As the title of this post suggests, I had a hospital birth with my son three years ago which resulted in an episiotomy after 2 hours of pushing. (He just wouldn't fit - I kept telling the MWs but it took them two hours to believe me and agree I was right!).
Anyway, due to a night's stay in hospital and a crappy piece of human needlework by the Doc, I ended up contracting MRSA. Looooong story short, I suffered multiple infections in the wound, 7 courses of anti-bios in 10 weeks, thrush in my broken and infected right nipple (AGONY!!!), two bouts of mastitis and a breast abscess before they finally conducted a breast aspiration under a specialist breast consultant and recognised the root of the cause of the infection as systemic MRSA, happily thriving in my yacky, congealed breast milk.
Immediately, I was made to stop breast feeding and both myself and my son were treated for the infection.
The whole post-natal experience was very painful and traumatic and it totally ruined breast-feeding for both myself and my little boy.
I told all this to my MW now I'm that currently gestating baby number 2 (yay!) and she suggested a Home Birth this time round. Her logic is that my house will be way cleaner than any hospital so the risk of contracting any infection will be minimised.
My question to all you home birth experts is this: What if I need another episiotomy during this labour? My scar is still painful now and at my last smear I was given a doomed look by the nurse who claimed "they bodged you up good and proper didn't they love?" Therefore the chances are, I'll probably need another one this time round. I'm fine with that but want to know whether the cut and subsequent stitches can be administered by MWs in my home?
Sorry you had such a rough go of it the first time. MRSA is pretty nasty. I had much of the same breast issues, minus the MRSA, we weren't sure what it was, but it wasn't nice. As for home birth, I would say try not to worry. Episiotomies, unfortunately, are more often done for the convenience of the doctors rather than because you need one. If a baby will fit through your pelvis, it will fit through your vaginal opening, and if not, you'll naturally tear. Now there are some people who do have pelvic injuries (like from a car accident) or congenital pelvic deformities that mean they actually can't birth vaginally because of the bone structure of their pelvises. But with rare exception, like in a true medical emergency when there isn't time to do a c-section, if given time, all babies can be birthed without needing an episiotomy. It's often just a matter of giving it time, assuming all else is well, for baby to get better positioned to descend, or for your contractions to give you a little break (sometimes they slow down if you need to rest and then pick back up), or you just need to be more upright or something similar. There may be times when baby is in distress and needs to be born urgently, so an episiotomy made speed that up, but that is rare in situations where there are few other risks, like you're having a spontaneous labour with no induction or augmentation, which drastically increases the risk of fetal distress. Home birth midwives are also very cautious when it comes to monitoring for fetal distress. In hospital, if baby had two unexplained dips in heart beat, it probably wouldn't mean anything and they might not even mention to you, at home, it would mean they would recommend a transfer. I know my daughter had one dip and the midwives were careful to keep an eye on it in case it happened again and were ready to transfer if it did. (I didn't, had a lovely home birth).
That said, a long pushing phase doesn't really mean anything so long as you and baby are well and it's a bit of a myth that babies have to be delivered in a certain amount of time and intervention is needed to make sure this happens. First babies often mean longer pushing times and that's totally normal. I pushed for 4 hours with my first, at home, and all was fine. The midwives certainly kept an eye on us and checked us both periodically, but sometimes things just slow down a bit and then pick back up. In my case, it was because my daughter was back to back and trying to get better positioned. It was totally fine (tiring! I squatted on and off for 4 hours!) but way better than being in hospital and definitely better than having an episiotomy. I had a small 2nd degree tear, which was no big deal and healed just fine. Most home birth midwives are more supportive of just letting you get on with it if you're well and both of you are coping, so 2 hours of pushing probably wouldn't have resulted in intervention at home, unless of course, there was a medical need for it. I would just talk over your concerns with your midwives. They can tell you how they would deal with a situation like that occurring at home and make some suggestions for how to avoid it next time around.
To add just a couple brief things, some women who have previously had episiotomies or torn naturally will tear along the same path as before, some will tear differently,and others wont tear at all. Also, I know some women who have had botched episiotomies, and tearing the next time resolved those issues when it healed again.
Midwives are capable of suturing 1st and second degree tears at home (though you may want to look into allowing minor tears to heal naturally using honey and/or seaweed) though you can opt to transfer for tear repairs (and third or 4th degree tears would definitely be transferred for with repair in theatre)
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