Episiotomy vs Tearing

JD83 · July 2014

Disclaimer: I did a search for this but couldn't find anything about this from this BMB. I don't hang out on any other ones so I trust the opinions here more than other places on TB.

So, basically, I'm sick and confined to the couch and bored, trying to work on my birth plan, and this is the one thing that I just can't decide on no matter how much I read. If anyone is interested, let's talk about it! What did/would you choose to have and why? If you've had either or both, how was recovery? I feel like the medical websites whitewash and gloss over the real details. Neither sounds like a pleasant choice, and obviously prevention is preferable, but still something that needs to be addressed.

Again, I apologize if I'm repeating something that was previously beaten to death.

rebennett06 · July 2014

FTM- so no practical experience here, but from what I've heard/been told by dr and others, tearing is the way to go because it heals more naturally? My dr does not do an episiotomy unless absolutely medically necessary (she said if baby is in distress, she can see him and knows she can get to him quicker than I could get him out) otherwise she prefers tearing. My aunt had a stage 5 episiotomy and still hasn't fully recovered (10 years later and still has a lot of muscle problems and sphincter issues...aka she poops herself, a lot...) so, my birth plan is IF we get in that situation, I want to tear naturally, but obviously if it is an emergency I don't care so long as baby comes out!!

Barefoot84 · July 2014

I teared naturally last time, and it healed really well. I would rather tear than get an episiotomy.

Sicheyanne · July 2014

FTM, so no experience. Just wanted to say that I'm so glad you asked this question! Thanks

JD83 · July 2014

Honestly, the idea of either one makes me cringe, which is why the decision is so hard.

@rebennett06, holy shit! Stage 5?! I didn't even know something that extreme existed!

ashaw512 · July 2014

You get stitches either way from ppl I've heard from but of course it depends on the tear and your doctor. I was reading a birth story that a woman specifically told her ob she didn't want to be cut and at the last minute her ob did it. At her check up a few weeks later her ob told her that she basically get paid more because her ob had to use an extra tool during the birthing process. And I guess it depends on your dr, like Zoeyy said, a lot of OBs don't do episiotomies anymore, and a lot of it is up to the hospital.

Irisheyes1247 · July 2014

Episiotomies used to be the norm, but I believe now the recommendation is against that. I tore and needed stitches with both girls. I don't know to what degree or how many stitches because I didn't want to know. I did not know/feel it while it was happening, at least not specifically as tearing different from the pushing pain.

trebekastan · July 2014

Have you looked into perinial massage?

JD83 · July 2014

I'm really surprised we haven't talked about this one yet. I've read that if you tear naturally, then it's more likely to be a 1st or 2nd degree tear and usually only needs a few stitches if any, but episiotomies are more likely to result in the 3rd and 4th degree lacerations. It makes sense, but I don't know how accurate that is. It's good to hear so many people say that natural tears are more favored by the medical industry. Makes me think that the docs aren't all scissor happy.

amom2four · July 2014

I had a second degree tear with dd1 and just shy of third degree tear with ds. I healed just fine with no obvious issues. I would also say tear unless it's an emergency situation or it's just blatantly obvious that baby's head will not make it through.

Recovery was definitely more uncomfortable with the two tears but they give you the most amazing spray bottle to clean off with after you use the bathroom, because let's face it urine will sting on a fresh wound. Seriously the greatest along with the ice pack pads. I would say maybe a week of discomfort and then it starts to feel better as sutures heal.

JD83 · July 2014

trebekastan said:

Have you looked into perinial massage?

Yes! Prevention is always preferable, but as we all know, sometimes it just doesn't work out the way we want. I'm planning on laboring at home before the hospital to let everything stretch, perineal massage, and bringing a yoga ball with me (I've heard that helps too), but if all that goes to hell, there needs to be a plan in place and I have a feeling at this hospital DH and I are going to have to be very clear, very firm, and very direct. I tend to live by the motto: fortune favors the prepared.

JD83 · July 2014

MermaidsMagic said:

trebekastan said:

Have you looked into perinial massage?

How the fuck is there not a Baby Mama gif for spraying Pam instead of EVOO?

I just LOL'd thinking about that scene!

poptart109 · July 2014

Mine is kind of a bad tear story. I had a 3rd degree tear and would have chosen an episiotomy. At my 6w check up I felt the same pain I had when I delivered and it was due to a hematoma that formed behind my already healed sutures. It had to be lanced and drained. it took a year and a half to not feel pain or discomfort from sitting due to scar tissue, despite being told my suturing was "done beautifully" by another dr. I was also slightly incontinent during that time. I heard episiotomies heal quicker.

mariaculbreth · July 2014

I had an episiotomy with DS. My dr gave me the option to either push for two more hours or get the episiotomy so I got cut! The healing wasn't too bad. At my 6 week appt I was almost completely healed. They say I will most likely tear naturally because of it.

rebennett06 · July 2014

JD83 said:

Honestly, the idea of either one makes me cringe, which is why the decision is so hard.

@rebennett06, holy shit! Stage 5?! I didn't even know something that extreme existed!

Neither did I to be honest...and I never double checked her, kinda just took her word for it!! But, after seeing her in the middle of an accident I don't really doubt her!!! Her baby's shoulders were stuck in her pelvis, apparently to the point where they were worried she would break something trying to continue to push, and had to have forceps as well...then again this was 10 years ago so I didn't really pay attention to her vagina stories at the age of 16!!!...But, it has me scared now!!

peanutbuttervibes · July 2014

I naturally tore and to tell you the truth, the recovery from it was the most painful part of labor for me. I had to take pain medicine for the first couple days. I remember getting up and feeling sharp pains down there, but I was fine after about a week. Not sure how many stitches I received though because when I asked all I got in response was, "Oh, I don't keep track".... So, I can only imagine!

MrsLaLaBug · July 2014

It's actually one of those things that you sometimes may not have control over. I did not want an episiotomy. However, I ended up absolutely needing one due to DD and shoulder dystocia. Trusting that your medical caregiver will make the best call for you and baby to deliver safely is all you can really do in this matter. You can try to prevent, but there are never any guarantees, just as with basically every other pregnancy related issue.

DISCLAIMER: FTM's... Don't let this topic scare you. And if any randos come in this thread and try to start the revolution, I'll flame them to the other side of the Mississippi for you.

suitern · July 2014

I got an epsiotomy during a forceps delivery because I wasn't giving enough to even get DS's head out-he cut, pulled while I pushed, and DS came out. I asked the chances of me having an episiotomy again because of last time and they said the new recommendation is to let the Mom tear vs. being cut. So, I would much rather tear naturally than be cut...as PP's said, it really isn't the recommended technique any longer.

ashleyb1114 · July 2014

I had a 1st degree tear with my first and healing wasn't that bad. It was obviously sore but way better than I expected. I researched it lat time and asked my doctor and got many of the same responses as I see on here as to why tearing is "better".

brachysira · July 2014

I had a first degree tear and, I think, one stitch. I had an epidural and did not feel anything during labor. After, I was in no pain at all except probably the minor soreness everyone must have. The nurses kept wanting to know my level of pain, pushing meds, and telling me not to be a hero, but I honestly felt great after struggling with a lot of pain during pregnancy. I used the squirt bottle because they said so, and tried not to mess with things just in case I might do something to hurt myself. I didn't look either because I just didn't want to know. However, I would have never known I tore at all if they hadn't told me and I was fine without any meds (except colace).

BabyMayinMarch · July 2014

I tore, and needed to get 3-4 stitches. It wasnt that bad, and I felt fine in a few days.

When I took Bradley Classes pregnant with DS they really pushed not getting an epis unless you are going to "tear upward" as then you may tear into nerves.

amom2four · July 2014

If you have tearing or an episiotomy for one birth, it doesn't mean that you will always need to be cut or that you will tear for later births. My mid-size kiddo was the one I didn't tear with and their heads were pretty similar in size. I did tear with my smallest lo though.

JD83 · July 2014

BabyMayinMarch said:

I tore, and needed to get 3-4 stitches. It wasnt that bad, and I felt fine in a few days.

When I took Bradley Classes pregnant with DS they really pushed not getting an epis unless you are going to "tear upward" as then you may tear into nerves.

Now THAT is the horrifying thought. I keep picturing a massive blowout even though I know it's completely irrational, like

when I know it's much more likely to only be a few stitches. Sometimes I really hate being a worst case scenario planner.

And yes, I completely agree with PP that no matter what the plan, sometimes shit just happens.

tatorhead328 · July 2014

I refuse to google any pictures regarding any of this.

amom2four · July 2014

Do NOT google anything!! Save yourself the horror stories.

T&HLove · July 2014

Natural tear over episiotomy. Easier healing.. And the episiotomy is only starting a tear that you might not have had otherwise. Of. Course, there are instance when an episiotomy would be preferred and your provider will know that. But I do recommend talking to them about your preferences.. Mine performed an episiotomy on me without my consent, and I had only pushed a few times. It was obviously routine in that practice.

JD83 · July 2014

T&HLove said:

Natural tear over episiotomy. Easier healing.. And the episiotomy is only starting a tear that you might not have had otherwise. Of. Course, there are instance when an episiotomy would be preferred and your provider will know that. But I do recommend talking to them about your preferences.. Mine performed an episiotomy on me without my consent, and I had only pushed a few times. It was obviously routine in that practice.

I would be so pissed. It's one thing to not want one and then end up needing it, but for them to just do it because it's what they do....heads would roll. I'm sorry that happened to you.

cls0602 · July 2014

Ftm so no experience, but my best friend has had 2 DD and I was JUST on the phone with her yesterday about this very topic (I have been pestering her with all sorts of labor and delivery questions lately haha)! I was in the room when she had her first DD, and they cut her. It was the only time during the entire process where she screamed and cussed. I believe I later explained it to her as something I'd seen in a "Saw" movie.
For her second DD she delivered in a different hospital and specifically asked the doctor not to cut her unless totally necessary. She did not get an episiotomy, but also did not tear. She recommended I tell my doctor the same. But I was also wondering if it's "worse or better" to tear... DH came out with the help of forceps. Really hoping this kid has my head!!! ;-)

kaleb87 · July 2014

I had both tearing and an episiotomy with dd. This is my confession, with dd my biggest fear of labor was getting an episiotomy. I am like @T&Hlove I had just started pushing when my doctor cut without even asking or explaining why. From there I still tore. I had a third degree tear internally and externally. The recovery sucked, but I worked through it. At my 6 week check up I still had every stitch. I had my dd in March, at my pap in September they realized the stitching had been to tight and created what they classified as "polyps". So I had surgery in November to correct it. I am praying for a better delivery this time.
The best advice I can give is if you have an episiotomy or tear make sure you ask for a stool softener!

portentosa · July 2014

I tore naturally. I also tore internally rather than externally so an external epi would have been unnecessary damage. My tear was deemed 1st degree because it only involved the vagnial lining, but because it was internal it took about 8 weeks to completely heal. Wasn't too terrible though... a peri bottle of water and can of spray lidocaine were my best friends.

ve304856 · July 2014

TheEmpireNeedsYou said:

The analogy I remember people using my first time around was this. If you take a new sheet of paper and pull on it, it takes (relatively) a lot of force to rip it. Now, if you make a little snip in the paper and then pull again in the same way, you can very easily make the small rip a lot bigger because the structural integrity of the paper is weakened. So one issue with episiotomies is that they're kind of like that little rip you put in the paper, and further tearing along that line is possible. I think that's one of the reasons a natural tear is generally more preferred these days.

This is exactly what they told me at my child birth class with DS. When I had DS the midwife said she was going to cut but I don't think she ever did bc she said I tore and it wasn't very bad for a FTM. I had 6 stitches. I had a very easy recovery. I was up and out of the house when DS was 4 days old.

SingleMom31 · July 2014

With DD1, I had been pushing for two hours without her coming out, so they used a vacuum to help me (I pushed, they pulled). To get the vacuum in the right place, the had to cut me. Turns out that she was stuck, so once she finally wiggled loose, she came faster than anyone expected and I tore too since they didn't stop to deliver the shoulders. Neither was bad individually, but they were both from the same point, so they had effectively a V shaped flap (bottom of the V towards my vagina) to sew back to the two sides. It took a long time to heal... Probably 14 weeks, and I have a fair amt of scar tissue left. After this one, they're going to revise it to get rid of the scar tissue.

lovesazzie · July 2014

I think unless you've got a horrible OB, you probably aren't going to have one without good reason. It seems like they really don't do them unless there's a really good reason these days. That said, I had really minimal tearing with my first that didn't require stitching, and didn't tear at all with my second. I wouldn't have known either way - birth was still painful, and recovery was still a little rough. My mom had 4th degree tears with me, so I don't really think there's any way to predict or prevent it. I tried perineal massage once while pregnant with my first and it was so uncomfortable we didn't do it again so I doubt I got any benefit from it!

ritzgrrl · July 2014

braybee said:

I naturally tore and to tell you the truth, the recovery from it was the most painful part of labor for me. I had to take pain medicine for the first couple days. I remember getting up and feeling sharp pains down there, but I was fine after about a week. Not sure how many stitches I received though because when I asked all I got in response was, "Oh, I don't keep track".... So, I can only imagine!

This was the case for me, too. Labor was painful of course, but I expected that. I didn't expect to be in pain afterwards.

It is gross to think about and also makes my vag hurt reading everyone's stories, but as someone else said, you really don't know it's tearing at the time. And thank goodness for that.

The Tuck's pads (is that what they're called? I don't want to Google it at work) were a life saver, too. Those, the squirt bottle they give you, and Motrin was what I lived on.

ETA: It's Friday, can't type.

bumpuser10199668 · July 2014

I was coming in here to say exactly what @theempireneedsyou said about the piece of paper analogy.. I would RATHER not tear or be cut, but if I HAD to choose, I would choose the tear simply because a natural tear is much easier controlled than an episiotomy is.

Side note:

I was writing my birth plan, and I've been pretty adamant about wanting to be able to do the pushing stage in alternate positions other than flat on my back, feet in stirrups. I was really interested in the squat bar. A couple of studies I read said that upright positions during the pushing stage resulted in something like 35% more likely to have a 2nd degree tear than those pushing on their back (surprised me)....BUT those pushing on their backs have 57% high chance of needing an episiotomy than those in upright positions. The article I read suggested that it was worth it to take the higher risk for the 2nd degree tear and push upright. Neither position showed any difference in likelihood of 3rd or 4th degree tears, so there's that.

CplusJ=S · July 2014

I already posted my story in the natural birth thread yesterday so here is a quick recap. I did not want an episiotomy. I told my OB who agreed to only preform one if there was an emergency. I only pushed 3 times for 15 minutes and baby was crowning. Despite the nurse giving me a perineal massage between contractions and telling me she didn't think I would tear, my doc cut me on the last push. There was no medical emergency. When I asked her about it at my 6 week check up she told me she does them routinely because they are easier for her to stitch up. I went through 8 weeks of recovery and it was not fun. I would always prefer to tear over being cut since there is a chance you wouldn't tear at all.

bumpuser10199668 · July 2014

dearfoam said:

@carmalarm, I hadn't read those statistics, but also was given the paper tear visual by my birth instructor. She had a tear at her first birth bc she pushed too fast, but in her subsequent births she learned to go slower and didn't re-tear. She also birthed upright (standing!) with the two that didn't tear.

She also reiterates the Bradley recommendation of IF you need one, ask for the dr to do a "pressure episiotomy" as in during an active push when baby's head is pressing from the other side to help lessen the pain form the incision.

Right, they are just increased odds not a guarantee. I did forget to mention that an upright position reduces the need for forceps or vacuum assistance by something like 60%. Totally worth it.

Djcieply · July 2014

I had an episiotomy but DS was in distress and needed to get out. It was either get him out fast or have a CS. I dont know what degree it was but I only had a couple stitches. The recovery for me was not all that painful, I didnt need any pain meds but the Dermaplast and Witch Hazel pads really helped relieve any discomfort I was having.

megs2011 · July 2014

I am dreading this.... alot. Really hope I don't tear or need to be cut.

saraeric · July 2014

@megs2011 ...me too...I really wasn't all the nervous about labor/delivery until I started thinking about tearing. Ugh

(

emmylu30 · July 2014

I too needed an episiotomy to get DS vacuumed out. It took a while to heal and I second (or third) the dermaplast and witch hazel pads. When it did heal there was a notch of scar tissue that was causing discomfort that had to be recut and cauterized but think that could have happened with natural tear also. Honestly I was upset at first about it since really wanted to avoid but my contractions were stalling and I understand they needed to get DS out. I talked to OB about avoiding this time and she said it's really up to my body and as long as don't need to get him out quickly then I shouldn't need another one.
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