Episiotomy

C

chrissy2

Registered User
I went through my birth plan with my doctor and on it I said that i dont want an Episiotomy. My doctor wasent to happy with that and he said because its my frist birth that I will be too small and that he is almost positive that i will need one, and he said that he always does them. Im not too happy with this, I going to stick to my birth plan and not let this happen unless medically necessary (ie baby is in distress and they need to use vacuum etc) Anyways I want to know how is the recovery after from the cut (pain etc) and is there anything you can do to help it heal faster and help with the pain. I read in a book that having a nice bath everyday after with lavender oil can help, where can you buy lavender oil on Hong Kong? Thanks Ladies :)
 
Hi Chrissy2,

I don't know anything about how is the Episiotomy works, i had c-section with my first and i am now about 3 months pregnant with my 2nd! what i wanna to say is that in HK, if you have your own plan about how to give birth you better stick with it because the docs most likely will try to talk you out of it for his own conveniences.

Regarding the levender oil, you can get it from some shops, there is one shop i know that they sale good pure essential oils, you can call ms. Lily at this no. 97248223, she is an oil and homeopathic therapist and believe she can also give you some advise.

Hope above helped.
 
I had in my birth plan to have an episotomy only if absolutely necessary. My OB does not do them routinely (I think it's a bit "old fashioned" to insist on them). As the baby was about to crown she told me she'd do one if needed and asked for my consent again. She ended up not doing one and I tore a little so ended up with stitches. They were a bit painful and uncomfortable for a few days, but nothing too bad. I just bathed and kept the area clean with warm water (no soap).

I have friends who have not been given an episiotomy and who have not torn with their first delivery.
 
Just stick to what YOU are happy with Chrissy and keep that open mind that you can change if you feel you need to at the time. I sometimes wonder about doctors who insist upon things before you are even birthing! You certainly don't need an episiotomy even if you require a vaccum assisted birth. I tore with both births, did not feel it at all and was stitched up very nicely and healed very quickly and well. It feels tight in the area after a couple of days and a bit tender but after about a week or two, you feel much better. Remember, you might not tear at all!

You can use condoms filled with water and then frozen and place them on top of a maternity pad in your panties to ease some of the swelling initially. Try to keep the area dry after bathing/showering but you as mentioned perhaps use a mild soap around but not on the area, like Dove. Try to remember when you are sitting to brace your arms and stand straight up instead of dragging your bum to the edge of the seat because that might hurt...some people like use a pillow under them perhaps on one side to alleviate some pressure on the area. Others sometimes use "donut" pillows. I didn't use any of these, I found just by being careful I was ok but you might like to give them a go.
 
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I didn't have an episotomy for my first in London last year and as a result I had quite a severe tear. The recovery of the tear was quite uncomfortable - peeing was hard and I always sat on a pillow. The bath didn't do to much either. I also lost a lot of blood. I don't think I want to go through it again and the chances of tearing in the same place is very common.

As I begin to think having #2, I had to bring it up to my new OB here who said, the best way to prevent another tear (if I tore in my 1st pregnancy, I will most likely tear again), is to to do an episotomy. He explained how this will help with delivering and he can do it what might seem last minute by looking to see where the baby's head is coming in.

I think for me, I will chose an episotomy if my doctor deems it necessary in order to avoid another tear.
 
Chrissy - don't be pressured into agreeing to anything you are not comfortable with, its your body, your birth. On the other hand, do keep an open mind as when its all happening for real it can all seem a little different than you expect. My birth plan didn't even make it out of my hospital bag actually! had an episiotomy and it was painful for several weeks, but who knows how a tear would have been. I put on my birth plan I would prefer to tear than be cut but on the day I just put my faith in the doctors and their judgement. Its pretty much okay now 3 months on. I If I was paying an OBGYN to deliver my baby and we didn't quite see eye to eye then I would be considering getting a new doctor.
 
Keep an open mind, docs don't do Episiotomy because they enjoy doing it but because it is necessary in most cases either to avoid a tear or to make room for vaccum. Perhaps you doctor feels in your case it will be necessary. I had a big Episiotomy and recovery was very hard for about 1 month, got infected and had to take antibiotics. Here is my advise to you:
1) Take rest, even if you feel energetic.
2) Take mild pain relief and antibiotics to avoid infection and aid healing.
3) Clean the stiches with betadine or any other disinfectant.
4) Using a donut pillow will ease the pain.
Good Luck!!!
 
I would just keep an open mind, birth plans can't be followed to the letter, things change, your OBGYN might have to make decisions fast. I had to be cut twice (30 stitches) to get my little one out and to be honest i didn't feel the cuts and the recovery time was fine, it was much faster than the recovery after my first baby's delivery, an emergency section.

Think as a new/expectant mother you have a plenty of other things to worry about.
 
I also asked for an episitiomy only if medically necessary... knowing that my first baby had a big head, I expected the doctor would do one without asking, but finally I tore a little and had absolutely no pain and no problem with the healing which was very fast. I would do it the same way without hesitation.
 
Look into an epi-no delphine plus: Epi-No | A Gentle Start to Life or Starnberg Medical - EPI-NO

Theyre very popular in Europe where there are a large number of home births. I used one for both my births and did not need an episiotomy. It also has a pelvic floor trainer for after the birth which is handy! A friend used it with a bub that had a particularly large head and didn't have an episiotomy either.

You can get them here in HK, details are on the second site.
 
Don't do it unless medically necessary.
I've had 2 births, no tearing.
Babies 4kg and 3.2kg.

You can also google advice on perineal massage. Does the same thing as the epi-no for free.
 
It seemed like a fact of giving birth here that an episiotomy needed to be done. When I told a doctor at one of my checkups at a public hospital that I did not want to have an episiotomy unless it was absolutely necessary, she was taken aback. She seemed to say that the episiotomy was routinely done to prevent severe tears from happening. She even drew a picture for me! In many other countries, episiotomies are avoided if possible. I asked that it be done only if medically necessary and had her add those exact words to my file.

For me, it didn't matter in the end, as I had an elective c-section due to a breech baby.

So, stick with what you want with your birth plan - it's your birth, but, as others have said, be open and flexible as things can change (sometimes very quickly).
 
That is riduculous that your doctor thinks all first time moms need an episiotomy, completley untrue. I had one due to baby in distress, and I also had a 3rd degree tear as baby bacially flew out of me, really short pushing stage. (tear are graded 1 through4, with 4 being the worst. 1st and 2nd degree tear are the most common types, and heal pretty quickly). I'd say the tear was a bit worse than the episiotomy, but again, it was a 3rd degree tear. Both with the tear and the episiotomy my stitches popped and I ended up with infecitons, so it took longer to heal, about 3 weeks. With the episiotomy sex was very very painful for months, until the scar tissue finally stretched. I think I took advil for pain? The easiest ice pack to use, it to put some water on a maxi pad ( don't soak though) and freeze it. It works well, and not so hard like a regular ice pack, and you need a pad anyway. I also used a herbal solution to cleanse the perineum afterwards that my doula gave me, can't remember the name of it though. ALso if you do perineal massage at the end of your pregnancy you can help tp prevent tears.
 
It really is old fashioned advice, and the majority of private dr's here don't do it routinely.
Be insistent if you don't want one, put it in your birth plan that this is your wish.
It can't be performed without your consent.
If there is a medical need for one, it can be performed very quickly.
Why cut yourself and go through healing when you may not tear at all?
Why have a 3-4 cm cut when you may only have a 1cm tear?

I wasn't even offererd one when I gave birth the first time at QMH, but at PWH the second time, they wanted me to sign a consent form the second I arrived in the delivery room.
I kept saying no, saying I would give my verbal consent if there was a need, and they kept insisting.
In the end I threw the form and pen at the midwife, who then finally gave up.
Of course, my 4 kg baby was born, and I had no tearing.
 
I had an episiotomy performed on me, I don't think she even asked for my consent. She just told me she was going to do it. By then, the baby was about to crown. I didn't even feel it.

But afterwards, boy oh boy did it hurt! As geomum said, it took about one month to recover. And everytime I peed, it burnt like hell. It was so painful going to the bathroom that I held back on drinking water.

Some tips: frozen peas wrapped in a tea towel helped. I also found the donut shaped cushion worked, as well as using a squeezie bottle when peeing. And most of all, take it slow.

My cut healed nicely.
 
i had an episiotomy as well... trusted my obgyn & so let him do whatever he feels is necessary. he did an excellent job & even the nurses commented that they could barely see the cut at all. yes, the first pee was painful, but then it got better day by day... i didn't feel any pain after about a week. i stayed pretty active before/throughout my pregnancy, exercising at least 3x a week so maybe that helped with the recovery?
 
I've heard both--

I've heard it explained that getting an episiotomy can lead to a worse tear. I've read this analogy: When they cut you, it is like taking a piece of A4 paper and cutting it with a pair of scissors--making a knick on one side--that cut area is an easier starting point to tear the paper than if you just tried to tear an uncut edge of the paper. So, if you're bound to tear, doing an episiotomy can cause the tear to be even more severe. I've had friends whom this happened too--and they're tear was really severe.

However, if they do cut you and you don't tear further, then that "line" will be easier to sew back together and may heal more smoothly without as much scarring.

For me, I wrote in my birth plan that I did not want to have an episiotomy. I tore. But, I tore internally more than I tore externally (yes, a lot of the tearing of the birth canal actually happens internally). Episiotomies usually only deal with the outter part of the birth canal, not the inner so there was nothing that could have prevented the tearing. I had a lot of internal stitches and a few external.

I've really never heard of a case where an episiotomy was helpful when a baby is in distress--episiotomies are done more for the mother than the baby--usually if the baby is in distress it's from some other reason (lodged in the birth canal and not coming down)--a mere bit of skin isn't going to really hold the baby back, I don't think.

Do you remember seeing some of these old-time movies where a woman goes into labor at home and the doctor or midwife comes and says to the husband, "Go boil some water and get me some clean sheets/towels" ? It is always assumed that the husband is told to boil water to "keep him busy" and "out of the way." This isn't true. The actual function of the hot water and towels is that the midwife would use them as hot compresses during labor to help the skin to stretch and prevent tearing. Most home-birth midwives rarely see tearing at all. They use hot compresses and olive oil to massage the perineum to soften it so you don't tear. (or they did in the past) Warm skin expands better. It's doubtful that anyone at the hospital, including your doctor will do that--and it's probably not a good idea to use the warm compresses too much as they can decrease elasticity in that area anyway (meaning you don't go back to your original shape later as well as you should) but....use olive oil. Start using it now. That area of your body should be just as moisturized as every other part of your skin--olive oil is a good choice.
 
"I've really never heard of a case where an episiotomy was helpful when a baby is in distress--episiotomies are done more for the mother than the baby--usually if the baby is in distress it's from some other reason (lodged in the birth canal and not coming down)--a mere bit of skin isn't going to really hold the baby back, I don't think. "

My episotomy was done because my baby was stuck in the birth canal and in distress beacause of it. It was critical to get her out ASAP as she wasn't breathing. Its not just "mere bit of skin" that was cut but deeper tissue and muscle as well. I have stiches deep inside my birth canal just as you do besides the 4 stiches outside.
 
I did perineal massage and used the epi-no for my first child- no need for episotomy or any stitches at all, plus I had a very understanding doc as well
 
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