Episiotomy vs Tearin

I def say the episiotomy!! but ask them to stretch you. My Obs with both my children used and oil and as they were prepping me to push began strtch my vagina before they came all the way down to help.

Good luck!

Different Dr and different hospitals do different things, but I am glad my Dr choose to let me tear. I didn't tear in the "norm" pattern and I cannot even tell that I ever tore, but I have a friend who said she was cut and she has a scar that even itches now. Both of children are 4 now. So, the ultimate choice is up to you, but I healed easier and do not have the discomfort as my friend does. Best Wishes and Good Luck.
G.

Massaging the perineum with olive oil or vitamin E oil may help to "elasticize" the tissue so you stretch better and tear less. Ask the doctor. A lot of doctors now are not doing episiotomies because they're superfluous and don't guarantee against tearing anyway.

I had both my daughters at home with a midwife. The first was 7.5 lbs, the second 9.5 lbs, and I didn't need a stitch with either one. I attribute this to three things: 1. one of the many wonderful things about midwives is they massage the perineum with olive oil and hot washclothes to aid the crowning
2. Because I did not have an epidural, I had sensation in the area where I needed to be able to feel what I was doing - often women tear because they can't feel their vaginas in order to push the right amount - too hard and too fast causes tearing (not baby's size - nature does not make babies that are too big for their mothers to birth). Many women get epidurals out of fear of the pain. I used hypnobirthing with my second birth, and experienced NO pain. I cannot recommend natural childbirth highly enough.

3. Because I was in control of my body and my birth I was able to change positions according to how the baby needed to come out. i.e. My first daughter was born with me on my back as that was most comfortable in that case. I was on my hands and knees with my second birth as that position was more conducive to her exit.

It's not too late to do some research and change your birth plan accordingly. Good luck and God bless!

I don't know who you have on your birth team, but a doula (yes, you can still hire one at this point - my sister hired one at 38 weeks for her VBAC) is a great idea, not only to apply the olive oil, but to advocate for you with your doctor who may want to pressure you into the Pitocin, and to coach and talk you through every stage so your birth progresses normally.

you may have to ask your doctor what he/she prefers to do... When I was due last July (here in Savannah)I was told that my obgyn wouldn't perform an episiodomy and that they prefered a natural tear instead. The idea is that the the body will only tear as far as it needs to allow the baby to pass and there is less of a chance of over cutting.

I recommend the episiotomy! I tore with my first and it took probably most of the year to heal, and still had a lot of scar tissue until my 2nd, then I asked the Dr to give me a episiotomy...the same with the 3rd. I healed up much quicker and nicer with the 2nd and 3rd. I had natural, no meds all three times and the only time I felt it was the first when I tore.
Either way though, the most important part of the healing is the "sits baths" where you either sit in a warm bath or use the hospital ones which allow warm water to flush the sore spot and soothe and heal--Several times a day!!! Good luck and Congrats!!!

I had a nine pound son at home and did not tear.His head was 15 inches around! My midwife massaged with olive oil during the pushing. I would encourage your husband/dr./doula/midwife to do the same. let your body do what it is supposed to. My midwife just predicted this one at 8.5-9 pounds already and I'm 38 weeks! I've got the olive oil ready....

I tore inside both up and down and would not wish it on my worst enemy! It took forever to heal, and when it did I was in so much pain from the scaring during sex, that I stopped trying to have sex at all. It took 8 months for the scaring pain to subside and for sex to become somewhat comfortable again. I told my midwife that I wanted an episiotomy with my second child, because I was so afraid of what I had been through before.
I would recommend getting cut over tearing to anyone who asked me. It's your choice, but a tiny scar where the sun don't shine is hardly a big deal to me.....

M. D
Alpharetta, GA

With girl number 1 I did not tear nor needed an episiotomy bc she was 6lbs and change. Girl number 2 I had an episiotomy and did not tear, she was 9lbs 6oz. the dr never told me he gave me one until after she was delivered. Which I am glad he did not tell me or I would have felt proble. I went natural pain med free for both girls and I did not even know the dr cut me. He told me I would have teared if not for episiotomy. I am glad I had one. I have heald up nicely and i have no itching from it. good luck to whatever you and your dr decide.

I have delivered five children, had three episiotomies, and two natural tears. The first natural tear definately healed much nicer than the episiotomies. However, the second one was a mess. I had been in labor for seven hours when the ob/gyn went to dinner. He said I had at least another hour to go. Well, two minutes later a chunky little fellow popped out sunny side up and ripped me so badly I practically needed reconstructive surgery. I believe that is what some doctors try to prevent with rutine episiotomies.
About epidurals, I thought the one I had was a scary experience. Further, it did not work. Others, however, love them, and they are probably safer for the baby than IV meds.
Good luck!

I have had three children and I prefered not to have an episiotmy. I tore significantly with the first child, but much less with the second, and the third was so minimal I didnt even need stitches. I think the decision is a personal one you must choose, but I would tend to think that episitomies would be less warranted with subsequent pregnancies, once your body has already gone through that trama and is more equipt to handle it. I have also heard advice about ways to prevent tearing before labor, but I have never tried any of those.

Hi A....the best advice I can possibly give you is most definitely the episiotomy!!! Hands down...I had no choice because of a difficult birth of live twins, 1 stillborn(triplet), and 39 1/2 hours of labor, but as a result of that horrible tear that I received, I have a LIFELONG disability of NO sphincter muscle in my rectum(another words, I was sewn up wrong because of such a horrible tear, that I must LIVE on massive doses of Immodium every day or suffer uncontrollable, "unfeelable"(no feeling at all) diarrhea & movements. Insist on the episiotomy sweetie! I was 31 then, had another baby at 34, same thing happened again, a bad tear, and I have suffered mentally & physically every since! I am now 56 years old. .....Jean

I too tore with my 1st,with my last three,everything was fine..I think every pregnancy is different.It's up to you..I think either way they both will heal fine and who knows,you may not need anything.....I wouldn't concern myself with it just enjoy playing with your 2 yr old and have fun being pregnant..Be Thankful you have such a WONDERFUL husband, I thought I had the last one <><

A. - get the episiotomy! When I had my first child - boy - the Dr. found out that the shoulders were wider than I was. We tried the "natural" way - and I tore all the way to my rectum. That was not fun at all having 37 stiches in my bottem. Not to mention the first time you try and have a bm! That was painful......be safe than sorry. On the second child the Dr. made sure he did it. On the third child, lol, he finally did it after my mother's third request. Looking back I think he was tired of her looking over his shoulder. It was a good thing since the baby's head would never have made it out!

Well, I was lucky in the fact that the nurse's worked with me rather then against me in the labor rooms on each of the births of my children. I never had a episiotomy ever. I aked the nurse's if they could apply warm cloths with olive oil and keep oil olive ready avail for the use in stretching if necessary. They all did two hospitals in Fl and one here in GA. I had a few tears with the first one with the second and one or two with the third. All tears were on the inside. i think the doctors did fine with the stitching each time when I had my third child durning an exam the doctor said he could tell by looking that I had some tears from the other children. I had an epi with all three...sorry I'm not brave and a different reason for each. The third one I'm glad I had an epi he had his cord wrapped around him and ooppps to late he was coming and the doctor had to keep turning him when he noticed...so glad because the turning with out it would of been even more uncomfortable. My advise I'd rather have a tear heal then a cut so let things tear and since your body has had a baby it might not be so bad this time. When I had my first child after much reading I went with tear. Studies have been done and show that a tear doesn't heal any slower then a cut. I've heard many women say then cut makes worse scar tissue. There's books out there that suggest using olive oil and stretching even during labor you may find interesting. I always talked about it to my doctors and the nurse's. Best wishes to you, you'll be in my thoughts. PS the tearing I had was on the inside due to the way the baby's hands were under his chin on two of them and epi would of made no difference in my situation it never was at the peri area.

A.-

According to the American College of Ob/Gyns having an episiotomy should not be considered routine. Childbirth.org has a large section on understanding episiotomies and why they are, in most cases, a bad idea.

The best way to prepare your body to stretch is to do Kegels, perineal massage before and during birth(your doctor probably won't do this but you can ask if your husband can, just have clean fingers and nice unscented massage oil) and to not rush pushing but instead give your body a chance to naturally adjust.

Good luck. I hope you have a tear-free birth.

I've had five children (two of them over 8 1/2 pounds) and would say avoid an episiotomy if at all possible. You may not tear at all, or it may be quite small; an episiotomy will usually be larger than a tear.

Re-read Caroline H's post. Very similar to my experience. Natural child birth typically goes quicker and with less tearing because you can "feel" what is going on. I had a birth plan that my doctor had a copy of and it stated, no epidural and no episiotomy.

Best of luck with the birth.

Dear A., Congratulations and best of luck with your birth. I'm a doula and mom (who tore with my daughter's arrival). I agree with the benefits of massaging the perineum. I wish I had been more adamant about that. Also, really listening to your body, and recongnizing the urge to push (without pushing too soon), trying various positions (side lying, squating, on all fours, etc.) If you're planning on having an epidural, see if they will allow you to receive a "walking epidural" with a lower dose, allowing your to walk and move during your labor...it will make a huge difference.
I always ask what the episiotomy rate is when interviewing OBs or doctors. Many prefer allowing the mom to tear, because of the healing process. Every practice is different. Whatever decision you make will be the right one for you. Bring oil in your bag, just in case! good luck, E.

With my first they did an episiotomy and I still tore. With my second, I didn't have an episiotomy but tore--they said it was because of the episiotomy with my first. So, if it were me I would try to avoid an episiotomy if at all possible. It was easier to heal with the second and natural tearing than with the first. Good luck and best wishes during this exciting time!!

Hey A.. With my first child the same thing happened to me. I tore and they did the episiotomy. With my second child I didn't have either. If I were you, I would just let nature take its course. Your body has been through birth before so it is more prepared now for your new one. Congratulations!

Episiotomy FOR SURE. I had one with my first--didn't feel it at all, and I didn't need any stitches at all afterwards. I definitely vote for it as the way to go. Good luck!

S.

Get a good doctor or midwife whose advice you can trust! Each person and situation is different, so you need someone there who will listen to you but also pay close attention to your body and the baby. After 3 1/2 hours pushing with my son, trying every position and technique and monitoring the baby closely, my doctor finally told me I HAD to have an episiotomy. His head was so big I tore beyond it through to my rectum. But I healed cleanly with only a tiny scar. For my second child, near the end of pushing I begged the doctor for an episiotomy and she refused to do it. I tore so badly and in so many places that 6 months later I am still not healed, have had numerous infections in areas they couldn't keep stitched, and even after healing will never be the same. Some things can't be sewn back together. It's great to have a doctor like my first, who will work with you as long as possible to avoid giving you an episiotomy, but who can tell when you really will need one.

I also would say avoid the episi if possible. I tore twice... nothing too bad. Healed fine. I think I've read that they just don't do that very much anymore.

A., I never had this problem. However....a tear is natural and the skin will close back together when stitched, but a cut will never truly be the same. The tears fit back together like a puzzle. Hope this makes sense. Anyway Goodluck!
Johna

From all my research on the topic, I believe that a natural tear is better. Tears usually heal better than an episiotomy, because tears happen through the path of least resistance, whereas an episiotomy is wherever the doc decides to cut. Usually a tear goes through less major blood vessels. Good luck on your birth!

Congrats on your pregnancy! I am a L&D nurse and the Dr.s I work with do not do an episiotomy for the fun of it. An episiotomy is used only if you start tearing up instead of down and if the head seems too big...you would prefer an episiotomy rather than a 4th degree tear into your rectum. I personally sit my patients up to labor down so the head will slowly stretch the skin and try to avoid any tearing. Everyone is different and every baby is different, you won't know what will happen until the time comes. Hope that helps a little.

K.

I had the same question when I was pregnant with Ava (delivered in September.) I did some research and asked a few doctors their opinion on it (I work as an RN in the ER) and what I found was that if you tear you usually have less injury than if you are cut. Episiotomies are rated on a scale of 1-4 (4 being the worst.)If you are cut to a 1st degree then you will probably tear to a 2nd, if you are cut to a 2nd degree then you will probably tear to a 3rd degree, and so on and so forth. You will heal better and have less injury if your MD will allow you to tear. Let your MD know up front your preference so there is no question when you are delivering. Sometimes if the mother is having a very difficult time delivering baby (like if a vacuum or forceps are needed) then the MD will need to make an incision in order to help baby out, especially if baby is in distress. Sometimes there is no time to mess around. Good luck in your decision (I chose no episiotomy and I did not tear and needed no stitches.)

Hi A.,

Massage your perineum regularly with olive oil or have your hubby do it! I would avoid another episiotomy for sure! Massage away!

C.

My first I had and episiotomy and then a third degree beyond that, thanks to forceps. But my second I barely tore, only two stitches. I think every child is so different, you can only go into child birth with a tentative plan. I think you would rather have an epi than tear in 4 places, but I would tell the doctor you would prefer to tear unless it is an extreme circumstance. The second is usually much easier. Good Luck.

Hi I am a doula and have had 5 children of my own. Medically it is better to tear then have an episiotomy. Most tears/need for episiotomy occur because of bad positioning. I do not know who you have for your birth team but I would greatly look into alternate positions than being on your back and sides and also having perineal counter preasure/massage during the pushing phase. If you do tear again you will mostlikely tear to the side of your scar- scars do not tear but the tissue around them does.
You also should be very vogorious in massaging your perineum from now until birth as you will benefit greatly from stretching out the tough scar tissue. You can use olive oil while doing this =-)
If you have any ??? feel free to ask and congrats on Baby #2...M.