Tearing along episiotomy scar

[OceanPrincess]

Hi ladies,

Looking for some info (anecdotal or scientific... anything really!) about birthing after a previous birth that included an episiotomy.

I had an episiotomy with DD and now that I'm pg again, I've started thinking about my next birth and am wondering about my epi scar.

Is it more likely that I will tear along the scar? Or will it hold? Or what??

Can I do anything to make the skin more supple/stretchy? Does olive oil massage help?

I tried to ask the Dr yesterday about it at my appt and he basically told me that 3/4s of women tear during their first labour and about half will tear again during their subsequent labours - either minor tearing/grazing or the more major kind.

The fact that I had a "bigger" baby indicates that I will have an "even bigger" baby this time round (I really don't think 3.7kg is that big but anyway) and if I tear along the epi scar then so be it. Pretty much what he said!

Supremely helpful - NOT.

Should I be worried?

[Trillian]

I had an epi with my first baby and with the next one I tore in a completely different spot. And then in a completely new spot after my third baby LOL. So I have 3 scars down there now. Your scar will be strong and there is no reason why you should tear in the same place as your epi. You could, but there is absolutely no way of knowing where you will tear, if indeed you do tear at all. Perenium massage can help make the area supple, but good management of the peri during birth as well as birthing in a position favourable to not tearing can make a world of difference.

And it is 50/50 whether or not this baby will be bigger and the weight of the baby makes very little difference in terms of tearing in my experience. Their head circumference will be negligible and the head will mould to fit anyway if you are allowed to take it slowly. The baby I had an epi for was only 4.18kg with a 35cm HC and my biggest baby was 4.56 with a 37cm HC and I only had a small graze that required no stitches.

[OceanPrincess]

Thanks Trillian, that is really nice to know. Not nice to know about your three tears and three scars (tho I did smile at that ) but nice to know I won't necessarily tear along the scar!

I think at my next appt (which will be with the MW, now that the Dr has cleared me as low risk and I can continue with the family birth centre) I will talk about my concerns and about how I'd like active management of the peri and that I'd also like to explore using the labour pool.

[Honeybee]

Eeek - I'm not even pg yet (or even TTC), but I do worry about this occasionally. I had an epi, and then tore right into my bottom. I had thought that the scar would be a weak point, so good to know that it won't necessarily tear that way if I'm lucky enough to have another baby.

Oh Trillian - you poor thing!

Best of luck OP - may your perineum remain intact this time!

xx

[Olive]

i had an epi first time as well as a labial tear,
second time i tore along the old epi scar but not as deep or as bad, had a labial tear again as well as severe internal tearing, second time was less painfull recovery wise!

[2CheekyMonkeys]

i have no idea. though as i was reading your question i thought what if they need to do another epi, would they cut along the same spot?

i had 2nd degree tears (internal) with DD1 and only needed and epi with DD2 becuase of the scar tissue for first birth blocking her in!! oh and second baby was bigger at 8 ound 10.

good luck with it! though as much as you worry and think about it now, when the time comes you wont really care what happens to get your baby out! then it will be all over and done with and you will have your little one... (and a sore 'area' ) :-)

[OceanPrincess]

... second time was less painfull recovery wise!

Olive do you think that's because you tore as opposed to being cut? I am in two minds about it... natural tearing vs cutting...

though as i was reading your question i thought what if they need to do another epi, would they cut along the same spot?

Probably???

I am really hoping to avoid it this time... It is probably one of the only things I didn't like about DD's birth... and I'm sure my Obs wouldn't have cut if it wasn't necessary (I know that sounds naive but I believe it) but I'm hoping that being in a birth centre with MWs this time I can try and avoid any of that...

But Hollo you are dead right, once he is here I won't really care

[Mummato2]

I think a MW's philosophy is natural tearing vs epi - so maybe they'll let you go to see what happens.

I tore naturally with my son - due to the fact he went from crowning to being out in about 20 secs (no guidance as to how to push and I had an epidural)

With my second she was bigger and I didn't even graze.

She was a water birth, I controlled the pushing and birthed on my knees.

Check out positioning and see if a water birth is an option for you. If it's not or you don't want to, try warm compresses on your perineum during the birth.

Good luck!

[Olive]

absolutely hun!!! id tear any day over cutting!, not as deep as the cut,i still have visions of her cutting her

[OceanPrincess]

Ack, olive I'd not even thought of that til now!!!!

Ok will put it on my list to discuss with the MWs - I'd heard already that water birthing can help, so I think I'm gunning for that.

Thanks ladies

[Trillian]

Tearing is definitely better than being cut because you only tear as much as you need to tear and it is usually only superficial with minimal injury/damage to the surrounding muscles, but with an epi, you are cut right through and more often than not, cut further than you really need to get the baby out. My healing time with the epi was terrible and I had incredible soreness when lifting my left leg but with the tears, I didn't even feel them at all - no pain or discomfort.

[Mad Scientist]

Healing from tearing is a breeze compared to healing from an epi. I tore along my epi scar, second degree but I didn't need salt baths or anything at all. It just healed so much better. I could actually walk the day after the birth. With my epi I couldn't stand up straight, had to spray down there with salt water and have salt baths. Anti inflammatories were my best friend! Tearing, I barely even needed panadol. Hopefully you won't tear but rest assured it's NOTHING like an epi