Episiotomy or Tear

[Assisi]

Is there anything I can do to try to prevent a tear or an episiotomy? Has anyone tried things like massage or hot compresses and found them helpful?

Also, if you knew you were going to have one or the other, which would you prefer and why? Online there are sites which say it is better to tear because being cut can lead to worse tearing (rectal) which wouldn't have happened otherwise, and that cutting is only beneficial to the OB because it is easier for him to stitch. But both my mother and my mil say that a cut is better because it heals easier and prevents worse tearing. So I was hoping to get some anecdotal evidence. Thankfully my OB does not routinely cut, but he does cut if he thinks you're about to tear.

 

[sparassidae]

Well for a start I go the public route with midwives rather than OB, so they don't cut.

I had a epi with my first, only because they needed to use the ventouse (fetal distress). I didn't feel it at the time, hurt like hell afterwards but healed fine.

I was concerned that I would tear for the next labour (because scar tissue doesn't stretch as well) and did the massage thing. I don't know if it helped or not (I wasn't very diligent with it), but I have never torn in any of my next 3 labours.

I know that breathing (panting) through the head passing is really important. If you push at that stage you are more likely to tear. I have found that really easy, and the midwives are great at encouraging verbally at that point.

This may be tmi, but practice next time you have a large bowel movement. Practice just breathing through it rather than pushing.

Hope this helps.

 

[jgonz]

It is better to tear than be cut. The torn tissue has fibrous ends that mend together quickly, whereas a surgical scissor cut has two sides that have to be forced together (think _paper cut_ and how hard it is to heal).

You can test this out yourself on a piece of paper... Try to gently tear a piece of paper from the top edge. See how it 'gives' a little before tearing? That's similar to skin. Now use a sharp pair of scissors and do a little cut. Now tear from the cut... it rips very easily, doesn't it? That's Exactly what happens with skin also.

Avoiding an episiotomy is pretty easy~ you make sure you have a health care provider who doesn't do episiotomies routinely.

To avoid a tear, don't push too hard~ especially when the baby's head is coming. Make sure your health care provider knows you are trying to avoid tearing, and have him/her use hot compresses to help the perineum stretch. You can do perineal massage before going into labor, but don't start more than 2 weeks before you're due (it's kind of pointless to start earlier than that, not that it would be bad for you).

HTH~

 

[llghoney]

subbing

 

[coffeegal]

they tell you to push hard but really you should little push, push push than stop and than again.
with my first they cut me and i tore.

 

[Assisi]

Thank you ladies. What you say makes a lot of sense. When I told my mum and mil I'd rather tear they both said 'oh no you wouldn't'. I talked to my OB about it at my last appointment, I will give the hot compresses a go and fix in my mind not to push hard (there's some great stuff in a book called 'Active Birth' which I've been reading). I will tell my OB I want to try this stuff to avoid a tear, I think he'll be cool with it, he seems pretty open.

 

[Assisi]

Lol, and I had a dream the other night that I woke up and the baby was gone, I'd had an emergency caesar! After I saw the cut on my belly my first thought was 'yay no episiotomy!'

 

[Hadassah]

Thank you ladies. What you say makes a lot of sense. When I told my mum and mil I'd rather tear they both said 'oh no you wouldn't'. I talked to my OB about it at my last appointment, I will give the hot compresses a go and fix in my mind not to push hard (there's some great stuff in a book called 'Active Birth' which I've been reading). I will tell my OB I want to try this stuff to avoid a tear, I think he'll be cool with it, he seems pretty open.

They sound like my mom and MIL... though my mom did mention with my brother she didn't have an epi, but with him coming so fast, it didn't really matter...

The more I read and research the more I find myself automatically nodding my head in agreement going 'this makes sooooooo much more sense than doing it the other way!'.

My MIL told my DH yesterday she's concerned about us not having had birth classes -- that I won't know how to breathe through the pain. I shot him a look and then busted out laughing.. with all the pain I have had to deal with in my life, I think I've learnt to breathe well during pain that just doesn't go away. The one thing I can look forward to is that this is a rollercoaster ride of pain, and not just constant shooting pain that doesn't go away for long periods (sometimes hours) at a time.

I'm more worried about complications *after* birth than during... We go monday to talk with the midwife and set up our plans, so I hope to cover everything with her and get some input on how they tend to handle things.

 

[Assisi]

They sound like my mom and MIL... though my mom did mention with my brother she didn't have an epi, but with him coming so fast, it didn't really matter...

The more I read and research the more I find myself automatically nodding my head in agreement going 'this makes sooooooo much more sense than doing it the other way!'.

I think that there is a trend now for women to be more educated about their bodies and more a part of the choices made during birth. I like that. I think I know myself and my body quite well, and I think I know what would be best for me in a normal birth. I wish I was going public so that I could have more assurance of less interventions. My OB is fairly open minded, but there is still the old expectation that the doctor knows best and I should just do what I'm told. My mil even said, 'I think women know too much about child birth these days.' I disagree. But it's not just my baby, and I'm the only one who doesn't want to go private. So now I just want to go in armed with the best knowledge and a plan in my mind so that I (or hubby) can make sure that we get the care we want.

 

[Assisi]

Well for a start I go the public route with midwives rather than OB, so they don't cut.

I had a epi with my first, only because they needed to use the ventouse (fetal distress). I didn't feel it at the time, hurt like hell afterwards but healed fine.

I was concerned that I would tear for the next labour (because scar tissue doesn't stretch as well) and did the massage thing. I don't know if it helped or not (I wasn't very diligent with it), but I have never torn in any of my next 3 labours.

I know that breathing (panting) through the head passing is really important. If you push at that stage you are more likely to tear. I have found that really easy, and the midwives are great at encouraging verbally at that point.

This may be tmi, but practice next time you have a large bowel movement. Practice just breathing through it rather than pushing.

Hope this helps.

Fantastic advice! Thanks!
That's why I want to go public, and next time (all going well) we will.

It is better to tear than be cut. The torn tissue has fibrous ends that mend together quickly, whereas a surgical scissor cut has two sides that have to be forced together (think _paper cut_ and how hard it is to heal).

You can test this out yourself on a piece of paper... Try to gently tear a piece of paper from the top edge. See how it 'gives' a little before tearing? That's similar to skin. Now use a sharp pair of scissors and do a little cut. Now tear from the cut... it rips very easily, doesn't it? That's Exactly what happens with skin also.

Avoiding an episiotomy is pretty easy~ you make sure you have a health care provider who doesn't do episiotomies routinely.

To avoid a tear, don't push too hard~ especially when the baby's head is coming. Make sure your health care provider knows you are trying to avoid tearing, and have him/her use hot compresses to help the perineum stretch. You can do perineal massage before going into labor, but don't start more than 2 weeks before you're due (it's kind of pointless to start earlier than that, not that it would be bad for you).

HTH~

Thank you! Makes sense.

I talked to Eddie tonight and now we have a joint plan on this score. He is going to help me to put your suggestions into practice on the big day.

 

[Leanna]

it is better to tear because being cut can lead to worse tearing (rectal) which wouldn't have happened otherwise, and that cutting is only beneficial to the OB because it is easier for him to stitch. But both my mother and my mil say that a cut is better because it heals easier and prevents worse tearing.

I agree with the first part and disagree with your mother and mother in law.

My mil even said, 'I think women know too much about child birth these days.'

She admits to not knowing things, which is why she thinks a cut is better *shudder*

To avoid a tear, don't push too hard~ especially when the baby's head is coming. Make sure your health care provider knows you are trying to avoid tearing,

Yes!

I think its largely about the provider myself. I was pretty trusting and had an obgyn and an epidural in my first birth. It was a bad combination. I figured they did this all they time so they knew what they were doing.... I was sorely disappointed once I learned that birthing in the United States isn't as "advanced" as it should be. The combination of my epidural (couldn't feel as much) and my obgyn not telling me to stop pushing when the baby was crowning lead to a 4th degree tear which from one hole all the way to the other. Lucky for me they stitched it up perfectly or from what I have read I could have had lifelong problems. Its been nearly 4 years though and they did it right.

My first experience lead me to find a midwife when I became pregnant the second time!! I told them many times I wanted to avoid a tear, how can I do it, etc. After a big tear like I had the first time I knew my chances of tearing again were higher.... but I only needed a stitch because I barely tore. The midwife took the time to tell me when to stop pushing and ease out the baby and I think she had some kind of oil to help things stretch.

I should never have had a 4th degree tear when my skin appears to be very stretchy and the baby was under 7 pounds.

 

[Hadassah]

Oh oww that makes me hurt just thinking about it.

 

[Hadassah]

....My mil even said, 'I think women know too much about child birth these days.' I disagree...

LOL! Women know too much these days about childbirth... As opposed to for the last 100 years of willingly being oblivious?

Sounds like my grandma! She said "Oh it was so nice when I gave birth to your Aunt Connie.. they gave me this medicine on a wristband I could sniff when I had major pains..." -- needless to say she knocked herself out and woke up when it was all over.

Yeah, sounds ideal!

 

[angelsgirl]

My mil even said, 'I think women know too much about child birth these days.'

My mother said the exact same thing to me the other day when I was talking to her about birth options!
I think it is awesome that we have the opportunity to know so much about the birthing process and our bodies.
She seemed to think i was focusing on the bad things that might happen with the labour and birth... rather than it being that I know what "could" happen and being prepared for that and knowing what we would prefer to have happen if something doesn't go as we have planned.

 

[-~Truth_N_Trust~-]

I just wanted to add to this wonderful advice - PRAY!

 

[Assisi]

^^ Great advice!

I know a woman who prayed for a painfree birth and got it. No drugs - and no pain.

 

[-~Truth_N_Trust~-]

wow!

We prayed everyday of both my pregnancies that I wouldn't need to be cut or have stitches (epi, tear or C/S) and praise God I didn't need anything. My babies weren't small either. I can only put it down to God.

 

[Assisi]

Wow leisamd! That fills me with hope. I have been praying the same thing.

 

[-~Truth_N_Trust~-]

 

[~Mrs. A2J~]

I would choose tearing over an episotomy. My mom had a routine episiotomy with me (6lbs 1oz baby) and had trouble ever since with it. She went on to birth two more babies (8lbs 14oz and 8lbs 15oz) with no tearing so it wasn't that she was too small for the first baby to fit.

I had an episiotomy with my first and still have sesitivity in the area 6 years later. That was also an unnecessary episiotomy. My first was only 8lbs 4oz whereas my second was 9lbs 12oz and came really fast and I had no tearing or problems birthing him.

There are a quite a few episiotomy happy doctors out there because it makes life easier for them. And they try to convince you that you need one when you're in a position unable to refuse i.e. crowning and in pain and in not a state of mind really to refuse.