Episiotomy vs Caesarian

[sarahk]

Hi ladies,

Just after some opinions. I am 35 weeks pregnant with my first baby and have to make a tricky choice...

I have a rare skin condition called Lichen Scleroses. It basically means that my skin in 'that' area is paper thin and tears easily. It often even tears when my husband and I have sex. Only a small amount, but enough to bleed a little and cause me pain. It's a pretty horrible condition to have.

So, anyway, I was discussing a recent minor tear with my OB on Monday, and she had a look and decided that I'll either have to have an episiotomy or a caesarian. She said that she can't risk letting me tear naturally (which I know is supposed to heal better) because she said that it would be likely that I'd end up with a 4th degree tear if it's uncontrolled. She said she would cut sideways. But, I'm scared that I'll still tear in the other direction anyway. Given my skin condition, healing can be a problem too.

So then there's the caesarian. I kind of know a little about what to expect as I had a cyst removed when I was 17 weeks pregnant, and that operation is very similar. But, it's still a big operation none the less.

I guess I'm just interested to hear from people who've experienced a severe episiotomy or tear as well as a caeser, and which took longer to recover from. I'd also LOVE to hear from anyone at all with Lichen Sclerosis (It's really hard to find specific information about this on the net).

It's upsetting that it seems that both options aren't the 'ideal' way to give birth, but it is what it is. And, after the scary operation that I mentioned, I am still just SO grateful to be pregnant at all!

[aussienic]

Hi, I can't help you with your questions but just wanted to say congrats on your pregnancy Not long to go now

What does your OB suggest? does she think you will be fine with an Episiotomy?

I just found this little bit of info

Childbirth

Many women are afraid of giving birth, quite understandably, with this type of genital condition. However, women who manage their condition effectively have given birth vaginally with minimal after-effects. The skin around the perineum will be more prone to splitting, so massaging a lubricant into the area for a few weeks prior to the birth may help. Also choose a position which reduces the risk of tearing. Speak to your midwife or nurse midwife for advice on positioning.

Sometimes, if your condition is severe, a caesarean section may be advised.


Good luck with your decision

[HotI]

What a tough position to be in. I would be concerned about an episiotomy providing a weak point and so you would get further tearing from the episiotomy cut.

There are techniques and positions that can help protect the perenium, e.g a warm face washer held on the area, no coached pushing. I would want to use these techniques during labour, even if you decide to go with the episiotomy as well.

Would there be extra difficulties with having a c section and healing due to your condition?

take care

[Roryrory]

I haven't been in either position but my mother had a c-section with me. 35-plus years after the even she is having problems with an incisional hernia which resulted from the c-section. I am not trying to sway you either way, but just to let you know that there can be very very long-term side effects to having a c-section. Best wishes with your birth and this tough decision.

[nickle730]

I wondered, as HotI asked, whether you are more likely to experience any complications with a caesar due to your condition?

If not, then PERSONALLY (only my opinion!) I would be leaning towards a caesar but I would certainly discuss further with your OB and be guided by her advice. If your condition is so severe that you tear during normal intercourse I would be very concerned that, even with an episiotomy, you would tear uncontrollably during delivery. This may have huge implications not only for your physical healing, but also for you mentally and emotionally. Although there are risks associated with a caesar, I assume your risks are no greater than any other woman's.

It's a tough decision, I wish you the best of luck in making it. And congratulations on your pregnancy!

[Razzberry]

After having an epi, that meant I was still in a lot of pain 3 months later, and now 19 months later is still tender, next time I will be having a c-section. I know people will say you recover faster from a natural birth, but that is just not the case for some people, including myself and my sister. My sister had an emergency c-section, and then a vbac the next time. She recovered much faster, with less pain from the c-section. I was on far more painkillers then my sister after my epi and was far less mobile.

Ultimately it i up to you, but I think if you are confused about what to do maybe get a second opinion from another doctor??

[Sagres]

If not, then PERSONALLY (only my opinion!) I would be leaning towards a caesar but I would certainly discuss further with your OB and be guided by her advice. If your condition is so severe that you tear during normal intercourse I would be very concerned that, even with an episiotomy, you would tear uncontrollably during delivery. This may have huge implications not only for your physical healing, but also for you mentally and emotionally. Although there are risks associated with a caesar, I assume your risks are no greater than any other woman's.

Going by what you have said (and me having no knowledge of the condition you have) I have similar thoughts to this. The tearing anyone experiences is quite unpredictable before the birth, so you are never going to have any good solid information to base your pro and con list about going for v. delivery, so what you feel comfortable with is the best way to go.

Good luck...x