer after to have sex and I was sore for a week or so.

MrsDL · June 2014

I tore with DS and needed some stitches. Like pp said, you have a few stitches and it's uncomfortable for a few days but not long-lasting. My doctor said they prefer to let patients tear naturally and then repair unless episiotomy is necessary - situation where they want/need to get the baby out faster - like your OB. I think in general it's a good policy - a conservative approach unless the baby is in jeopardy.

mockingjay1 · June 2014

Like PPs have said it is best not to have an episiotomy unless necessary. You are more likely to tear (worse) if you get an episiotomy than if you just let it happen on it's own.

Jan1214 · June 2014

Thanks for all your responses. It is so helpful to read about other women's experiences.

sunflwra · June 2014

I had to sign something in my paperwork with my OB's old group practice that I could not refuse one if they felt it was medically warranted. I wouldn't have had an issue with getting one if needed but there were such difficulties with my delivery that my OB just let me tear naturally since she had her hands full with the vacuum, etc. This was something I felt that I wanted to be educated on but that I was willing to go with my OB's recommendation at the time, so I think an open mind is still important.

carcrashheart · June 2014

Labor down for as long as you can. It will hopefully help to lessen the tearing. Don't get an episiotomy unless necessary.

jlove253 · June 2014

I just wanted to add that my new on was shocked it hear I'd had an episiotomy with dd because in our state you need to report if you preform one, that's how discouraged ob's are again them. My previous on did it because dd's head was so big and I'd been pushing for almost 3 hours at that point with her getting stuck in the process. I'd way rather have an E cut than a c-section cut, and it really wasn't a big deal to heal from it.

So I imagine op that the likelihood of you having one is slim.

kimberly_ann81 · June 2014

I tore with my first. Didn't even feel the tears at that point in the labor. I would avoid an episiotomy at all cost.

Jan1214 · June 2014

lissydee said:

I work L&D and it's not standard practice. Only extreme instances warrant it (fetal distress, shoulder dystocia, some vac assisted deliveries) and there is always review of the cases where an episiotomy is given. It's not a preferred intervention and we take that seriously. I'd highly question am provider who routinely does them now a days--it should not be standard practice.

I will definitely be asking about this. I'm hoping it was a listening error on my part!

MrsAdventure · June 2014

FTM, but I just have to say the idea of either (episiotomy or tearing) really freak me the hell out. I don't know why, but these two things worry me more than almost anything else about labor. Maybe because I have had some tearing in the past (certain sex positions do this to me, nothing compared to a baby, but enough to make me bleed). I'm sure I've built it up in my mind as something much worse than it is, lol, but I can't help it.

moroccojade · June 2014

KatieKarasin said:

Just throwing it out there that you should read about perineal massage as a way of, hopefully, avoiding an episiotomy.

The jury is still out on this one...

https://www.scienceandsensibility.org/?p=5899

I am not convinced there is much of a benefit.

momtojad · June 2014

My midwives let you stretch and manually stretch with fingers first. They do not cut episiotomy. The apply counter pressure with hot rags to loosen the muscles. I had a med free birth and it wasn't that uncomfortable to let the head do the work and save my vagina from being cut or torn. They sort of coached me through how to slowly let him out, too.

morrkim · June 2014

I got one after dd's heartrate started dropping while trying to push, so they wanted to hurry. The cord was wrapped around her neck 1.5 times.

Momma&babies · June 2014

I didn't have one with DD but I did rip. My doctor said he would give me one if it looked like I would rip however, he didn't have time because I pushed her out so quickly. I think only get one if it looks like you will rip. I have no experience with the healing process but the rip healing process was not fun.

turtles7 · June 2014

Don't image google it. Just don't. Lol

AnnieRoo13 · June 2014

This is so interesting to me as a FTM. I had really thought an episiotomy was sort of a standard practice and I hadn't read anything on it, so I'm so glad that this topic came up. It's officially been written down on my list of questions to ask at my next appointment.

PineApple85 · June 2014

lissydee said: Momma&babies said: I didn't have one with DD but I did rip. My doctor said he would give me one if it looked like I would rip however, he didn't have time because I pushed her out so quickly. I think only get one if it looks like you will rip. I have no experience with the healing process but the rip healing process was not fun. doing one because "you will rip/tear" is counter-intuitive, is it not? So lets CUT you because we think you might tear naturally on your own? Um, what?

That and its much preferable that you tear naturally on your own than being cut. Once you are cut, you have a tendency to tear even further/worse. Someone already gave a great analogy about trying to rip an intact piece of fabric. Its hard to do. But once you put a tiny cut in it and then try and tear...well...you can imagine the rest.

This. An episiotomy should not be done because you might/will tear. It makes the tearing worse. I would switch from a provider that gives this as a reason to cut. My OB last pregnancy (I switched to a MW late in the 2nd tri) said she only cut to retrieve the baby (vac or forceps), my MW that delivered DS and will be catching this one, too, said the same thing.

ETA: also, I second @carcrashheart : laboring down is helpful to prevent/minimize tearing. The jury's out on perineal massage but I figure it couldn't hurt and my MW does it for me.

dr_pr · June 2014

j3nnyb said:

My OB practice does not do episiotomies routinely. If I remember correctly, the only time they do it is if the baby is in distress and heart rate drops too low. I had meconium in the amniotic fluid too but my OB let me tear during delivery. I ended up with a second degree tear that was almost a third degree tear. Dermoplast was my best friend until it healed.

I want to clarify my reply from last night--I not only had meconium in the fluid, but I also have a heart valve defect that was causing some problems during pushing (my heart rate/bp was plummeting after each push and they had me on oxygen between pushes to keep it from going too low; DD's heart rate was always fine). So it may have been more my heart issue rather than the meconium that lead to the episiotomy. I really didn't think to ask, since all I wanted was to get her out of me!

alysonmh · June 2014

I had a large episiotomy, 14 stitches. I felt no discomfort afterwards so it wasn't an issue at all. To this day I don't know why my doctor did it. I gave birth almost 11 years ago and didn't think to ask why it was done back then. This time around I'd like to avoid it if possible and my doctor says tearing isn't really worse unless it's going in a bad direction (i.e. towards the clitoris, ouch!). Sometimes they need to happen but I would recommend making it clear with your doctor that if during delivery they want to perform an episiotomy they give you an option first so that you can make the decision.

abbyful · June 2014

alysonmh said:
I had a large episiotomy, 14 stitches. I felt no discomfort afterwards so it wasn't an issue at all. To this day I don't know why my doctor did it. I gave birth almost 11 years ago and didn't think to ask why it was done back then. This time around I'd like to avoid it if possible and my doctor says tearing isn't really worse unless it's going in a bad direction (i.e. towards the clitoris, ouch!). Sometimes they need to happen but I would recommend making it clear with your doctor that if during delivery they want to perform an episiotomy they give you an option first so that you can make the decision.

Oooooh, yikes, I crossed my legs reading that!

dr_pr · June 2014

j3nnyb said:

dr_pr said:

j3nnyb said:

My OB practice does not do episiotomies routinely. If I remember correctly, the only time they do it is if the baby is in distress and heart rate drops too low. I had meconium in the amniotic fluid too but my OB let me tear during delivery. I ended up with a second degree tear that was almost a third degree tear. Dermoplast was my best friend until it healed.

I want to clarify my reply from last night--I not only had meconium in the fluid, but I also have a heart valve defect that was causing some problems during pushing (my heart rate/bp was plummeting after each push and they had me on oxygen between pushes to keep it from going too low; DD's heart rate was always fine). So it may have been more my heart issue rather than the meconium that lead to the episiotomy. I really didn't think to ask, since all I wanted was to get her out of me!

That makes sense to me. My OB warned me right before I started pushing that it was urgent for me to push DD out as quickly as possible, otherwise it would be a real possibility I would need an emergency c-section. Also, once DD was delivered everyone in the room needed to be quiet until the OB suctioned DD out, so DD wouldn't get startled and take a breath in or start crying. It was the longest two minutes of my life to wait and hear DD cry. I'm really hoping I don't have to deal with meconium again with this one.

I hear you on the meconium--that sucked! All they kept telling me was that she shouldn't cry, so what's the first thing she does when out? Fortunately, she didn't aspirate too much and they were able to care for her in-room and not take her away. Those were some scary minutes, though!

missnacholover · June 2014

If I get one, I'm totally asking for the husband stitch.

dr_pr · June 2014

missnacholover said:

If I get one, I'm totally asking for the husband stitch.

Ha! My OB is a woman, so she didn't even joke about that. And I would have punched H if he suggested it.

jibell · June 2014

I had one with DD because she got stuck and heart rate dropped... I had already torn so they cut a bit more and she came out on the next push...

The needle for freezing and the stitches hurt more than the actual delivery...

mrsodonnell12 · June 2014

Heck no!!! Doing them routinly is so outdated. If baby is in distress and needs to be out asap I get it, otherwise decline!!

wallygirl · June 2014

carcrashheart said:
Labor down for as long as you can. It will hopefully help to lessen the tearing. Don't get an episiotomy unless necessary.

dr_pr said:

j3nnyb said:

dr_pr said:

j3nnyb said:

My OB practice does not do episiotomies routinely. If I remember correctly, the only time they do it is if the baby is in distress and heart rate drops too low. I had meconium in the amniotic fluid too but my OB let me tear during delivery. I ended up with a second degree tear that was almost a third degree tear. Dermoplast was my best friend until it healed.

I want to clarify my reply from last night--I not only had meconium in the fluid, but I also have a heart valve defect that was causing some problems during pushing (my heart rate/bp was plummeting after each push and they had me on oxygen between pushes to keep it from going too low; DD's heart rate was always fine). So it may have been more my heart issue rather than the meconium that lead to the episiotomy. I really didn't think to ask, since all I wanted was to get her out of me!

That makes sense to me. My OB warned me right before I started pushing that it was urgent for me to push DD out as quickly as possible, otherwise it would be a real possibility I would need an emergency c-section. Also, once DD was delivered everyone in the room needed to be quiet until the OB suctioned DD out, so DD wouldn't get startled and take a breath in or start crying. It was the longest two minutes of my life to wait and hear DD cry. I'm really hoping I don't have to deal with meconium again with this one.

I hear you on the meconium--that sucked! All they kept telling me was that she shouldn't cry, so what's the first thing she does when out? Fortunately, she didn't aspirate too much and they were able to care for her in-room and not take her away. Those were some scary minutes, though!

I completely agree with you ladies. We had a meconium aspiration as well some other issues at birth. One of them being a nuchal cord (twice around). Not hearing her cry was the scariest thing ever. I'm glad you ladies got to keep your babies in room. Mine ended up being a NICU baby for a week. OB and pediatrician said her little body could have handled one or two of the issues but not all of them. She was the biggest baby in the NICU and a little fighter. Bringing her home was the best day of my life!

Momma&babies · June 2014

lissydee said:

Momma&babies said:

I didn't have one with DD but I did rip. My doctor said he would give me one if it looked like I would rip however, he didn't have time because I pushed her out so quickly. I think only get one if it looks like you will rip. I have no experience with the healing process but the rip healing process was not fun.

doing one because "you will rip/tear" is counter-intuitive, is it not? So lets CUT you because we think you might tear naturally on your own? Um, what?

That and its much preferable that you tear naturally on your own than being cut. Once you are cut, you have a tendency to tear even further/worse. Someone already gave a great analogy about trying to rip an intact piece of fabric. Its hard to do. But once you put a tiny cut in it and then try and tear...well...you can imagine
the rest.

I actually 100% agree with you once you put it that way. When I was in labor with my DD I actually had an on call doctor at the hospital that I never met before. During pushing he said to me if it looked like I would rip he would cut and honestly at that point I couldn't of cared less but I pushed her out in two pushes which didn't give him a chance.

He was a much older doctor so obviously old school because most doctors now a days won't cut because supposedly the healing process is easier if you rip but I only have one experience which was ripping and it wasn't fun.

lizgrace03 · June 2014

Guys, I'm really scared. I'm not kidding. I'm such a wimp about this stuff.

lisaren · June 2014

I had one with first born and owieeeee

My MW does peri massages. No tears or epi for me!

jlove253 · June 2014

jibell said:
I had one with DD because she got stuck and heart rate dropped... I had already torn so they cut a bit more and she came out on the next push...

The needle for freezing and the stitches hurt more than the actual delivery...

Seriously! My epidural ran out right before I started pushing and the nurses figured dd would be out so fast it wouldn't matter. Three hours later, she's finally out and the stitching process hurt so bad I thought I was going to drop dd! Ugh.

And to anyone who is scared, it's been 2.5 years, and while I remember that it hurt so bad, I can't remember what the pain actually felt like. And obviously I'm in this boat again, so it wasn't traumatizing enough for me to not want another baby

abbyful · June 2014

I guess I'm in the minority, but I don't remember the stitches hurting. I had a natural med-free birth (I remember THAT hurting, but I'll do it again this time around too), and I think my doctor gave me a local numbing shot before doing the stitches.

mb314 · June 2014

Episotomies are only necessary if the baby needs to get out quickly, in the case of an emergency. It is generally better to tear naturally. Generally, tearing naturally results in smaller area that is opened and heals better. The way it was explained me is that if you start cutting a piece a paper and pull at it, it's going to continue to tear even more. But if you don't cut the paper and pull at it so it tears, it tears less quickly and less severely - so apply that to the lady parts.

FWIW I was TERRIFIED of tearing before labor. I didn't have an epi, and honestly, I didn't feel the tears and didn't realize I tore until afterwards. It wasn't a big deal.

PineApple85 · June 2014

What abbyful and mb314 said: I don't remember tearing at all. Pushing the baby out hurt but I don't have a memory of "oh, I just tore! ouch!". I don't remember getting stitched at all.

And it hurt, but I'm doing it again, obviously, and I'm planning to go med-free again.

lizzielu82 · June 2014

This thread makes my vagina hurt

mslynn2012 · June 2014

I had done my research, talked with my OB and put in my birth plan that I DID NOT want an episiotomy. I did not want to be cut!!!

Then we had an er csection, so I ended up being cut anyways.

This time I just want a healthy outcome for mommy and baby

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