Tearing naturally vs episiotomy

[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!