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thread: Tearing naturally vs episiotomy

  1. #19
    BellyBelly Member

    Oct 2006
    Perth
    3,299

    Thanks Trill, I'll try the sitz bath! I had physio ultrasound on it while I was in hossie which reduced some of the swelling and have been putting ice packs in my knickers which has given me relief too.


  2. #20
    Life Member. Every Australian needs a Farmer.

    Dec 2005
    In Bankworld with Barbara
    14,222

    If you wet a pad with water and freeze it you can pop that in your knickers too. I loved my sitz baths in hospital LOL

  3. #21
    BellyBelly Member

    Dec 2005
    3,130

    i found that the natural tear hurt ALOT more but for not as long where as the epi still hurt but not as intense but it lasted for longer. DTD hurt more afterwareds with epi too. would rather tear anyday.

  4. #22
    BellyBelly Member

    Dec 2009
    Sydney, NSW
    168

    I had to have an episiotomy as she was not coming out - I would have prefered to have torn naturally and had a few stitches compared to having to be cut and needing several stitches much more painful ice packs become GOOD friends

  5. #23
    Registered User

    Mar 2007
    Melbourne
    4,031

    I have had both, episotomy in DS1 and DS2 and tearing naturally in DD.

    The tearing naturally healed quicker and was less stitches, that could be down to my OB knowing what was going on down there!

    I had U/S in hosp and ice treatment also and it helped heaps in both cases.

    MW believe a tear will heal better...I would tend to agree unless of course you are going to tear to the point of a 3rd degree and have many stitches then I would think episotomy may be better???

    As my OB explained she would see how it went, if she thought it was going to be a bad tear she would do and episi otherwise a small tear was better.

    I also agree with Hollo, think the tear was better for DTD after.

    See how you go....

  6. #24
    BellyBelly Member

    Nov 2006
    Bendigo, Victoria, Australia
    1,293

    I had 2nd degree tear with DS, and am currently wondering what will happen this time round, (due in 5 days!!) don't want an epi, but did find the tear healed really well, and I had very minimal discomfort.

    everyone told me to have salt baths, and use ice packs, but I didn't need them, just a little panadene.

    what i do highly recomend for a tear is 2 showers a day, just bend over & let the water do it's job to keep the area nice and clean & I found that using an ultrathin pad to wick the moisture away meant no rubbing or toweling getting caught on stitches.

  7. #25
    BellyBelly Member

    Mar 2010
    45

    episiotomy healing time was 6 weeks, before I could walk normally, tears with my two others, I never felt

  8. #26
    sweetgloss Guest

    Given the choice I would choose to tear naturally.
    Last edited by sweetgloss; January 23rd, 2011 at 11:20 PM.

  9. #27
    BellyBelly Member

    Jan 2010
    SA
    129

    If the doc thinks you should have an episiotomy when u r in labour, do they inform you first? Do they get your permission? Or do they take it upon themselves to do it while you are in the middle of a contraction or something, and dont notice the extra pain!?!
    KWIM???

  10. #28
    BellyBelly Member

    Mar 2010
    45

    If the doc thinks you should have an episiotomy when u r in labour, do they inform you first? Do they get your permission? Or do they take it upon themselves to do it while you are in the middle of a contraction or something, and dont notice the extra pain!?!
    KWIM???
    with my first thats exactly what happened, no questions asked... after that made sure they knew I prefered to tear

  11. #29
    BellyBelly Life Subscriber

    Nov 2009
    Scottish expat living in Geelong
    5,572

    If the midwife or doctor feels an episiotomy is appropriate they must gain your consent before performing one (unless you are unconscious and unable to consent). Failure to do that would be assault, although it does happen. If you are concerned then ensure your birth plan states "no episiotomy without my permission" and be vocal that you do not want one unless there is a medical reason.

  12. #30
    BellyBelly Member
    Add damprye on Facebook

    Aug 2009
    Western Australia, SOR
    1,152

    I was unable to consent to having an epi but it was required as they were going to lose both me and my baby if they did not get him out there and then. My doctor also knew that I trusted him to make the right decisions if I were unable to and he also listened to my wishes every step of the way when I could still make my own decisions, including withholding the need for the VE until they had no choice. If I had of consented sooner, it would have been easier on everyone but I am glad he respected my wishes but stepped in where needed
    The epi never did heal properly though. The two sides never rejoined each other successfully even though they did get stitched. I say that where possibly, tearing is best but there are most definately times where episiotomies are required.

  13. #31
    Registered User

    Jul 2008
    Balnarring, Vic
    1,900

    Everybody has said it already so I'm just backing up what they've already said.

    A tear is a thousand times better than being cut! I was cut first time round and needed over a hundred stitches. I was restitched twice because it wouldn't stay together. Although I wasn't cut and didn't tear second time around (thankfully!) every client that I've had who has just torn, has needed less stitches and have had no problems with healing.

    So, all in all, I've seen the proof that a tear is better. Saying that though, in it an emergency, sometimes a episi could be needed.

    Eta- as far as consent goes, legally they have to have it. I was not even aware they had done mine until after I'd given birth. Nothing was said to me and it's a story I've heard all too often. I guess all you can do is have it on your birth plan,have dh aware of your choices and also let hospital know. That way, they are given no option but to tell you. It's dodgy, but it does happen.
    Last edited by loulabelle; April 13th, 2011 at 05:53 AM.

  14. #32
    BellyBelly Member

    May 2008
    North side, Brisbane
    754

    They threatened to cut me ... I said no ... turns out I tore in a different place to where they were going to cut (before they threatened me with an epi), so I would have ended up with an extra lot of healing to do!! Go natural!

  15. #33
    Registered User

    Oct 2007
    Brissy
    2,208

    Well I seem to have had very different experiences - with DD#1 I had to have an epi (after extended pushing) - my stitches weren't painful, and healed wonderfully!

    With DD#2 I tore and let me tell you it took HEAPS longer for it to heal, and it was sooooo painful. Given the two options - I would choose the epi.

    But that was my experience

  16. #34
    BellyBelly Member

    Nov 2006
    Warburton
    537

    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.
    A sitz bath is just a bowl or basin big enough to sit your bum in. Sea salt can be lovely, also a drop or two of tea tree oil or lavender oil (not too much or it might sting) - these are natural anti-septics and lavender has analgesic properties.

    Healing herbs can also be great. They reduce swelling, promote tissue healing and relieve pain. You can also dip soft cloths or even those cotton wool cleansing pads in the herbal liquid, put them in a ziploc bag and cool them in the freezer, then apply them cold to swollen areas - this is great for haemorrhoids!

    Another method that speeds healing and relieves discomfort is using a perineal cleansing bottle - easiest to do while seated on the toilet. You can fill it with warm herbal liquid, or warm water & sea salt, and add a drop of your essentail oil too if you want. This is just great during those first few days when weeing feels 'stingy'.

    You can also use active Manuka honey on tender healing tissues. Smear it on a pad and apply it gently - yes it's sticky but if you wear for an hour or so and then step into a warm herbal bath it's a pretty nice healing regime.

    I have even heard of people using nori - dried seaweed sheets - to help heal minor tears. I haven't tried that myself but why not.

    On my blog I have a study about reducing perineal damage that showed that the kneeling position was associated with less tearing. I notice that a lot of women giving birth in pools choose a variation of the kneeling position.

    I just remember, "it's designed to tear, and it's designed to heal". And there is research that demonstrates that tears do heal better than episiotomies. I've also been told it's better to tear lettuce than cut it for salad, it tears along the cell boundaries - I'm sure it's a similar principle with skin cells.

    I do think that freedom of movement in labour, commencing pushing when your body compels you and the urge is overwhelming - not when they 'tell' you you are '10cm' - own choice of postion during pushing with particular consideration to being OFF THE BED, and undirected pushing, following your body's urges as the foetal ejection reflex is triggered, are all pretty significant right up there with the right of consent/refusal of episiotomy. 'Breathing your baby out' can happen when such bodily autonomy exists, but women's birth experiences are all so varied. As a general rule the only advice or encouragement I give when a woman is pushing is 'listen to your body' and 'you're doing fine' (and that's the truth!) But I have seen situations where the expulsion urge is very strong (a fantastic thing, it means her body rocks and is working great!) and the midwife has noticed the skin is getting a little white wear it is stretching - and has suggested the mother pant and quit pushing if she possibly can - and on several occasions this back-pedalling has prevented a tea while the skin had a change to oxygenate and stretch. Sometimes a change of position can help at this point - like getting off a birth stool onto hands and knees, or changing from squatting to side-lying. Sometimes those intense open-pelvis, gravity-positive positions are helpful for getting the baby round the J-curve and under the pubic bone and well onto the peri - and then you don't need it, you can choose another position once you're just off crowning, to ease baby's head out nice and slow.

    And placing your hand on your peri, feeling the gradual progress of your baby's head emerging, can be quite helpful for some women, it helps them know 'where they're at'.

    Another trick is reducing all the forces at play.

    There's:
    1. gravity
    2. the expulsive force of the uterine contractions
    3. volitional pushing/bearing down efforts
    4. the foetal ejection reflex

    Even if you needed them ALL during most of second stage, to bring baby right down, you *might* not need them all at the point of crowning. To ease bub out gently, perhaps you could employ just 2 or 3 of these forces, eg:

    - give a gentle volitional push in between contractions, and see what happens
    - reduce gravity by kneeling or side-lying, or head-down/bum up
    - try puffing, through 'horse-lips' for a contraction, instead of bearing down (this can be wonderful for letting everything stretch up beautifully!)

    But I think you really need to be totally free to choose the right positions for you, and be free of well-meaning people telling you what to do, in order to tune into your body enough to know what you need at that time. And there certainly is a way you can ask for this in your birth plan, if you think this approach is for you.

    Also just watch those shoulders. Sometimes we all do a lovely job easing that head out so gentle - and then the shoulders shoot out and nick a tear. Gently does it!

    Amazingly, during water births, the attendants usually can't see a darn thing, and the mother manages just fine, and I don't think I can remember a waterbirth in which the mother needed stitches later.

    I attended the labour of a friend last year, but was not able to stay for the whole birth (my baby was only 6 months old, and it was a 60 hour primip labour!) But she told me about it later - how she was pushing well in a supported squat, but the midwife saw she was about to tear, and assisted her into another position, and she birthed that wee bub (slightly asynclitic) with no tearing - I thought, what a great job that mum and midwife did. The midwife thought she would have torn right to a 3rd degree tear if they hadn't acted swiftly in that moment.
    Last edited by Julie Doula; January 25th, 2012 at 02:25 PM.

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