Episiotomy vs Caesarian

Hi ladies,

Just after some opinions. I am 35 weeks pregnant with my first baby and have to make a tricky choice...

I have a rare skin condition called Lichen Scleroses. It basically means that my skin in 'that' area is paper thin and tears easily. It often even tears when my husband and I have sex. Only a small amount, but enough to bleed a little and cause me pain. It's a pretty horrible condition to have.

So, anyway, I was discussing a recent minor tear with my OB on Monday, and she had a look and decided that I'll either have to have an episiotomy or a caesarian. She said that she can't risk letting me tear naturally (which I know is supposed to heal better) because she said that it would be likely that I'd end up with a 4th degree tear if it's uncontrolled. She said she would cut sideways. But, I'm scared that I'll still tear in the other direction anyway. Given my skin condition, healing can be a problem too.

So then there's the caesarian. I kind of know a little about what to expect as I had a cyst removed when I was 17 weeks pregnant, and that operation is very similar. But, it's still a big operation none the less.

I guess I'm just interested to hear from people who've experienced a severe episiotomy or tear as well as a caeser, and which took longer to recover from. I'd also LOVE to hear from anyone at all with Lichen Sclerosis (It's really hard to find specific information about this on the net).

It's upsetting that it seems that both options aren't the 'ideal' way to give birth, but it is what it is. And, after the scary operation that I mentioned, I am still just SO grateful to be pregnant at all!

Hi, I can't help you with your questions but just wanted to say congrats on your pregnancy :) Not long to go now

What does your OB suggest? does she think you will be fine with an Episiotomy?

I just found this little bit of info

Childbirth

Many women are afraid of giving birth, quite understandably, with this type of genital condition. However, women who manage their condition effectively have given birth vaginally with minimal after-effects. The skin around the perineum will be more prone to splitting, so massaging a lubricant into the area for a few weeks prior to the birth may help. Also choose a position which reduces the risk of tearing. Speak to your midwife or nurse midwife for advice on positioning.

Sometimes, if your condition is severe, a caesarean section may be advised.


Good luck with your decision

What a tough position to be in. I would be concerned about an episiotomy providing a weak point and so you would get further tearing from the episiotomy cut.

There are techniques and positions that can help protect the perenium, e.g a warm face washer held on the area, no coached pushing. I would want to use these techniques during labour, even if you decide to go with the episiotomy as well.

Would there be extra difficulties with having a c section and healing due to your condition?

take care

I haven't been in either position but my mother had a c-section with me. 35-plus years after the even she is having problems with an incisional hernia which resulted from the c-section. I am not trying to sway you either way, but just to let you know that there can be very very long-term side effects to having a c-section. Best wishes with your birth and this tough decision.

I wondered, as HotI asked, whether you are more likely to experience any complications with a caesar due to your condition?

If not, then PERSONALLY (only my opinion!) I would be leaning towards a caesar but I would certainly discuss further with your OB and be guided by her advice. If your condition is so severe that you tear during normal intercourse I would be very concerned that, even with an episiotomy, you would tear uncontrollably during delivery. This may have huge implications not only for your physical healing, but also for you mentally and emotionally. Although there are risks associated with a caesar, I assume your risks are no greater than any other woman's.

It's a tough decision, I wish you the best of luck in making it. And congratulations on your pregnancy!

After having an epi, that meant I was still in a lot of pain 3 months later, and now 19 months later is still tender, next time I will be having a c-section. I know people will say you recover faster from a natural birth, but that is just not the case for some people, including myself and my sister. My sister had an emergency c-section, and then a vbac the next time. She recovered much faster, with less pain from the c-section. I was on far more painkillers then my sister after my epi and was far less mobile.

Ultimately it i up to you, but I think if you are confused about what to do maybe get a second opinion from another doctor??

Thanks for your responses! Just to clarify, my condition only affects the area around the vagina (lucky me), so the fact that that part of me tears easily and heals badly would not affect a caesar incision at all. In fact, the operation that I had at 17weeks to remove the cyst (very much like a caesar, according to my OB) healed really well.

I guess the thing is that my OB knows that I will tear. She's not guessing, the skin is that delicate. As Nickle730 said, I even tear through normal intercourse. My husband would die if he knew I said this, but his penis is NOT as big as a baby's head!!! He he he!!! So, because she knows I will tear, and probably quite badly, she said she would definitely make a preemptive incision.

I think I'm leaning towards a caesar, it's just so hard because I really wanted to experience the 'normal' birth.

I can not help with your condition, but I had a episiotomy cut off the side and I have had no trouble with it at all. It healed beautifully and I had no pain at all (even when going to the bathroom - I think because it was to the side).

I have however had some discomfort while having sex but from what I hear that is pretty normal after having a bub, and I can say that six months on everything is back to normal.

If your netherregions (love that word) are that delicate I would probably be inclined to go a c-sec as Im not quite sure how you would heal. Did you OB say anything about the healing process?

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I think I'm leaning towards a caesar, it's just so hard because I really wanted to experience the 'normal' birth.

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You could still go in to labour yourself and then go to have hospital for the caesar.

If you choose a caesar, there are ways to make it right for you. i like the idea of Maternal assisted c section, and i read of another woman who organised for her baby to be birthed from her tummy ( c section) slowly and in a few different steps so it was closer to a vaginal birth experience for the baby.

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If not, then PERSONALLY (only my opinion!) I would be leaning towards a caesar but I would certainly discuss further with your OB and be guided by her advice. If your condition is so severe that you tear during normal intercourse I would be very concerned that, even with an episiotomy, you would tear uncontrollably during delivery. This may have huge implications not only for your physical healing, but also for you mentally and emotionally. Although there are risks associated with a caesar, I assume your risks are no greater than any other woman's.

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Going by what you have said (and me having no knowledge of the condition you have) I have similar thoughts to this. The tearing anyone experiences is quite unpredictable before the birth, so you are never going to have any good solid information to base your pro and con list about going for v. delivery, so what you feel comfortable with is the best way to go.

Good luck...x

Well I've never had a c section, but I've had an episiotomy with one birth and a second degree tear with the other. My episiotomy caused me pain for well over a year afterwards, and was never right until after the birth of my second child (where the tear healed much better and is now fine). So if you have healed well from your other surgery I would be opting for a c section. I have a friend who had a 4th degree tear, which is awful and causes many ongoing issues, she had a c section for the next birth.

Have a good talk to the ob about missing out on the birth. You could ask for it to be as natural as possible and have baby skin to skin while still in theatre etc

I have had 2 CS and had great recoverys with both no majot dramas, had a wound infection that went fast with AB's (can get wound infections from epi as well.)

I think given fact you tear having sex i think a cs would be best for you as if you extended epis and had a 4th degree tear you could have a lifetime of problems which could effect not only you physically in havoing sex, could effect bladder and bowel function, mental health and confidence, your marriage may also suffer. Sorry to sound so negative but it could all impact.

Good luck and congratulations!!

I can't tell you ladies how much I appreciate your knowledge, advice and opinions. I think that at a time like this, it's great to have reassurance. It's also wonderful to read about other people's experiences so that I can form my own decision and feel good about it. Well, as good as I can under the circumstances!

I agree with HotI about going into labour naturally then having a caesar - that way your baby is ready to be born, and you'll get the hormones you need :)
All the best with your decision!

Yes, thanks! I like the idea of going into labour naturally too. It means that I know that the baby is ready. I'm going to discuss it further with my OB in a week. I'll let you know what I end up deciding to do.

I have taken care of patient with lichen sclerosus and find that this condition can be perplexing to manage. When trying to decide between vaginal birth or c/s the issue that is of concern for the woman is not what is the most natural for mother and baby, it is how will the recovery go after delivery. I think that we can all agree that a nice, easy vaginal birth is wonderful. Lichen is a condition where the skin can tear with nothing more than gentle touch or mild pulling. Vaginal delivery, no matter how easy, is never a gentle touch or mild pulling. All of the stretching exercises that work for most women to prepare the perineum will not work with lichen. This is a BIG difference. The patient WILL tear with delivery and it is not so much how much or in what direction but how will it heal afterwards with all of the inflammatory response from the cut or tear. Here is where we do not have enough data out there to guide us in the decision making process. There is no one right answer that fits all comers. It truly is a difficult decision. Clearly a c/s will avoid any issues relating to healing with lichen sclerosus, as steroids would not be a good choice to place over an episiotomy or natural wound as they delay wound recovery and that is the treatment of choice for lichen. Good luck in your choice. In my practice, I discuss all of these issues at great length with my pregnant moms who have lichen in the vulvar area (or other vulvar conditions for that matter) and then they make the decision. When they cannot decide, then I usually recommend a c/s only because with that mode of delivery there is no guess work about how the recovery will go and will there be any aggravation to the area that is already so fragile.
Good Luck