Tearing naturally vs episiotomy

[Laranna]

DH & I were going over my birth plan the other day and he questioned if I'm going to tear, why would I want to tear naturally over the doctor taking a scalpel to my perineum. His theory is that an episiotomy would heal faster and better than a natural tear because it would be a clean cut.

When I tried to explain it to him, I found that I couldn't. I just know I would prefer to tear naturally (if that's the case).

So, tell me why is tearing naturally better than having an episiotomy? Which one heals better?

[Olive]

tears i believe heal better as they knit back together better as opposed to a smooth edged cut ITMS.
also epi's tend to go deeper into the muscle then just tearing.
having had both id go for the tear over the epi any day!!
you can also do lots to try and avoid a tear!

[feeb]

Tears heal better than an episiotomy as a tear is going down the weakest park of the skin and or muscle where as epis is forced to go where scissors are.

Perineal massage and optimum positioning for pushing (on all 4rs, sitting on toilet, standing etc) also can assist in reducing tearing or severity of tearing.

good luck

[melbel]

A tear will tear alongthe natural grain lines of the skin if that makes sense and so the knitting back together is more natural and therefore quicker and stronger. Also a tear will only tear as much as is needed for bubs to get through, no more......with a cut they tend go further than is really needed so making a larger than necessary wound to heal up afterwards.....the only time a cut is prfereable over a tear is if it is threatening to tear directly towards the anus...then you should go for the cut on an angle to reduce potential damage and anal fissures etc etc.......

[Trillian]

Noooooo! Your DH has it the wrong way round! Tearing is much much better for you as you will only tear as much as you need to tear, and often the tear doesn't even include the underlying muscle and can be small and superficial, but with an epi, you are cut through muscle and all and it aint a small cut by any means. I had an epi with my first and was cut in the 4 o'clock position - if you were looking at a vagina like it was a clock face, it would have been about where 4 o'clock would be. I couldnt' sit properly for weeks and it felt like I was sitting on rose thorns because I could feel evey single one of the stitches. But when I tore with my next two, I never felt a thing, it healed really well and really quickly and the scarring is minimal.

[Laranna]

Excellent, thanks ladies, just the info I was looking for! Now I should be able to explain it to DH a lot more clearly

I have been doing perineum massage and using an Epi-No to try and prevent tearing, so here's hoping I don't tear!

[Trillian]

I would be putting in your birthplan that you want to make sure that you have great perenium management during the birth of the baby. By this I mean that you want your support team/midwife to make sure that you are in a position that is conducive to not tearing, like those Feeb suggested as well as supporting the perenium during pushing and if you look like you are going to tear to get you to slow things down and breathe the baby out instead of actually pushing them out.

[onthefly]

Oh god no, don't have an episiotomy!

[Smoke Jaguar]

Best way to avoid tearing is not to push but to breathe the baby out - not guaranteed, but definitely the best way to minimise or avoid tearing
Tear over cut, any day!

[Mildez]

This is what we were shown when we were studying midwifery. It demonstrated how when the perineum was cut with scissors how easily an extended tear can happen after an episiotomy has been performed.

Get a piece of paper and tug on it with force holding onto each top corner with each hand. Note it either won't tear or you need a huge amount of force to tear it.

If then you use the exact same kind of paper and give it an episiotomy lol with scissors down the middle a little bit and then tug on the two corners like the uncut paper you will see then how easily it is to tear the paper further down from the cut you have done making the torn bit much bigger then the original cut. The same principle can be applied to the perineum.

The nastiest tears I have seen have actually been extended episiotomies where its torn through the end of the episi. I am not saying there isn't a place for an episiotomy but they are definately done way too often and if allowed the time to stretch I would wonder how many women would not even tear/graze. One the the specialists I work with basically does routine episiotomies on all women having their first baby. All simple because he doesn't want to wait the time for a slower more gentle birth. As a midwife I would only ever do an episiotomy if the baby was distressed and needed to get out very quickly which occassional does happen. I haven't had to do this before as in that situation I have been lucky enough to have the obstetrician with me so he does it and I take the baby to resus if need be.
And I am amazed often that the women I am sure will tear don't and the ones I think wont do. You can't always pick it.

[*Beema*]

I had two tears and then was given an Epi, things were looking pretty bad and were probably going to be a lot worse without the EPI and they had lost DD's HB and had to get her out quickly.

So it was one of those situations where I was already tearing badly and the medical need to get DD out came to the forefront.

As for the healing it sucked bigtime, I can't tell you which was worse or healed better as I didn't want to look, but I did have trouble with one of the stitches not dissolving and skin grew over the top and it had to be cut out 8 weeks later when we found out, and in the end I had to be restitched as it wouldn't stop bleeding due to low platelets.

I have to say that it did take a long time to get back to "normalish", I would get significant pain on my Epi Scar when DTD (sorry tmi), it was terrible, but it was clearly the EPI as it was to the side where it was.

Next time I would definitely prefer to tear, as I hadn't even realise that I had two tears before the EPI, but I damn well knew when I had the Epi!!

I hope that all your preparation does the job and you come through it without needing to worry about tearing or Epi's

Take care and I wish you all the very best in the weeks to come xxoo

[AwesomeFoursome]

I've had both, episiotomy with ds and tear with dd. The tear healed heaps quicker and less painful than the episiotomy.

[Fleur]

Haven't had an epi, but did have a 2nd degree tear with DD2 (VBAC).

Part of this may or may not have been due to her size - I tend to think it was more about the fact that I was on my back which I did NOT want, but that's just how it worked out.

FWIW it healed really quickly, I was refusing the pain meds after day 2.

Fingers crossed you won't tear anyway!

[Laranna]

I would be putting in your birthplan that you want to make sure that you have great perenium management during the birth of the baby. By this I mean that you want your support team/midwife to make sure that you are in a position that is conducive to not tearing, like those Feeb suggested as well as supporting the perenium during pushing and if you look like you are going to tear to get you to slow things down and breathe the baby out instead of actually pushing them out.

Trillian, yup this is exactly what I have in my birth plan.

Thanks so much for your input ladies - it has made things alot clearer for me now. I only knew I would prefer to tear over an episiotomy but I just couldn't explain why! Makes so much more sense now

[julie_ann_jules]

I had an epi ealier this year with DS. When my OB cut the Epi it HURT LIKE HELL!!!! That was the only time I screamed throughout my entire labor! it was just horrible But my bubba was in distress and he needed to be out so I don't regret it.

[studymum]

IMO tearing is natural womens bodies did it before the epi was invented, having a knife doing the work isnt right, unless of course it is in aid of avoiding bad medical problems.

And having someone come at me with a knife while I was pushing I would probably kick them in the head, and the idea just disturbs me.

I did the perenium massage techniques for the last few weeks of pregnancy and I asked for my mw to do perenium massage and support during my pushing. I ended up having to have a epidural and was pushing on my back (much to my disgust), but got no perenium tears, only 2 sml stitches on one labia. But tearing can be so random, some woman never do, some dont, some both, just luck I reckon.

[Laranna]

Well girls, I did tear (vaginal wall and 2nd degree). The midwife said this was because bubs hands were up as her shoulders came out and she moved her arms down as her shoulders and body came out! Her head came out nicely! Seem to be recovering well, still feel bruised and tender though. I'm glad I didn't have to have an epi!

[Trillian]

Yeah, unfortunately stuff like that happens and it is totally out of your control but again usually they are only minor and they heal really well. Your vagina and vulva will feel like that regardless of whether you tear or not because when you think about it it does a pretty amazing job to stretch to let the baby through. If it is troubling you, run yourself a 'sitz bath' - a bath with a decent amount of salt in it as it is really quite soothing. You could also put a compress on it as well.