Thinking I would prefer a C/S to an episiotomy

[Fleur]

double post

[Fleur]

You don't have to consent to an episotomy. Talk to your Ob, tell her you would rather tear then be cut. Look at things you can do to prevent tearing as well, positioning, supporting the perenium etc.

^^ yeah that.

I haven't had an episiotomy, but I have had a CS and a VBAC in which I tore naturally. The recovery from my tear was soooo much better; 2 days of panadol and I was fine & dandy, compared to a couple of weeks for my CS - and that was a 'good' recovery.

Ultimately it is impossible to predict how you will fare with either option. Yes, there are some horror stories around tears and episiotomies, but there are also women who have had quick & easy recoveries from them; and it is the same when it comes to CS.

Yeddi makes a really good point re the other benefits of vaginal birth, for your baby, and what Arcadia says is true as well - it may be too late for CS by the time it comes to it.

Talk to your OB about your options for your birth plan, and go form there. Hopefully she will be able to put your mind at ease and (especailly if her rates of both are low) hopefully you will need neither!

[*Beema*]

I have had both.....

DD1 was born in a huge rush, ended up with a Epi after already having two tears and it was getting pretty messy down there, her HR was lost and she had to come out then and there.
DD2 was born via CS, due to no amniotic fluid, growth had stopped, breech and constant labour and being highly medicated and then not being able to stop them meds due to BP.

The recoveries were very different, DD1 it hurt to sit, it didn't feel "the same" for a long time, painful sex I would say for approximatly 12 months, it was very tight and I used a cream to help everything "stretch" again. BUT I was up and about from the start, I had freedom I wasn't limited with what I could do, lifting, driving, etc
DD2 the recovery from the CS was extremely painful for me, it was not walk in the park for me, it is major abdominal surgery, I couldn't get out of bed by myself, I experienced seering pain when I did, and if my bladder or bowels were full it made it even worse, once getting home 7 days post CS, I slept in a chair for another week or so, because I couldn't get up from lying flat without help. But four months on and I have no isses down below, my CS scar still hurts when kiccks or bumped by DD's unfortunately my uterus tore during the CS, so no only go across but up the side as well, and I have been advised that future deliveries would have to be a CS due to the damage.

If I had my choice...

I would still chose a VB with a tear/episiotomy, because I have been there done that and I know how to deal with the pain/treatment etc to get it all "working" again. I found the CS just too debilitating and to not be able to get out of bed was horrible..... I like my freedom

[crumpet]

i was induced for DD's birth (at my request) and things progressed well BUt my heart rate shot through the roof and DD's kept dropping, both of which caused a lot of concern to my OB....

he said he needed to "help" me to get her out and asked to use the forceps and i said no, he then told me i had torn and would need stitches and would i consent to a episiotomy....

i had epidural so it didnt hurt, actually i didnt feel a thing when it was done.

once the cut was made my DD literally fell out, my OB told me not to push, and as far as i was concerned i wasnt, my body might have been i dont know, but she just fell out!!!

i was obviously stitched up and to be honest the ligament pain i had ( i was in stirrups for over a hour at a time, 3 times in the 5 days leading up to and including delivery) was sooooo much worse!

i was tender, but i really only noticed it when i went to stand or sit, once i took panadol on the day after she was born and that was it, i didnt need the ice packs or anything.

its definitly a personal choice and honestly before DD's birth i was terrified of being cut and having my fanny stitched but i hardly noticed it....

and TMI but i was sure id be in agony DTD but there is no pain from that either.

good luck with ur decision, do your research and choose the option you feel is right for you!

[KimmyF]

I had an epi and vaccuum with DS due to he was presentiing and it was unlikely he was coming out on his own ( he had his hand well above his head kind of like superman lol) I ended up with PPH (not due to epi) and had to go to theatre to find the bleed so I had been stitched up after the birth then unstitched and restitched back in theatre and I needed two blood transfusions so my recovery was a bit jaded by that. I couldn't get out of bed for a few days due to the catheter and being too weak. But within a week apart from being a little sore, I was back to my normal self. We resumed DTD after 6 week check up, I think the first time was a little painful but I honestly think that was all in my head as I knew what had gone on "down there". I took only panadol for pain relief and had some salt bathes and felt generally pretty good.

Good luck with whatever you decide, but ultimately it is your choice xxx

[BellyBelly]

You know you can reduce your chance of vacuum & forceps by 40% by having a doula - 40% less chance of episiotomy right there! Oh and 50% less c/s.... And... Lots more

[LionsandBears]

I haven't had either but was scared of both. When I discussed my fears of an epi with my private midwife, she told me there were 2 reasons I'd need an epi. 1) If I start tearing into the urethra/clitoris. and 2) if it looks like the perineum is about to burst from the middle out (hard to describe - imagine a marble trying to burst through some cling film). In both situations, a sideways epi would be preferred both to reduce potential damage.

I had a vaginal breech birth with a slight tear in the perineum. no stitches needed.

There are some good medical reasons for a c/s but remember it is major abdominal surgery. It's the great big needle near the spine that scares the hell out of me.

Also, I concur with Yeddi's analysis of post-VB sex. Wow!

[FabFiona]

Thanks all. As usual you have given me plenty to think about.

This is not an issue about consent for me. DH and I are switched on, take no prisoners kinda people. We are also very comfortable dealing with medical staff who tell big fat fibs about risk etc. I wouldn't have an OB that I didn't trust or that I had to negotiate with.

I guess this is all hypothetical. I hadn't considered the point that sometimes they are not interchangeable ie. when the baby is in the birth canal. I also hadn't realised that the size of the cut can be different depending on the circumstance.

I hadn't even considered a VBAC and all the issues that go with them. Thanks for raising this point.

I would always prefer to tear if it came to that. That was my strong preference at my first birth, of which this thread reminded me. I had a small tear for my first labour (1 or 2 stitches I think). We were back DTD within 2 weeks and I felt no different.

I understand that everyone's experience is different. Thanks everyone for sharing your points of view.

Cheers, Fiona

P.S. Your points about making sure husband was not at that end of the bed during an episiotomy made me laugh. During our first labour he was adament he was staying up at my head and not going 'down that end'. The reality that there really were no ends to the bed and regardless of where he stood he got a good view was a bit much for him!

[BellyBelly]

Most independent/ homebirth midwives have never ever done an episiotomy, some remember just one they had to do one time. Think that speaks volumes about the ability of our amazing bodies and those who care for us.

Most of us go into birth without any emergencies. But the amount that do at home vs hospital is huge. Not saying where you should give birth, but to take note at the natural ability you are given to birth without interference and differences of whats possible for you - we all plan to birth a certain way - question is - what are you doing for yourself to give yourself the very best chance at that?

[FabFiona]

Most of us go into birth without any emergencies. But the amount that do at home vs hospital is huge. Not saying where you should give birth, but to take note at the natural ability you are given to birth without interference and differences of whats possible for you - we all plan to birth a certain way - question is - what are you doing for yourself to give yourself the very best chance at that?

I just bought me a subscription to BellyBelly - I think that's a very good start!

[BellyBelly]

LOL well I was going to be cheeky and say being here is a good start But the great news is, there are sooooo many things you can do, and it's not hard to get access to. I see you're in Melbourne - I highly recommend you look up some great independent birth education classes. Rhea Dempsey's Birthing Wisdom ones are a great start (she is my teacher) and the About Birth classes are great too

[FabFiona]

Thanks for the tips. We did the Birth Ready class with Victoria Marshall-Cerins for my first pregnancy. We also had a doula and she was great. Still looking into a doula for this time as ours has moved away.

In reality I'm unlikely to medically need either an episotomy or a c/s this time. I'm just getting caught up in my own head with a thought that I couldn't get out. However like the anal planner that I am I'd like to be prepared for all possibilities.

[LoveKnowsNoBounds]

Hi!
I think I would prefer not to think about what is going to happen the next time round. I had an episiotomy and then ended upp with nearly a 4th degree tear as my DS waved his arm at a crucial moment and I remember feeling the 'pop'. My doctor was amazing and I was stitched up for what felt like forever. I had abit of discomfort over the next few days but I used those iceblock things that really helped lol. By my 6 week checkup all was fine and I look and feel 100% normal. I am so grateful that I didn't have a c/s. That would have meant extreme difficulty over the next 6 weeks and who knows for how long. My DH could only stay home with me for 2 weeks then I was solo. I can't imagine doing that with a C/s. For me I'd take the epi anytime but with a very good doctor who knows what they are doing!

[Pretty Butterfly]

Most independent/ homebirth midwives have never ever done an episiotomy, some remember just one they had to do one time. Think that speaks volumes about the ability of our amazing bodies and those who care for us.

Most of us go into birth without any emergencies. But the amount that do at home vs hospital is huge. Not saying where you should give birth, but to take note at the natural ability you are given to birth without interference and differences of whats possible for you - we all plan to birth a certain way - question is - what are you doing for yourself to give yourself the very best chance at that?

I agree.

I have no doubt, that I been left to my own devices, I would have "felt" the need to change positions.. my daughter was posterior (we didnt know at the time), and had I gotten up off the bed, and onto all fours (where 4 of my 7 have been born!), I believe she would of come down fine. A tear may of resulted, but prob not an epi.

[ShootingStar]

I had an episiotomy with DS. I really had no choice, he had to come out in a hurry and to me that was more important. Havent had a C/S. But in discussions with people i know who have had a c/s.. i would much rather a c/s any day. I dont think i will ever be the same down there ever again. I had a really bad recovery with my episiotomy.. to the point i couldnt stand for more than 10 minutes at a time for the first 3 months without being in pain... then needing to have a skin tag removed as i wasnt sewn properly. Up until i had DD i couldnt DTD without being in constant pain. I only tore with DD but was so thankful the doctor who stitched me was actually a plastic surgeon. He fixed me so at least i can DTD now and the majority of the time not be in pain.. but things just arent the same. Im a bit worried what will happen this time round and pray i dont require another episiotomy, but if they give me the choice, ill be taking the c/s.

[KimB]

I had an epi with my 1st one and swore never again. Not only was I disfigured they didn't even sew my pelvic floor muscles back together. I ended up having repair surgery in 2005 to bring the muscles together again. Sex was horrible as I had no control over the muscles and I thought I had been doing my PF exercises wrong. I have also had a c/s and it was so much easier. Yes initially it was harder but I had no infection and it healed really well. I have the faintest scar there now. I would do another c/s over an epi any time.

[Razzberry]

Next time I will DEF be demanding a C/S!!! I had an episiotomy after a long labour when my baby was in distress and stuck in the birth canal so was cut and had the vacuum. I had many discussions with my ob, who said he would only do an epi if absolutely necessary - if a severe tear was going to result etc. The recovery was insane - My daughter is 16 months and I still have not recovered. It was agony to sit down for 3 months and at times now it is still tender! I had strong painkillers in hosp for 5 days, they had to keep my catheter in for 2 days as the nurses said I "was so swollen down there, if I had probs going to the toilet, it would be hell and excrutiating pain to get it back in again!"
My sis had an emerg c/s and didn't even need panadol the next day. She could walk and move around better then I could. she has since had a vbac and regrets it after tearing and the recovery being much worse and painful!!!

So I know its major surgery to have a C/S but I have endometriosis and reckon I have a high pain threshold and noone can understand the pain that others feel (which is a good thing!!!) so I think it really has to be an individual decision!

[Inertia]

Fiona, while I have agreed with you initially, it is probably really fair now for me to tell you that it was a decision I never had to make, and I am not speaking from any form of experience.

I had 6 VBs, all intact. I damaged the pelvic floor muscle with Diva by being impatient though (to avoid a cannula) and pushing before I was fully ready to. That is, I was pushing fully during those contractions that you can hold off on for a bit, iykwim. They are just meant to be little nudges to move babies head down and help with dilation, but he was putting holes all through my damned arm!! So the best advice I can give is to listen to your body and go at its pace.