epsiotomy vs natural tears

L

lg969

Registered User
hi all

Im due in 8 weeks and I would love some advice regarding epsiotomies versus natural tears. I am opting for a natural birth and my doctor has suggested that I get an epsiotomy and not let it tear naturally. What method hurts more and what heals faster?

also, she suggests that its better go directly for a c-sect if complications occur during the natural birth as getting as epidural relaxes your lower body and makes it harder to push....does anyone have any past experience with this?

i am super freaked out and would love any advice/experiences.
thanks
 
Ummm, I don't have experience of natural tearing, I had it on my birthplan but then when the time came the doc did an epesiotomy. With hindsight I'm a bit p1ssed off about that but the reality is when you're in the midst of giving birth you don't have that much free brain space for decisions so you pretty much do what someone tells you to do. At least that was my experience. Having said that the episiotomy wasn't *that* bad and I don't think it would have been worth the fight to stick with my original request - you have stitches, you get better, you move on. There's so much else to think about.

On the c-section, I'd say that is worth fighting and from my personal experience I'd say your doctor is feeding you a line. Of course it depends on the nature of the complications, some c-sections are absolutely necessary but that you can't push with an epidural is rubbish. I had a walking epidural which was topped up every few hours as the effect faded and the pain came back, they would then usually let it wear off as you go into labour proper and by then you're in the zone and you don't need it. I had an epidural and my baby was out in five pushes.

A c-section is easier for the doc, bigger pay packet and a short time frame, this is where your husband needs to be your advocate because if she starts to push you to have one when you're in labour it could be distressing. You need to coach your husband/birth partner with what you want and get him to ask why she is recommending a cs, is the baby distressed? Are either of you in any danger? Would it be ok to wait until the epidural wears off a bit and try some more pushing? I had a meeting with Hulda at Annerley to talk through all this, she's pro natural birth and knows a lot about the doctors and hospitals in HK, if I were you I'd book a meeting with her and make sure your husband can attend too and you can discuss all your worries and scenarios.

At the end of the day, no matter what happens as long as you are all safe and healthy at the end of it, that is what is important but I'd also not let a doctor's personal opinion take away the natural birth you are looking for if you can possibly avoid it.

Good luck.
 
An episiotomy shouldn't be automatically done, only in cases of a big baby, baby coming bottom first or a short perinea, also it will take longer to heal and it's more painful than a natural tear. Maybe you won't need an episiotomy at all, or the tear will need only 1 or 2 stitches.
Concerning the peridural and the fact it's harder to push, it's true, but easy to reverse, as you can just not ask for the last "shot" of pain killer so you can feel the birth and it's easier to push. Don't be afraid by the pain, it's just part of the natural process, and it stops as soon as the baby is out.
I can understand your stress, but your doctor seems to be a bit "pushing". It's the most wonderful experience for a woman, make it yours !
And congratulations ;)
 
My first born, I had an episiotomy and it hurt like CRAZY for probably 2-3 months while it was healing. My second born, I had a 2nd degree natural tear and it did still hurt a bit, for about a week - and then it was totally fine. My daughter is only 3 weeks old and the scar doesn't hurt at ALL. It took me soooo long to get to that stage with my first...

I know that probably a part of it might be because it's my 2nd, not my first - but I do think that the natural tear did help. I heard that doctors prefer episiotomies because a) it can shorten labour a bit, and b) it's much easier for them to stitch up afterward...

Yes an epidural can make it harder to push - but seriously, even if they have to use the vacuum to help you, it would be much better healing wise than a c section!! My 2nd, they used the vacuum (without the episiotomy) and it sped things up a lot because I'm a really bad pusher (or maybe it was just the effect of the epidural, but I wouldn't have NOT wanted the epidural...) - the vacuum wasn't as bad for me or the bub as I thought it would be...

My experience is that a natural tear seems to heal much better than an episiotomy, and that even with an epidural and assisted birth, it's possible to have a very fast recovery. I've never had a c section but I'm sure I wouldn't have recovered as fast from one of those - I'd do ANYTHING to avoid that...
 
I am due in 4 weeks with #2. WIth my first, I had a 3rd degree natural tear. My doctor here said that I could do an episiotomy, but it goes against the natural grain of my skin so could hurt in fact even more. The percentage of me tearing again with #2 is quite high and especially in the same exact spot which was not fun the first time around - painful, longer recovering time and more bleeding. My baby is bigger this time around so both my OB/GYN here in Singapore and in the US suggested a c-section. Episiotomies have also been decreasing over the past years in the US . . .
 
I would go for the natural tear unless it's absolutely necessary and we had that in the birthplan plus I kept emphasizing I didn't want to tear or have the episiotomy to the nurses and they said they didn't want me to either. I would recommend doing perineal massage every night now though so you can stretch the area down below and then you can kinda mimick how the stretching will feel like when you push. You can just use some olive oil and your partner can help you as well. We used the Epi-no but we weren't diligent about it. I had a first degree tear and it took about a week to feel normal. The nurse said it was a very little tear and she stitched it up with the dissolvable sutures. Also when I was pushing, the nurse would massage the area with KY jelly to reduce tearing. A good ob/nurse midwife will also help you control your pushing and let your body naturally stretch out so they may stop you from pushing (when you don't want to, but listen to them!) so you don't tear as much either.

About c-sections, they're usually unnecessary and I think unless it's a medical emergency, your doctor is just trying to make their lives easier. Watch the Business of Being Born...VERY eye-opening. Also, ask WHY whenever a procedure is mentioned. If not you, your husband/birth partner!

Good luck!
 
I would say try to do it without episiotomy to begin with but if it's just not coming then trust your midwife's/doctor's judgement as to whether one is necessary, I had two episiotomies for my first child and they were both very superficial and healed really well and quickly. Lot's of women get them so don't stress too much and I do think they are preferable to getting a very deep tear in terms of healing.
 
P.S. I got an epidural after 40 hours of back labour and I was still able to push my baby out. Once I was fully dilated, they turned off the epidural and syntocin so that I could get the feeling back!
 
If it's your first baby, then I would tend to agree to try doing a natural tear. I had an epidural, left leg was numb for about 5-8 minutes when it came time for me to push which is a side effect of it, but I managed to push him out. Knowing what I know now, I opting for a c-section rather than episotomy especially if my US OB/GYN says it as they are never pro c-section - only if it' necessary. It's true though, UK and Asia are very pro c-section usually for convenience factor so definitely ask about their reasoning for one.
 
I had an episiotomy and it was painful only for about 4 days. By the time I got out of the hospital, it wasn't painful anymore. There is a lot of discussion about HK doctors being pro c-section, but i would have to say that having a c-section never came up in conversation with my OB with my first child or currently with my second child (who hasn't been born yet). I know she would only suggest it if she thought I really needed one. Anyways, as for epidurals making it harder to push, I got an epidural (one that numbed my entire bottom half so not a walking one) at 10:30pm and had to start pushing by 11:45pm. The whole time that I pushed, I didn't feel a thing and had to rely on my husband, midwives and OB's instructions as to when to push. By 12:35am, my son was born. My OB had to suction him out after I pushed for a good 40 minutes, but I didn't feel like there was anything bad about it....With respect to getting a c-section or not, if it were me, with my trust level of my doctor and me knowing that she knows how I feel about c-sections, she would never suggest one unless she felt that it was medically needed at the time for either myself or the baby. If I were you, I would have a conversation with your doctor and set out parameters about when you would want one and when you wouldn't and I would say at the time of the birth, you just have to put trust in your doctor that he/she will do what you want. Believe me, you don't want to me stuck with making hard decisions in the middle of your birth as you are in enough pain as it is.
 
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Not sure I follow the epidural v c-section question. Is your OB suggesting that if you think you might want an epidural you should just have a c-section instead? If so, I agree that this is rubbish!

One thing that I would be wary of with the epidural is topping up too soon. With my first (2nd due in Oct), the nurse/midwife told me that once I started to feel pain again I could get a top up, so I did. When the OB came to check up on why he hadn't been called back in (was expecting me to progress faster), it turned out that my contractions has slowed waaay down b/c my body relaxed so much. He explained that this is when you can run the risk of needing an emergency c-section, as my water had broken many hours before. This didn't stop the nurse (at Matilda) from offering me yet another top up a couple of hours later when my contractions had come back full force and I was definitely feeling it. I declined and delivered not long after.

All told, it was @12-13 hrs of labor, which isn't bad and several of which weren't painful at all. The actual delivery was painful but pretty quick. This time, I am going to hold out as long as I can before having the epidural and not take a top up.

I had some natural tearing which hurt during delivery but with the pain meds after, it healed without my even noticing it. Was too preoccupied with the struggles of breastfeeding!

I think you really need to be able to trust your OB on this one. I thought I was big on natural tearing only but OB explained that if the tear is going to be really bad, an episiotomy can help make it more uniform and ease recovery. What kind of tearing you are having is, of course, a mid-delivery judgement call. They will try to get you to stop pushing so the skin can stretch naturally, but this can be hard to do too! My tearing turned out to be natural only but had the OB said that he felt an episiotomy had been necessary, I would have trusted that this was he right medical decision.
 
I would def go back to your Obs on the "epidural = c-section" thing. Put it this way- apparently 90% of women who have a vaginal delivery at the Matilda have an epidural, and most of them dont end up having c-sections. That said, if you're giving birth in a public hospital, my understanding is that they don't have "mobile epidurals", only the more old fashioned ones which do significantly reduce sensation in the legs considerably and can slow labour down/ increase risk of c-section. However, with help from the midwives/ Obs you should still be able to push a baby out- many women do.

Re the episiotomy- ultimately it's a judgement call on the day but I'd be concerned if my Obs was assuming I'd definitely have one. Most Obs see minor tearing as preferable to episiotomy but episiotomy as preferable to major tearing. They're only going to know that when the time comes.

Have you done any antenatal classes? It really does help you feel more prepared and understand your options on pain relief and intervention so you can have an educated discussion with your doctor.
 
Both my midwife and doctor told me that natural tear was always better than episiotomy - and I had natural tear with my first baby (second degree tear.. which required a bit of stitching) which healed quite easily in about 6 weeks.
 
I went for a natural tear and still had to get stitches. Have nothing to compare it to, but I have also heard that it is out of favor in most developed countries, and that a natural tear heals better. I don't really see an advantage to an episiotomy - you might not need stitches with a natural tear whereas you certainly need it with an episiotomy, and if you do need stitches with a natural tear, then it was no worse than an episiotomy. Also, note that you can tear only the outer/inner layer of your perineum with a natural tear, but need to cut through all the flesh with an episiotomy.

As for the epidural, I had one and I was a chicken so I was completely numb when I was pushing the baby out. It took awhile, probably just over an hour, and I was exhausted, but I was trying as hard as I could and I don't think having no epidural would have changed that. I mean, again, can't compare it to anything. My doctor was funny, she said for her first child she had an epidural and for her second child she decided to do no epidural, and then decided afterward, hmm, next one, I'll do an epidural again! Like other posters said, you can always let it wear off a bit and if it's too much pain, then get it topped off.

Also, I remember my roommate at Matilda had to get a C-section (at least, she was convinced to), and then she couldn't properly feed her baby in certain positions because it hurt her, and couldn't lay the baby on her stomach. Don't know if that was just her; maybe others can give their opinions?
 
It is certainly true that having an epidural will make it harder to push the baby out and thus being more likely to end in a tear or episiotomy. I had both of my babies completely drug free but did so for 'vanity' reasons I have to say as I didn't want to be cut either by c-section or episiotomy.If you think about it logically it all makes sense. If you are able to stand upright and walk around the room then the babies head is able to push down more effectively, naturally stretching the perineum and generally making for a quicker easier birth just as nature intended. Just imagine you were trying to do a bowel movement lying flat on your back numbed from the waist down and and then magnify that to include an average size baby. In simple terms it becomes easier to imagine why statistically such a large number of mothers who have epidurals end up needing intervention. Add to that the fact that when you are lying on your back and the baby is unable to press down as effectively, it will often go in to distress as the labour begins to drag on. Of course all of this means once again that you are more likely to need quick intervention in order to get the distressed baby out. Hence a cut to the perineum or worse a c-section.

I am not saying that my labours didn't hurt...they really did. But I would have to say that the few hours of pain were definitely worth it to be able t0 keep my perineum intact and my stomach flat now 9 and 6 years down the track. Also being able to get up minutes after the births and shower and feel normal again was priceless...call me vain but I would do it all the same in a hear beat.
 
I used an 'epi-no delphine plus' (a machine that you use to slowly stretch the perineum daily 2-3 weeks prior to EDD) to minimize the possibility of tearing, epi-no's are used a lot in Holland and other parts of Europe where they have a high % of home births. You can get them here in HK - details are on their website.

Also had an epidural with both kids, which wore off in time for active labour once I was fully dilated. In the beginning it tempered the pain and allowed me to get some much needed rest, by the time I was fully dilated I was able to move and could easily squat supported by the OB and my husband - gravity did quite a lot of good to get things moving!
 
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