If you’re an experienced birthing mother, chances are you began wondering about birth the moment you see the second line on your positive pregnancy test.
Will I labor as long as last time?
Will I go into labor around the same week?
And if you had a previous episiotomy, you might be wondering, will I need another episiotomy?
Every birth is unique of course, but it can definitely be hard not to compare a previous experience with your upcoming labor expectations. If your episiotomy was painful or difficult to recover from, it might even be a source of worry.
Does A Previous Episiotomy Mean A Repeat Episiotomy?
So, does a previous episiotomy mean a repeat one?
In short, not necessarily. In long, it may depend on why you had one and how things healed. Here are 3 things to know about repeat episiotomies:
#1: Routine Episiotomies Aren’t Recommended
At one point in maternity care, episiotomies were a fairly routine procedure and something the majority of birthing women received.
The thought process behind performing this surgical incision was that a straight cut would be easier to repair and would heal faster than a natural tear (which may not be straight). However, as time passed and more research/observation was done, it turned out that episiotomies didn’t actually heal better and they rarely healed faster.
In fact, we eventually realized that having an episiotomy increased the risk of a more severe tear, infection, scarring and prolonged postnatal healing.
Routine means done as part of typical care. There are certain situations in which episiotomies are medically necessary or beneficial. However, neither the World Health Organization or ACOG recommend routine episiotomies, only medically necessary ones.
#2: A Repeat Episiotomy May Depend On The Reason For Your First One
If you had a routine episiotomy due to care provider preference and not due to medical necessity, there’s a good chance a repeat won’t be necessary.
If that’s the case, it may be a good idea to learn more about avoiding unnecessary episiotomies, which you can read about in BellyBelly’s article 7 Tips To Avoid Having An Episiotomy.
While routine episiotomies aren’t recommended, occasionally medical reasons do pop up making an episiotomy necessary. Some of these reasons include:
- True fetal distress necessitating a quick birth during the second stage (pushing)
- A tear occurring upwards towards the urethra
- Instrument (vacuum or forceps) assisted birth
- A very short perineum where an angled episiotomy might prevent a deep tear from vaginal opening to/through anus
If you had an episiotomy due to fetal distress or instrument assisted birth, it’s very possible you won’t need an episiotomy unless those situations occur again. If It was due to an upward tear or short perineum, it’s possible different positioning during the pushing phase could help reduce your chances of a repeat episiotomy.
You can read more about avoiding perineal tears in BellyBelly’s article Tearing During Birth – 9 Ways To Help Prevent Tearing.
#3: How Your Episiotomy Healed Could Impact Remaining Intact, Tearing Or Needing An Episiotomy
An episiotomy is a surgical incision into the perineum and thus requires stitching to heal. Whether a natural tear or episiotomy, scar tissue is a possibility. However, because episiotomies tend to be deeper cuts, the potential for thicker scar tissue is a possibility.
Everyone’s body produces scar tissue uniquely. Some women can experience deep cuts and their perineum remains flexible and with well healed scar tissue. For other women, a deep cut could result in thick scar tissue reducing the flexibility of the perineal skin. This means it’s possible that for a few women, scar tissue could become an issue in avoiding a repeat episiotomy.
If you’re concerned about scarring, it’s important to talk with a healthcare provider. It’s possible perineal massage before or during labor, and perineal support (especially with a warm compress to help increase blood flow and skin elasticity) could reduce the risk of another episiotomy by helping the scar tissue to stretch.
Thick scar tissue pre labor isn’t necessarily something to be concerned about, though being aware can help you have a plan in place should it become an issue. The concern would be if during the pushing phase the scar tissue just wouldn’t budge preventing a baby from crowning or encouraging an upward tear. Neither are likely, but being aware helps in creating a just-in-case plan.
There’s no way to know until labor how things will unfold. Generally speaking though, a previous episiotomy doesn’t guarantee needing a repeat one for future births. There are many options to help reduce the risk of tearing and/or episiotomy. It’s also important to be sure your maternity care provider is up to date and following current guidelines regarding episiotomies. Making sure you and your maternity care provider have the same goals can help reduce anxiety about the possible “what ifs” of birth.