# Episiotomy to prevent tearing? Opinions anyone?



## josephine3

Sooo.. My last birth i had a 3rd degree tear, and tore internally to the left hand side, i had to have the skin cut however for repairs.. I alsao lost a lot of blood and am very worried about a repeat performance.

Does anyone think an episiotomy might be a good idea this time maybe at an angle to the right?
Any experience would be appreciated. X


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## melfy77

I had one both times, and they're really not that bad. It was a little more uncomfortable the first time, but nothing a few Tylenol couldn't handle. This time it's been much easier. I know they try not to do them anymore, but they still do it at my hospital, and I would have teared pretty badly without one.


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## josephine3

How do u know u would have torn without one may i ask?


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## teal

I had an episiotomy and had a separate tear into my bowel so it doesn't always prevent a serious tear x


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## melfy77

melfy77 said:


> I had one both times, and they're really not that bad. It was a little more uncomfortable the first time, but nothing a few Tylenol couldn't handle. This time it's been much easier. I know they try not to do them anymore, but they still do it at my hospital, and I would have teared pretty badly without one.

I wasn't feeling confident about my pushing, and since I had an epidural (which I'm really really glad I for), it was a lot harder to ''know'' how hard to push, and it's always been ''narrow'' down there. Of course maybe I wouldn't have teared, but I don't regret getting the procedure. I gave birth last 4 days ago and I barely feel any pain now.


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## x__amour

I am asking to avoid an episiotomy if I get a VBAC. I'd prefer to tear naturally as I have heard it's easier to heal from than a surgical cut. :flow:


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## Warby

I had a fourth degree tear with my second. It took a while, but it healed up. I discussed the idea of an episiotomy with my doctor when I was having my third, as I did not want another tear. He said he would do an episiotomy if he felt I needed one. Turns out I did need one.

In my experience, healing from an episiotomy was much easier, faster, and less complicated then healing from the fourth degree tear.


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## george83

x__amour said:


> I am asking to avoid an episiotomy if I get a VBAC. I'd prefer to tear naturally as I have heard it's easier to heal from than a surgical cut. :flow:

I had an episiotomy last time and this time I had a second degree tear only 5 days ago. At the minute the pain and discomfort feels exactly the same and I'm constantly swallowing painkillers and anti inflammatories every 2 hours. I'm hoping my tear will heal much quicker than my cut did as apparently the join is more natural


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## Feronia

Healing from a natural tear is MUCH easier than healing from an episiotomy. Try this: tear a piece of paper with your bear hands, and then tear it after cutting a small vertical line first. The second one will tear farther than the first with the same amount of force.

Here are a list of ways to avoid tearing naturally: https://www.pregnancy-and-giving-birth.com/avoid-episiotomy.html

Bottom line: try to birth upright or in water and avoid an episiotomy to increase your odds of having an intact perineum.


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## AC1987

:haha: I was JUST about to post asking for ways to avoid a tear... i dont think I'd ever ok an episiotomy because I don't know if I would even tear to begin with.


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## Warby

See, here's the thing with the tearing versus episiotomy argument:

Yes, undoubtedly, a first or second degree tear (small tears around the labia) do heal relatively easily.

The OP is talking about a pretty significant tear. She had third degree. I had fourth degree. These tears tear way past the labia and into the anus (my tear completely severed the muscle ring). It took me about 6 months to heal naturally. There were issues with going to the bathroom and passing gas. Sex was uncomfortable and we didn't do it again until around seven months post partum.

I needed antibiotics after birth because some fecal matter could have gotten into my bloodstream.

I was lucky that I healed on my own. Some women need reconstructive surgery after a fourth degree tear.

So when facing the option of a surgically managed cut towards leg muscles, or re-tearing into the anal sphincter, the episiotomy may just be the way to go. 

For me, personally, my doctor didn't automatically decide to do an episiotomy. He said he would do one if needed. I did get one having baby #3, but not with baby #4.


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## josephine3

Yeah thanx to the above post! I think i also had the antibiotics and i had immediate surgery with a spinal block which wasnt pleasant. I was also thinking that tearing into the leg area may be better than towards the anus again! How did ur episiotomy go may i ask? Did u have any tear extending beyond it? I think i was lucky that my surgeon did a great job and i healed well with no problems. I worry that the same might not happen again!


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## Warby

josephine3 said:


> Yeah thanx to the above post! I think i also had the antibiotics and i had immediate surgery with a spinal block which wasnt pleasant. I was also thinking that tearing into the leg area may be better than towards the anus again! How did ur episiotomy go may i ask? Did u have any tear extending beyond it? I think i was lucky that my surgeon did a great job and i healed well with no problems. I worry that the same might not happen again!

The episiotomy went great. The cut was angled towards my left thigh and my perineum stayed intact. No tearing anywhere and the episotomy cut was not very big. The episiotomy area was a bit sore afterwards but healing from that was an absolute walk in the park compared to healing from the fourth degree tear.


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## Beanonorder

I had an episiotomy and healed quite well from it. It is something they automatically do here when you reach 10cm. As I am a foreigner I initially refused and they resepected that. But I was just too physically exhausted to push her out without one. So after an hour and a half I agreed and twenty minutes later she arrived and I didn't tear anymore. 
In China you labour and deliver in a communal room (four to a room) so I watched five other women give birth in the time I was there and not a single one pushed for more than twenty minutes and I put that down to the episiotomy. I pushed for almost two hours!


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## Swinx

Warby said:


> See, here's the thing with the tearing versus episiotomy argument:
> 
> Yes, undoubtedly, a first or second degree tear (small tears around the labia) do heal relatively easily.
> 
> The OP is talking about a pretty significant tear. She had third degree. I had fourth degree. These tears tear way past the labia and into the anus (my tear completely severed the muscle ring). It took me about 6 months to heal naturally. There were issues with going to the bathroom and passing gas. Sex was uncomfortable and we didn't do it again until around seven months post partum.
> 
> I needed antibiotics after birth because some fecal matter could have gotten into my bloodstream.
> 
> I was lucky that I healed on my own. Some women need reconstructive surgery after a fourth degree tear.
> 
> So when facing the option of a surgically managed cut towards leg muscles, or re-tearing into the anal sphincter, the episiotomy may just be the way to go.
> 
> For me, personally, my doctor didn't automatically decide to do an episiotomy. He said he would do one if needed. I did get one having baby #3, but not with baby #4.

Thankyou for opening my eyes! I've never given birth before, but all I've read previously are arguments against.


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## Warby

Swinx said:


> Warby said:
> 
> 
> See, here's the thing with the tearing versus episiotomy argument:
> 
> Yes, undoubtedly, a first or second degree tear (small tears around the labia) do heal relatively easily.
> 
> The OP is talking about a pretty significant tear. She had third degree. I had fourth degree. These tears tear way past the labia and into the anus (my tear completely severed the muscle ring). It took me about 6 months to heal naturally. There were issues with going to the bathroom and passing gas. Sex was uncomfortable and we didn't do it again until around seven months post partum.
> 
> I needed antibiotics after birth because some fecal matter could have gotten into my bloodstream.
> 
> I was lucky that I healed on my own. Some women need reconstructive surgery after a fourth degree tear.
> 
> So when facing the option of a surgically managed cut towards leg muscles, or re-tearing into the anal sphincter, the episiotomy may just be the way to go.
> 
> For me, personally, my doctor didn't automatically decide to do an episiotomy. He said he would do one if needed. I did get one having baby #3, but not with baby #4.
> 
> Thankyou for opening my eyes! I've never given birth before, but all I've read previously are arguments against.Click to expand...

I should also add that third and fourth degree tears are very rare. :)


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## Srrme

My Doctor cut me a tiny bit and I also tore in 3 other places. :dohh:


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## Feronia

I wouldn't praise the episiotomy for only pushing for 20 minutes. Lots of things affect how long the second stage takes; epidurals make it last longer, and so does your position. I only pushed for 19 minutes and I was completely upright. No episiotomy, and no tears. I also had a water birth, which is one of the best ways to prevent tearing along with being in an upright position since your pelvis is 30% more open!

And it's not a question of 4th degree tear vs. episiotomy. Many women who receive an episiotomy wouldn't have teared (or only would have had a minor tear) otherwise.

I like this quote:
"The truth is that episiotomies are rarely needed when a woman gives birth in a squatting position bolstered. This position provides maximum pelvic pressure, optimal muscle relaxation, a great expansion of the perineum, and minimum muscle strain. It is also the best prevention against severe perineal laceration. When a woman lies on her back with her legs in stirrups and trying to displace against gravity, is likely to start in a deep laceration tissue below the skin surface. However, propped in a crouched position, any laceration will usually be superficial and will heal quickly." (Michel Odent)


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## Beanonorder

Feronia said:


> I wouldn't praise the episiotomy for only pushing for 20 minutes. Lots of things affect how long the second stage takes; epidurals make it last longer, and so does your position. I only pushed for 19 minutes and I was completely upright. No episiotomy, and no tears. I also had a water birth, which is one of the best ways to prevent tearing along with being in an upright position since your pelvis is 30% more open!

You're absolutely right that many things affect how long the second stage takes. You're very lucky that all of those options were available to you. But for the record, in a regular Chinese hospital, epidurals are not given for natural births and women HAVE to deliver on their backs with their legs in stirrups. Other positions are not considered. In the research I've done I've come across one hospital that offers water births (and that is even including the western hospitals). Very difficult to get a place in it and far out of the price range of typical Chinese people.


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## Warby

Feronia said:


> I
> And it's not a question of 4th degree tear vs. episiotomy. Many women who receive an episiotomy wouldn't have teared (or only would have had a minor tear) otherwise.

No, it's a question of avoiding a SECOND major tear by having an episiotomy. It sounds like you've never had a major tear so perhaps can't understand how traumatic they are. The OP was specifically asking about getting an episiotomy to avoid a second tear. I am sure the OP would prefer to avoid both tearing and episiotomy, and the advice you shared about position and water birth is helpful in that regard. 

But once you have had skin, muscles and organs stitched back up, and underwent a long healing process, you aren't eager to go there again. If I had torn the same areas again, I don't think I would have healed so well.


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## kate1984

My vagina and scissors will never mix, that said this is number 5 and I didn't tear with the other 4


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## Feronia

Warby said:


> Feronia said:
> 
> 
> I
> And it's not a question of 4th degree tear vs. episiotomy. Many women who receive an episiotomy wouldn't have teared (or only would have had a minor tear) otherwise.
> 
> No, it's a question of avoiding a SECOND major tear by having an episiotomy. It sounds like you've never had a major tear so perhaps can't understand how traumatic they are. The OP was specifically asking about getting an episiotomy to avoid a second tear. I am sure the OP would prefer to avoid both tearing and episiotomy, and the advice you shared about position and water birth is helpful in that regard.
> 
> But once you have had skin, muscles and organs stitched back up, and underwent a long healing process, you aren't eager to go there again. If I had torn the same areas again, I don't think I would have healed so well.Click to expand...

I'm aware of the OPs question, and my response is the same; even though scar tissue is not as pliable as perennial tissue, you aren't guaranteed to tear. I'm a doula, and I've known of clients in my area who had 3rd and 4th degree tears in one birth, no episiotomy in the next and only very minor tears (or no tears at all) that don't require stitches. Healing from a minor tear is much better than healing from an episiotomy, and you're less likely to tear in subsequent births anyway.

That really sucks that they try to make you give birth on your back in China! I don't know the laws in China, but at least in North America and the UK you can always refuse something, even if it's made out to be "mandatory."


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## Beanonorder

Well I initially refused so I'm sure they can too! But as they only ever have one child and they do it all alone I don't think it occurs to them to say no. Its basically a case of 'well everyone else does it' and a lack of education.


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## josephine3

Yeah mayb i should have been specific that im worried about tearing into the same area again and worry that the muscles will be weaker there. I should add that my first was a water birth and i still tore badly! I also think it actually contributed to my tear by lack of control, lack of counterpressure and no guidance thru the pushing phase. I also pushed for 2 hrs :( tbh im leaning towards on my back this time it cant be much worse! I wudnt be allowed to use the pool again even if i wanted to because of the tear and heamorrhage.
Gosh anything can cause a debate on bnb!


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## teal

josephine3 said:


> Yeah mayb i should have been specific that im worried about tearing into the same area again and worry that the muscles will be weaker there. I should add that my first was a water birth and i still tore badly! I also think it actually contributed to my tear by lack of control, lack of counterpressure and no guidance thru the pushing phase. I also pushed for 2 hrs :( tbh im leaning towards on my back this time it cant be much worse! I wudnt be allowed to use the pool again even if i wanted to because of the tear and heamorrhage.
> Gosh anything can cause a debate on bnb!

I had a check with my consultant at 8 weeks post and his concerns was that while I've healed quite well this time if I tore again they wouldn't be able to repair the damage as well. I had an episiotomy, separate 4th degree tear. There was also the concern of tearing between the two scars. I was recommended a section if I ever had another baby but to be honest the birth and recovery had put me off. 

Good luck :hugs: xx


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## Warby

Have you talked about it with your doctor/midwife? What did they suggest?


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## clairebear0

With second babies you tear less.

My doctor said he basically would judge how you are tearing to determine if it is a good idea to get an episiotomy...for example, if I was going to tear my clitoris or something he would want to give me an episiotomy. I think you should talk with your doctor about what your wishes are so they are clear.


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## josephine3

Yeah iv spoken to a doctor she said she thinks i would be ok to deliver vaginally but couldnt really give me any advice on the episiotomy. Just that they normally have a 'high threshold' for performing an episiotomy and she could write on my notes i requested a 'low threshold'...

I cant imagine anyone tearing 'up' towards the clitoris??!


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## Seity

No, no, and no. They won't even do them at my hospital except in a medical emergency because they know you are much better off tearing, if it's going to happen.


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## smileyfaces

I had an episiotomy first time round and can honestly say it is much easier just to tear naturally. The recovery from an episiotomy compared to the second degree tear I got with my second pregnancy was much more painful! Id avoid an episiotomy if possible!


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## roomaloo

I had a forceps delivery first time. They DESTROYED my perineum with an episiotomy. I have a rectocele as a result and am waiting to have reconstructive surgery

Had a home birth second time and had a first degree tear. So you aren't guaranteed to tear along a previous scar, and mine is front to back


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