Episiotomy vs tearing?

MarySMP · October 2015

FTM here. I've done a little research online and see pros and cons to both. Anyone have a strong opinion one way or the other? My doc said that he prefers episiotomies over tearing as they are easier to stitch, but will let me tear naturally if I insist. I've heard that recovery can be easier with tearing as it typically requires fewer stitches, but that it can also go the other way and tear horribly. Thoughts/ stories of experience?

emzie54 · October 2015

My understanding is that episiotomies are to be avoided unless absolutely necessary.

mvhyde · October 2015

!!!!!Warning ouchies ahead!!!!!

I had a tear it was 3rd degree superficial tear. meaning the skin was torn from the vagina to the anus but the muscle around the anus was still intact. So I don't know how easy it was to fix, but I was walking as soon as my epidural wore off. I only felt pinching around the stitches when they got dry. Anyways, I had to be careful, rinsing 3 times a day till the stitches were out (more often while I was still bleeding). Also (in case you are worried about future sexy time) my vag is still good for sex. Though pushing a 7lb 15oz baby through it has lead to some loosening, my husband still enjoys intercourse (kegels help).

I don't know how it would feel to tear if I didn't have an epidural, but I imagine that getting an episiotomy without an epidural is pretty bad. Also massaging and gently stretching the perineal area, with a suitable lubricant, in the weeks before delivery makes it more likely for FTMs to deliver with an intact perineum (see https://www.ncbi.nlm.nih.gov/pubmed/10076134 )

(Aside: I mentioned somewhere on the board that I had an episiotomy, but I was not being careful with my terms, it was actually a tear)

juju0592 · October 2015

I would let your body decide. With my first, I tore. I tore the bad way. Yeah the stitches sucked but it wasn't impossible to deal with. My second I didn't tear at all and didn't need any stitches. Iv heard horror stories about women getting cut though, my cousin got a bad infection. Usually, if you wait til your body is absolutely ready to push- it tries to keep itself intact

danasphillips · October 2015

emzie54 said:
My understanding is that episiotomies are to be avoided unless absolutely necessary.

This. I don't believe many doctors perform episiotomies anymore.

ainverso · October 2015

My ob doesn't do episiotomy unless absolutely necessary. He uses massage prior to delivery to stretch naturally and delivers baby slowly. I didn't tear or have to have an episiotomy. He says it is easy to repair either way, but heals faster if body naturally tears

stlmomof2 · October 2015

I would never let my doctor do an episiotomy on me again if I had the choice. I almost wished I had the option of a csection instead. I know that may sound crazy but I had a 4th degree episiotomy with DS and the doctor had to use a vacuum like gadget to get him out. Because I am so petite they thought that I would have a small baby. I never had an ultrasound in my third trimester either. DS was 9 lbs even. A 4th degree is the worst you can get. They cut from your vagina to the anal sphincter. I was walking the next day but I had to use pain medication for a good whole week. I couldn't poop for a week and needed stool softeners. It was pretty rough.

The worst thing about it was I was told I could never have another vaginal birth again by my OB. Well... I could but if I tore again I can develop incontinence. Not something I want either. This baby will be delivered csection. I'm not happy about it because I never been "under the knife" and I feel like I am missing part of what childbirth is supposed to be. Like I said though I can't risk anymore tearing.

MeghaJake · October 2015

I also didn't think doctors performed episiotomies anymore. I would opt for tearing naturally. My first didn't come out easy - there was talk of forceps and vacuums although none were used. I don't remember the tear being bad at all.

PedsIsHardcore · October 2015

I tore. I had a 1 degree going up and a 2nd degree going down. I didn't feel it at all. I will not get an Episiotomy. Whatever happens will happen and my OB's will repair it.

CBWifey · October 2015

I had a tear, but for some reason no one could tell me how bad it was when I asked recently? Kind of ridiculous. I know that it took approximately 45 minutes to stitch up, and I had to do the rinse as well for weeks. But I have read again and again a tear is preferable to an episiotomy. I also think it was partially my fault. I was in labor for 24 hours and when it came to pushing, I was tired of the baby retracting back up after each push so, I decided at one point I was going to push her out no matter what, and I think maybe my body wasn't ready yet? So I guess to answer your question, I think tearing is the way to go because of the strength you'll have down there from scar tissue, as it's a zig zag type year vs a straight line. Edited for spelling

lwebley · October 2015

My dr has said she won't do an episiotomy unless I'm going to tear forward, toward my clitoris.

usernametaken1 · October 2015

I read that if you're going to tear horribly an episiotomy might only make it worse.

As an analogy, think of stretching a piece of intact fabric so hard it tears, vs making a cut in the fabric and pulling, it just rips apart more easily. Painful analogy, but it seems to make sense, not sure how sound it is.

mahlod · October 2015

Ladies this is probably my biggest fear with all the unknowns of first-time pregnancy.

I can't even continue to read some of your comments. My entire body goes into panic mode just thinking about possibilities of tearing

:-S

I need to try and read up on this just so i can be prepared.

samara267 · October 2015

Plenty of women avoid tearing and getting an episiotomy. I encourage you to research the concept of the fetal ejection reflex and to avoid coached pushing. Instead rely on spontaneous pushing and let your body do most of the work. Many women tear because they simply aren't ready to push, or push too hard due to coached pushing.

BarrettJ89 · October 2015

I had an epidural (liquid gold, in my opinion) so I didn't feel a thing during labor. My son was 8 lb, 4 oz and I tore big time. I tore internally and ended up with 3 sets of stitches on the inside. Healing wasn't bad at all. Personally, I trust my doctor and if he says tearing naturally heals better, then I'm going that route again with this baby.

Miss Lilac · October 2015

Episiotomies are not common practice and/or even recommended in my area. When I asked my doc she said it's just not something that's really done anymore. It's actually in my birth plan that I do not want one.

enkb · October 2015

ACOG (American Congress of Obstetrics and Gynecologists) says ;Additionally, there was a general underestimation of potential adverse consequences associated with the procedure, including extension to a third- or fourth-degree tear, anal sphincter dysfunction, and painful sex. Data suggest that women who have an episiotomy do not have significantly improved labor, delivery, and recovery compared with those who do not have one.'

World Health Organization says 'Routine episiotomy, or liberal use of episiotomy, is unfortunately very common, both in under-resourced settings and in some developed countries. The latter may be contributing to the persistence of this practice also in under-resourced settings despite overwhelming evidence against its routine use.'

A bunch of other articles, starting from the 1980's say episiotomy as a routine and in all but an incredibly few and specific cases are worse in every way to a natural tear. They are actually harder to repair, take longer to heal, are associated with more problems down the line (incontinence, sexual dysfunction, etc). Plus, you don't actually know you are going to tear until you do, so in at least some cases an episiotomy would be done when you wouldn't have torn at all.

I would highly recommend you do some reading and if your provider is telling you they do routine episiotomies or that a high percentage of their patients require one, I would be asking them a lot of questions about why they are going against the recommendations of the WHO and ACOG.

stlmomof2 · October 2015

The reason I ended up with an episiotomy was when they decided that baby's heartbeat was dropping and in distress they wanted to do a csection but he was already in my birth canal. I had no choice but to push and he was not coming out.

I am very angry because the entire time I had 1 nurse who was never in the room besides maybe twice and my OB comes in that very last minute. Being told that they don't do third trimester ultrasounds etc seems kind of bullshit to me. Everything was an assumption at my doctors office. The assumption I was going to have a "small" baby is what they made their decisions on. I was being yelled at...literally yelled at by my OB "why aren't you pushing hard enough your baby is going to die!". How much more like crap could of I felt during labor?!?! Nurses and doctor all APOLOGIZED to me after DS was born saying they never thought he would of been this big judging from "my size" Like I said i have a petite figure.

I am extremely angry about it because I do feel cheated from a vaginal birth for this baby. But I am so glad DS came out healthy at the end.

CBWifey · October 2015

@stlmomof2 I was just reading some of the other ladies posts and got to yours and was shocked how you were treated. I am so so sorry. I can't believe they treated you like that.

englishtearose · October 2015

I had an epis. It wasn't bad, but she didn't even ask me. She just did it. I didn't work in L&D at the time so I have no idea what his heart rate looked like, I pushed 3.5 hours, etc...I'm not bitter about it, but I do wish she would have explained to me before doing it.

Unknown · October 2015

This content has been removed.

samara267 · October 2015

englishtearose said:

I had an epis. It wasn't bad, but she didn't even ask me. She just did it. I didn't work in L&D at the time so I have no idea what his heart rate looked like, I pushed 3.5 hours, etc...I'm not bitter about it, but I do wish she would have explained to me before doing it.

I'd be absolutely livid if someone cut an epis without asking my permission. I don't care about the circumstances. Asking the question takes 5 seconds. Hell. No.

fishsticks-n-custard · October 2015

No episiotomy for me. That was one of the first things I talked about with my OB. It's not an incredibly common procedure anymore but there are definitely docs who still do it so I made sure she wasn't one of them. When she answered "I don't typical do those", I responded, "Good because you cut me and I cut you." I don't think she gets my sense of humor.

jrouge12 · October 2015

Agree with many PPs, my doctor said episiotomies were not advised or routinely done anymore. I question how up-to-date your doctor is on their research.

lwebley · October 2015

usernametaken1 said:
I read that if you're going to tear horribly an episiotomy might only make it worse.

As an analogy, think of stretching a piece of intact fabric so hard it tears, vs making a cut in the fabric and pulling, it just rips apart more easily. Painful analogy, but it seems to make sense, not sure how sound it is.

This is exactly what my dr said!!

hvwitham · October 2015

I've had both, first they had to cut (without drugs might I add) because my son went into distress and needed to be born asap. With second I tore naturally.

The episiotomy was horrible. It bled off and on for 8 weeks, then I had some problems with scar tissue, and it ended up taking a full year, yes, year, before I was totally pain free. (I probably could have avoided this lengthy recovery by having a silver nitrate treatment but I opted not to. My vag had been through enough.)

My second I tore in multiple places, but all small-ish tears. So although the stitching took forever because there were like 4 sites, my recovery was like a dream come true. Five weeks later I was riding a bike. The difference was unbelievable. Maybe just good luck but I don't know.

Both of my kids were over 8lbs (one almost 9) and born quickly, so that may have impacted things but if you can possibly avoid an episiotomy I say DO IT!

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