Episiotomy vs. Tearing Naturally

valerie4786 · March 2016

Ouch. How about neither?

My Dr talked to me yesterday about labor & delivery and a general birth plan required by the hospital. She is very pro natural/unmedicated birth and also seemed to advocate that an episiotomy is the better option if necessary. I've been reading into the pros & cons of the episiotomy vs. tearing naturally a little bit, but I'm curious what other Bumpies are thinking & planning?

Obviously I think that in an ideal situation, most of us would have neither...but in some instances one or the other is bound to happen. So, what are you choosing? If it is bound to happen, would you prefer the episiotomy or to tear naturally? Anyone have any good articles on the pros & cons of both that you can provide? Second time and plus moms, what is your experience with one or the other and the healing process?

dandyleah · March 2016

With DD1 and DD2 I tore naturally. I had an epidural so I didn't feel anything and as soon as they were born I was stitched up and healed really well with no complications. When I go in to have DD3 it will be the same. I talked with my OB about it today (different dr than my first 2) and he confirmed he will let me tear naturally unless an episiotomy is absolutely medically necessary.

Bluejay3030 · March 2016

I thought most doctors were moving away from episiotomies in favor of natural tearing, but I could be wrong. I told my OB I wanted to avoid it last time and will do the same this time.

Unicorn522 · March 2016

I've heard that tearing is almost always better than an episiotomy. The recovery pain and time and amount of stitches needed is significantly less with tearing. I asked my doctor about it when I was pregnant with my first and he said he hasn't done an episiotomy in over 10 years.
eta: I did tear but my recovery pain was nothing that Motrin couldn't handle. Within a week or two after delivery most of the pain was gone for me.

Merciel · March 2016

If I have to choose, I'm definitely going with natural tearing over an epi.

...and then I will be super duper extra cranky that you can't get the Epi-No in the U.S.

KidShrink · March 2016

I asked my pelvic floor physio, and she said natural tear all the way as it leads to less pain and other issues after. A friend of mine just gave birth to her second, and she ended up with an episiotomy both times (the first because his cord was wrapped around his neck, the second because the doc told her if she did it, she was coming out on the next push, otherwise, it might take much longer). Perineal massage is supposed to help reduce/prevent (to a certain extent) the need for either. My physio also recommended an epi-no (discussed on another thread), but I haven't convinced myself to dish out the money for that one yet.

valerie4786 · March 2016

From the little bit that I have read so far, it seems that tearing naturally is the better choice. So I'm a little surprised my Dr said she encourages the episiotomy, if necessary, over tearing naturally especially since she's pro natural/unmedicated births. It seemed like her reason was because it's easier to stitch up vs. tearing. I'm at a practice with several Dr's so she may not be who delivers my baby, but it definitely makes me have some questions for the other Dr's and their views on this.

kami09 · March 2016

I had an episiotomy & I'm not entirely sure if other doctors cut as far down as mine did, but the recovery really sucked. I also had bleeding issues a few months after birth.

tripledaggerWed95976 · March 2016

As pretty much everyone else said, I would definitely prefer natural tearing over episiotomy. I think many docs nowadays (especially younger doctors) prefer natural tearing

schafer17 · March 2016

Lurking from the June board. My doctor let me tear with my son because she said the healing would be faster. Sounds like I'm the odd one here, but I had 3rd degree tears from 2.5 hours of pushing with a face up baby. IT WAS A HORRIBLE RECOVERY. It was about a year before I was able to have sex without pain and now 3.5 years later, I still have some pain at times. I moved recently and am now seeing a new doctor and the whole practice said they would have never let me tear that bad naturally. So maybe it depends on the situation, but I wish I would have had an episiotomy. I'm hoping this next delivery goes smoother because 3rd degree tears are ridiculous to recover from.

lalala2004 · March 2016

valerie4786 said:

From the little bit that I have read so far, it seems that tearing naturally is the better choice. So I'm a little surprised my Dr said she encourages the episiotomy, if necessary, over tearing naturally especially since she's pro natural/unmedicated births. It seemed like her reason was because it's easier to stitch up vs. tearing. I'm at a practice with several Dr's so she may not be who delivers my baby, but it definitely makes me have some questions for the other Dr's and their views on this.

I would completely question whether your doctor is really pro unmedicated/natural births. Apart from being med free, the idea of "natural" birth is that there are minimal interventions, and an episiotomy is certainly an intervention.

mumbolino · March 2016

In Germany they don't really like to do episiotomies anymore, unless absolutely necessary, at least that's what my friends back home have been telling me.
You heal much better/faster if you tear naturally. (If you tear at all.... all depends on the pushing phase etc..)
Just reading Ina May Gaskin's Guide to Childbirth book (which I really like, btw... VERY POSITIVE! ) and she also strongly advises against it, if possible.
So if I am lucky enough to attempt natural labour,(fingers crossed...) I will definitely have a no in my birth plan when it comes to episiotomy. (unless necessary to prevent harm to myself/bub)
But: there MIGHT be reasons to do it, as a previous poster has mentioned, and in those circumstances it might be beneficial.
Definitely worth getting informed beforehand! :-)

JoMunson · March 2016

I'm requesting no episiotomy for any reason. For me, it makes more sense to let my body do its own thing (even if that means a tear, because I have confidence my body even knows how to tear) than to let a doctor decide how much room to give my baby.

CrystalBolte · March 2016

I would prefer natural tearing to an epi as well. I anticipate that I probably will tear, but I've read that natural tears tend to heal easier. Not always the case, but generally.

mumbolino · March 2016

In the Ina May Gaskin book, the first part, a lot of women tell their birth stories. Obviously, since they were mostly on The Farm, they are very natural births. It seemed to me that tearing (yes or not) is depending a lot on how you push and can even be unrelated to size of bub. (Some women there had a 10 pound (!!) baby and did not tear....
So fingers crossed for all of us :-)

kbrands7 · March 2016

JoMunson said:

I'm requesting no episiotomy for any reason. For me, it makes more sense to let my body do its own thing (even if that means a tear, because I have confidence my body even knows how to tear) than to let a doctor decide how much room to give my baby.

While I agree that I'd much rather tear than be given an episiotomy, there are circumstances in which they are done in order to avoid a c-section. Having had a previous c-section, I'd definitely prefer to avoid that so if I'm given the chance to vbac, I'm not laying down absolute statements in a vaginal birth plan. I'm sure it's not the majority of incidences, but I know that in cases of severe fetal distress during pushing, my practice will ask to perform an episiotomy rather than doing an emergency csection if the baby is right there but stuck and the heart has decelerated/accelerated dangerously. Otherwise, they won't routinely do them and will opt for slower pushing/massage/stretching etc.

vinerie · March 2016

I think this is a really interesting question. I am not informed about this at all. But I do have a question:

Is there any validity to the idea that IF (this is a key assumption) a bad tear is inevitable, that a doctor doing a precise incision is better than letting things tear on their own? In other words, can an episiotomy "control" the degree and underlying damage of the tear?

FWIW, they discussed this at my most recent birthing class and my hospital said they are rare and that doctors don't just jump in and do one. It's a "last resort" kind of thing and only when the baby's health is at stake. It will be discussed along the way and other options to resolve the situation will be tried first.

ETA: My friend had an episiotomy and was back to having sex 8 weeks postpartum.

kp90 · March 2016

I also don't want either and the sound of both freak me out... but during our birthing class the other night, the nurse teaching the class said the doctors in the hospital where I will deliver almost always prefer the episiotomies because they are easier to stitch and she said they heal better. Regardless.. I'd rather not have either. I'm hoping the whole awkward massaging of the peri area prevents either!

kwrightnb · March 2016

I've just started my baby classes and we had about a 30 minute discussion on this in yesterday's class!! The nurse told us that only about 8-9% of births require an episiotomy now (in Canada I'm not sure how different the US is). She said if the doctor thinks there will be a 3-4 degree tear, they will do one. But she also said new studies show that a small tear heels much quickly and is less painful then a surgical slit and stitches!
but then on the other hand my mother had an episiotomy and said it never bothered her after the birth at all.. I don't wait either

auntieembabes · March 2016

I had an episiotomy, didn't feel it at all because there was already so much ouch. Not a big deal at all. Had the sexy times 5 weeks postpartum, no problems.

Bltbear82 · March 2016

I think it was @laurenmdrn16 who mentioned the tissue tearing example to illustrate the difference between tearing naturally and an episiotomy? Long story short, try tearing a tissue and try tearing it after its been cut with scissors and notice the difference in severity.

Before I started pushing last time I told the nurse I was terrified and I didn't want to tear and she coached me through the whole process. Granted maybe I didn't tear because I pushed for 3 long hours and my doctor was very, very patient about letting me wait to push until I felt the urge versus being medically deemed "ready"?

But I felt like voicing the fear and reiterating it in the moment helped me feel more in control, plus it reminded everyone that I didn't want an episiotomy unless absolutely necessary.

hellogoodbye2 · March 2016

This topic has definitely changed my mindset a bit.

I did did have an episiotomy with my DD and even though I have nothing to compare it to, I didn't think my recovery was bad at all. At my 6w pp check-up my doctor was very pleased that the tear looked pretty much non-existent.

Even though I'd rather not tear at all, I think I'll let my doc decide what's best in the moment with this upcoming birth.

RMLandy · March 2016

I had an episiotomy because my son was in distress and needed to be born IMMEDIATELY. I have nothing to compare it to but the recovery wasn't any worse than I expected and had pain free sex before my 6 week check up. I asked my dr if they could just go ahead and plan to do it again and she said no, they don't do it unless medically necessary.

saraleigh2 · March 2016

There are some pushing/labor positions that make tears less likely or less severe for example on your side vs on your back etc there are multiple L&D positions that might work better for you we covered these in my birth class.

yogahh · March 2016

Question for those that had an unmediated birth previous and either tore or were cut- since you weren't numb from the epidural did you feel the tear or cut? Was it horrible? I'm still on the fence about the Epi and the fear with tearing is what is making me waiver.

Also, regarding stitches... I've never had any before, vag or other places! What does recovery of stitches feel like? Especial vag stitches? Is it super itchy?

missnc77 · March 2016

@yogahh - After watching the birth videos on my birthing class, I don't think it was the tearing that made women give into the epidural, it was the intense labor pains and hours and hours of laboring that did it. The reason I am still considering trying to go natural is that I've heard your tearing is much better because you can actually feel pain. But, I also know if I'm not dead set against an epidural, then I'll probably give into it during all that laboring - why kid myself? That shit looks awful.

Actually, after the past several weeks I've had, I just know I'm in store for some good things, and I'm just going to sneeze and the baby will come right out all beautiful and camera ready. #positivethinking

LadySamLady · March 2016

This thread makes me want to get into bed and hide under the covers forever.

lalala2004 · March 2016

@yogahh it's my understanding that you don't actually feel the tear itself because the "ring of fire" sensation and the intense pressure of that kind of numbs the rest of the area. Apparently the shot they use to numb the area before stiching is more painful than the tear itself. Of course, this is just what I was told, I haven't experienced it.

Par13 · March 2016

I would prefer to tear naturally.
With DS, I tore pretty badly (due to him being born arm first - like in a superman pose). I only needed ibuprofen for pain relief, but wasn't able to have pain-free sex until about 4 months postpartum.

Par13 · March 2016

yogahh said:

Question for those that had an unmediated birth previous and either tore or were cut- since you weren't numb from the epidural did you feel the tear or cut? Was it horrible? I'm still on the fence about the Epi and the fear with tearing is what is making me waiver.

Also, regarding stitches... I've never had any before, vag or other places! What does recovery of stitches feel like? Especial vag stitches? Is it super itchy?

-- QBF --
@yogahh
Recovery with stitches burned for me, especially after I peed. The perineal bottle was a lifesaver because there was no way I could wipe normally after going to the bathroom.

I don't recall itching and I think the stitches dissolved on their own.

mumbolino · March 2016

yogahh said:

Question for those that had an unmediated birth previous and either tore or were cut- since you weren't numb from the epidural did you feel the tear or cut? Was it horrible? I'm still on the fence about the Epi and the fear with tearing is what is making me waiver.

Also, regarding stitches... I've never had any before, vag or other places! What does recovery of stitches feel like? Especial vag stitches? Is it super itchy?

I have no clue. Obviously. But my mum had an episiotomy for one of her births and she said she did NOT feel it as everything is already so tense/stretched... she said in the whole picture of things a tear / cut are nothing to worry about (obviously.. not talking about horrible tears here, ok? I am sure those are no fun, especially not to recover from).

evalynn24 · March 2016

@yogahh this is in regards to getting stitches. Once when I thought they had all come out I wiped and caught one

. Needless to say, that was pretty damn painful. Sometimes I could feel them pulling a little bit too, but I think that was partially just the healing process in general. I think my epidural wore off at the end and I did feel him give the local, but then it was nothing to actually get the stitches. By then you are so focused on baby anyway you won't even notice what the doc is doing. I wouldn't let it deter you from an unmedicated birth.

KelleAlward · March 2016

I tore. Honestly I didn't even know I tore, it just all hurt down there when I was pushing and baby was coming out. I had the epidural but I could feel everything below my hips, so I could feel the birthing pain, but not the pain from the contractions in my abdomen. I had several tears, the worst of which was deeper inside me, that one needed stitches. The smaller more external tears hurt because they got pee on them every time I went to the bathroom, and it burns bad. That went on for a few weeks before they healed enough. The internal stitched tear felt more achey, and it did itch a little as it healed, not that I dared give in to the urge to itch it! The biggest help for healing was Epsom salt baths and lots of dermoplast. Hope this helps answer some questions.

Bluejay3030 · March 2016

Par13 said:

I would prefer to tear naturally.
With DS, I tore pretty badly (due to him being born arm first - like in a superman pose). I only needed ibuprofen for pain relief, but wasn't able to have pain-free sex until about 4 months postpartum.

@Par13 This is exactly what happened to me lol. I've never heard of anyone else that got that unlucky, although I'm sure it happens all the time. The recovery was so painful!!!! I should have known because in every ultrasound DD had her hands above her head.

auntieembabes · March 2016

yogahh said:

Question for those that had an unmediated birth previous and either tore or were cut- since you weren't numb from the epidural did you feel the tear or cut? Was it horrible? I'm still on the fence about the Epi and the fear with tearing is what is making me waiver.

Also, regarding stitches... I've never had any before, vag or other places! What does recovery of stitches feel like? Especial vag stitches? Is it super itchy?

I'd never had stitches either, it pretty much was carnage down there. I didn't notice itching, it was just sore. Icy pads and witch hazel pads fixed it.

auntieembabes · March 2016

lalala2004 said:

@yogahh it's my understanding that you don't actually feel the tear itself because the "ring of fire" sensation and the intense pressure of that kind of numbs the rest of the area. Apparently the shot they use to numb the area before stiching is more painful than the tear itself. Of course, this is just what I was told, I haven't experienced it.

I couldn't feel the stitching at all, and the only reason I knew I'd been cut was the sound of the scissors. My epidural didn't really take (only a patch on my thigh went numb) so it wasn't that the drugs covered the pain. I also didn't notice a shot before the stitching - I think at that point the pain receptors in the area just don't have anymore f*cks to give.

wamam027 · March 2016

yogahh said:

Question for those that had an unmediated birth previous and either tore or were cut- since you weren't numb from the epidural did you feel the tear or cut? Was it horrible? I'm still on the fence about the Epi and the fear with tearing is what is making me waiver.

Also, regarding stitches... I've never had any before, vag or other places! What does recovery of stitches feel like? Especial vag stitches? Is it super itchy?

So this is totally gross and TMI, but might give you a little hope as to the feels down there. I've magically become severely allergic to berries of all sorts this pregnancy, first tri when I ate strawberries I got super itchy and swollen all over and that lasted several days with benedryl; so I stayed away from strawberries. We had assumed it was just strawberries so last month I got a huge package of blueberries and went to town on those. In 2 days I was SO SO swollen down there and was uncomfortable because it was so swollen. I called my ob and she told me to come in, checked me, and apparently I was so swollen that I had torn pretty good and had several lesions to boot. I didn't feel a thing down there other than uncomfortable due to the swelling and had NO idea that all that was going on. My ob said that was for sure an allergic reaction and I needed to stop eating blueberries, take benedryl, and ice myself. My ob was astonished that I didn't feel all that and she said I should definitely "be prepared" for any tearing I might happen to experience with childbirth.

kp90 · March 2016

Never read this thread before you're about to eat.

dsmith211 · March 2016

kp90 said:

Never read this thread before you're about to eat.

lol.... This 100%. I have my breakfast right here, but I'm holding off for a min or 2.

RMLandy · March 2016

I just want to reassure the FTMs that while yes, there are a few cases where the tear situation was BAD, for the most part it's not such a huge deal. I was SO worried about it with my first and of all the different pain to recover from, the stitches do not stand out in any way. Peri bottle, dermaplast and you barely notice it! You will all be fine!

RMLandy · March 2016

I just want to reassure the FTMs that while yes, there are a few cases where the tear situation was BAD, for the most part it's not such a huge deal. I was SO worried about it with my first and of all the different pain to recover from, the stitches do not stand out in any way. Peri bottle, dermaplast and you barely notice it! You will all be fine!

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