Posted by
mayafox
19 yrs ago
What are your thoughts on episiotomies? Does anybody have any information on circumstances when an episiotomy is preferable to a natural tear? For instance, I heard that Asian women have smaller perineums, so episiotomies may not be such a good idea because of a greater risk of third degree tears (Ouch!).
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I was told that tearing repairs better than an episiotomy. I opted for this and i repaired really well, mind you i didn't ask for any details of this after the birth ie how many stitches etc i figured the less i heard about the better off i'd be!!!! I do know i did repair very well though it wasn't from lookking my self just what the gyni told me.
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There are times when an episiotomy is absolutely required, such as the baby being in distress and there is not enough time to wait for the perineum to stretch.
Back in the 1970s and 80s, they became almost routine in the UK, about 50% of births and about 90% in maternity units. I believe that figure was higher in the US.
So in the late 1980s a number of studies were carried out to examine the routine use of episiotomy. The outcome from researchers was that an episiotomy does not result in less childbirth trauma, improved healing or fewer maternal problems than a tear. So now UKmaternity units have moved away from the routine use of episiotomy and only perform them for specific reasons.
In my opinion, your doctor should not be talking about an episiotomy until the actual birth because it should only be done if medically necessary, rather than for the convenience of the doctor.
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I am having my baby at Qune Mary and they ask you to sign a consent form allowing them to perform an epesiotomy. I understand the need to have one if it is an emergencey but am afraid they will give me one whether I need it or not.
Have heard that natural tears heal better aswell.
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I am also going to the QM and planning not to have an epi unless it is medically necessary, but I do know that they really encourage you to sign the consent form. All the docs I have spoken to at the QM 'recommend' a premptive episiotomy. Not wholly convinced that is the way for me though.
I heard that having an epi reduces your chances of developping haemhorroids during labour. Anybody know whether that is true?
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i know they keep talking about episiotomy during birthing classes, etc but post-delivery, i feel (personally) it's not really a major issue.
my doc was one of those who did it as a routine for first-timers. i told him that my preference was not to have one and to tear naturally but if necessary during delivery to do it.
he did do it in the end, not sure if necessary or not but that was the last thing on my mind. i had stiches but i didn't ask for details, it didn't hurt, just uncomfortable and i healed in a week.
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ha ha haemhorroids developping during labour....bit late if you've developped then during your pregnancy!
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bw
19 yrs ago
I had to have a vacumn extraction and so think the episiotomy was necessary. But I tore despite the episiotomy! Doc couldn't repair it in the delivery room due to the bleeding and I had to be taken to the OT for surgical repair. Healing from the epi + tear was the most difficult part for me post-delivery...took 3 months and I couldn't sit.
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ok post-natal hemorrhoids...read somewhere that it's common among women who experience constipation during their pregnancies (if you don't already have piles then)...
not sure how true but i was paranoid about getting piles so i made sure i was never constipated and went to the loo every morning!
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Ha hey scot no bragging about your 2 hour delivery please!!!
I as I had requested NO epi in my birth plan i was allow to tear nanturally and i aslo had to have forceps and suction but the Dr didn't feel it necessary to do an epi like bw. As i said in my above post i healed well. Hemorrhoid got them any way and i didn't have a problem with constipation during pregnancy.
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prune juice! i drank that post-delivery to avoid straining and piles...it worked for me!
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I delivered at QMH and had a huge argument with the (teenage, trainee, bad-attitude) doctor who wanted me to sign the consent form. I signed for emergency c-section, forceps or ventouse, but didn't want to sign for the episiotomy (having heard that they are standard practice - whatever the staff may say to you). Basically they wouldn't let me go into the labour room (and so get some drugs...) until I had signed. I had a ventouse delivery so I think the epi was necessary in the end, but I was very very uncomfortable for at least the first couple of weeks and the healing process was not nice (no infection or anything, just painful). I will be back at QMH in a few months and I am not signing the form. Whatever. I am quite sure if it's an emergency they will do what is necessary, or they can ask me to sign in there and then.
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Gosh, you guys. I love being pregnant and can't wait to meet my baby but thinking about the labour is seriously making my toes curl!
I haven't had piles so far, but I guess they are a pretty unavoidable outcome of such severe pushing. *sigh*. Perhaps I should be asking about ways to get rid of them post partum instead of how to avoid them!
One of the things that worry me about the episiotomy is that we have a history of keloids in my family and so we have always been told to avoid any unnecessary surgery in case the scars do not heal properly. I guess I will have to try and explain this best I can when they try to force me to sign the form.
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Don't worry, every womens labour/delivery is different. You might have your baby out in a couple of hours or might have to have a c-section and so all this will be nothing to worry aobut. What every happens you'll look back and say it was worth all the effort!
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Save your breath trying to explain anything at QMH. You are a patient and therefore you know nothing. They are doctors and they know EVERYTHING.
(of course it's all worth it in the end, but it is also worth going in well prepared...)
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They made me sign the consent form too but I had my partner monitor them so that they didn't go anywhere near me with a pair of scissors (or whatever it is they use!). I ended up tearing a lot as baby came out both shoulders and a hand at once - don't think the epi would have helped much in that case anyway. I seemed to heal pretty quickly but I must admit to not being game to have a look for about 6 weeks by which time I was totally healed. I know I had a lot of stitches so imagined that I looked like roadkill down there, hence me taking my time to have a look!
The key at QMH is to stick to your guns and make sure your birth partner is there to reinforce your decisions. The student docs range from decent to absolutely incompetent and their ability to think outside the box is fairly non-existent. Also having to explain what and why they are doing something is not their forte. If you don't get satisfactory answers from the particular doctor you're facing kick up enough fuss until you find a doctor who satisfies you. I know I did (after one student doctor had 3 attempts at inserting my IV into my hand - I lost my temper at this point when my contractions were a minute apart, told her she was hopeless and to get me a "proper doctor". Needless to say a competent doctor promptly arrived and had no problem inserting the IV)
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Any thought on this? Is an episiotomy or a natural tear safer/ recover faster? I saw articles saying that massaging the perineum does help avoid an episiotomy. Where to get the vitmain E oil as lubricant?
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crj
19 yrs ago
There are lots of good comments above.
I had an episiotomy, as do most women giving vaginal birth in HK.
It is very true what they say in the pre-natal class - you just won't care when you are in the delivery room, and you won't feel it at all.
Afterwards, you don't even really notice, it is just another part of you healing...
Good luck!
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I asked my father (ob.gyn) on this when pregnant with my first -
He said that with all studies, there is a bias towards what they WANT to prove. So from the more "medical" standpoint, they stand behind the idea that an episiotomy is better and heals faster, while those who want natural say that the tear is better and have the research to prove it. He told me that all things being equal, they are probably almost equal in terms of healing, pain and overall health. He just gave the example that women before epiosiotomies in the olden days would just tear and heal, and then after epiosiotomies because the done thing that women got them and healed, and overall - women just heal down there.
I wanted an all natural birth but ended up having an episiotomy and I imagine a tear would also be similar in healing. I had an all natural birth I dont' even remember them cutting or even if it hurt. I could even sit down on a regular chair afterwards (as soon as I was discharged 3 days post birth) and didn't notice any significant discomfort aside from the discomfort that anyone would have down there.
I've heard of all sorts of things being massaged down there (olive oil too!) in order to help it - a stronger pelvic floor also supposedly helps you to not tear at all. My friend did a lot of massage and limbering up down there - no epiosotomy, no tear and just a good stretch.
My other OB/GYN friend also says that she says from her own anecdotal evidence of delivery many babies -the younger you are, the easier you stretch and don't tear or even need an epiosotomy. (she's delivered quite a few teen babies as well.) The older you get - as with all things, it's harder.
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Thanks hkchoichoi, very comprehensive indeed. During the prenatal class the nurse said Asian have thicker and less elastic muscles down there so they need to perform epi in general to avoid a serious tear.
I believe I may not really care/ notice that at the end. Afterall it's just a small part in the whole process.
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So I had my baby not so long after I created this thread, and I ended up not having an episiotomy.
I was steeling myself up for lots of resistance from the midwives at the QMH, but to my surprise, they were very easygoing about not going in for the cut unless it was medically necessary. So if this is really what you want to do then don't worry too much about having to push your case. Docs and midwives *will* try their best to accommodate your wishes.
Having said all that, I have to say that I am still in two minds about whether I should have had an epi or not. I ended up having 2nd degree tears that took AGES to sew up -- a lot of pain to go through when you are exhausted from giving birth and just want to have some quiet time with your baby. I healed pretty quickly, but there's no reason to think that a cut wouldn't heal just as well, if not better, since at least the cut is controlled and in one place.
Crj is correct though -- when push comes to a shove, you won't notice whether you are cut or whether you tear!
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I had both my children at QMH. The first was a very long labour - about 28 hours - and the doctor gave me a small cut and pulled Hannah out with forceps after 20 minutes of unsucessful pushing. He could see how tired I was and I was delighted with his decision. The episiotomy was painful though and took a week to heal. My second delivery was much faster and there was no need for an episiotomy. It wasn't even mentioned by the midwife, and although I tore naturally, it healed much faster and I felt no discomfort at all and was able to move around straight after the baby was delivered. I had no doctor present at my second delivery and the midwives were brilliant, so I would second mayafox's opinion of the staff at QMH. If my husband lets me have another baby, I'll be happy to go back there!!
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cd
19 yrs ago
The thing that I have found reading this thread is that you're all saying it is an either or situaution, i.e which is better an episiotomy or a natural tear, but it is quite common and possible to have neither. I had a small internal tear with my 1st which needed 2 stitches, an episiotomy with my second, which I did not give permission for and was not told was being given(in Germany), and would not recommend it, but the last 3 I had no tears and no stitches, and they weren't small babies, 8lb 13oz, 9lb 1oz and 9lb 14oz. You really won't know until the point of delivery if you'll need one, but they are done here as routine. But I stated on my birthplans with the last2 that were born here that I did not want one, and the staff were happy with that.
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I had my 2nd baby at QMH VBAC, my husband and I were prepared for a natural birth ie no pain relief etc, asked all the relevant questions during the hospital visit, wrote down a very detailed birth plan and on the D-day the staff was great, only mid-wives, my husband kept a low-profil but firm stance on no pain killer, no drugs to improve contractions and no episiotomy unless medical necessity, and they did their best to assist us. the mid-wife told me after birth that she realises at the very last minute that baby's head was actually quite big, too late for an epi, I ended up with a tear which was smaller than the routine epi would have been, and healing was better than one of my friend who had a proper epi a few days later. I also pushed the baby for a full hour and did not get any hemorroids, compared to my friend who was delivered by vacuum as she was so numb from the epidural she could not push and she got hemorroids anyway.
Anyway it is something we worry about quite a lot during the pregnancy and really doesn't matter in the end on the delivery day.
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