January 2016 Moms
MarySMP
member
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Episiotomy vs tearing?
MarySMP
member
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?
Re: Episiotomy vs tearing?
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)
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.
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.
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.
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.
Marriage: 4/2008
Baby Carriage #1: 5/2012
Baby Carriage #2: 1/2016
Married DH: 2013
DD: Dec 2015
BFP 8/14/17 --> Due 4/27/2018
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!