Thinking I would prefer a C/S to an episiotomy

Hello all,

This has been a thought floating around in my mind since my first bub. I didn't have either for my first labour, but a few friends have had both and I've been thinking about their recoveries and the impact that both procedures have had on their lives.

I've read some horrific stories on here of recoveries from episiotomy's. To be fair, I've also read some horrible c/s ones but to me they don't seem as bad.

I suppose it comes down to someone taking scissors to my vagina as opposed to my abdomen. The thought of having my vagina cut in that manner is not ok with me. Having to deal with a scar site in my abdomen seems a bit easier for me to manage than my vagina.

Now, if I tear that's a different story. I know what can be done to prevent this. If it happens, so be it. But an episiotomy seems so brutal to me. I know a c/s is also, but mentally I think I can live with this.

Here's hoping I don't have to deal with either scenario. My OB is pro-VB and her episiotomy and emergency c/s rates are low so I'm not worried about being pushed into either scenario. However I do want to make my thoughts clear to her.

Sorry if this is a bit all over the shop. This thought has been running around in my head and I've been keen to get it out.

Did anyone else have this consideration in their birth plan? What are your thoughts?

Fiona

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.

Hi Fiona,

I had a c-sect after a failed induction and my recovery was excellent. I do have a very prominent scar on my lower abodomen though, which is uneven and feels lumpy from the scar tissue, apart from that I have no discomfort.

I can't comment on the episiotomy as I haven't had one.

I don't know under what circumstances an episiotomy is deemed necessary vs tearing naturally but I guess every person would have a differing opinion based upon their personal circumstances. For example, a gf of mine had a 3rd degree tear with her first bubba and opted for a planned c-sect for her second bubba due to complications during her recovery for months afterward - I don't know if her recovery would have been very different with a episiotomy b/c her DD 'turned' sidewards whilst she was pushing, so I think the episiotomy might have had to be a large cut anyway?

Hey Fiona,

It's good that you are thinking about these things! I know lots of other people will have thoughts on epi vs c/s but I can share my epi experience? Might help...

I didn't have a formal birth plan but I had spoken about it with my Obs and she knew what I wanted.

I labored unassisted until it became apparent that DD was a little stuck and needed a bit of help. I'd been in labour for 30-odd hours and pushing for two. I'd started thinking maybe a c-sec would be needed but thankfully my Obs and support crew got me back on track. I had an epi and vacuum and she was out in two pushes.

No epidural or spinal block (or GA!), no major abdominal surgery, no six-week driving exclusion, no time in recovery without DD, none of that. It took about six weeks for it to feel ok down there and maybe 3mths until it felt ok while DTD.

It's been fine since then.

I had some concerns around tearing along the scar with bub #2 and I did tear a little bit but it was fine - healed completely within about a month I think.

To me, that is a much more preferable experience to a c-sec! I was terrified of a caesar!!!

I think it's worth remembering that a epi is a small cut through part of your vagina but a c/s is major abdominal surgery. Bit of a difference in my mind!!

I had a very good ob, and had an episiotomy for a forceps birth. Honestly? My recovery was no issue whatsoever. I have had no pain from it, it healed well. Sure, there was a little stinging in the first few days when I went to have a wee, but it was all over before I left hospital. I also had a superficial tear. The thing that made me feel horrible and in pain was actually haemmoroids! The joys of me pushing for four hours.

I haven't had a c/s so have had nothing to compare it to, but the episiotomy was no issue for me.

i can't comment on a c-sect as i haven't had one. but, like PacRakMG, i had an episiotomy for a forceps birth.

i had no issue with healing - i don't even recall any stinging/pain after about the first two days. i was offered pain relief in hospital but had one lot of panadol & that was it. i didn't find it difficult to clean in the shower or painful when i did so. they had prepped me for a c-section so i'd had an epidural before the epi was done so i can't comment on the pain of the epi itself.

i'm pretty sure we'd resumed DTD within 8-12 weeks but can't remember now! it was a little uncomfy at first but nothing painful & i've had no pain or issue since.

ETA - i also want to add that for whatever reason, i seem to heal quickly in general. i don't know if that's a legitimate medical thing or not, just an observation about myself! no idea if how you heal in general has any impact at all!

I think it comes down to the risk of it - there are things you can do to prevent an epi - ie, refusing consent, trying different birthing positions, support to your peri etc, whereas, if you agree to a c-section, thats a decision thats final and you have to live with it for the rest of your life.

I've had 2 sections. I still get pain from the muscles in that area - the muscles are usually torn apart by the OB's hands, and they do knit back together when you heal, but you still experience pain. Some women get an awful overhang of the skin and muscles in the area as well because its hard to bounce back into the shape it was before, its pretty unattractive.

I think I would personally prefer to take a risk on something that may NOT happen, than have something that is guaranteed to happen ya know? C-sections aren't easy to recover from, especially if you suffer an infection, which is quite common - I got an infection with #2 and it laid me up for a month. Which was awful when I had a 19 month old and a newborn to take care of.

I say do research into both, not just people's stories though, cos people's opinions always get chucked into their stories as well ;) So have a chat with your OB, see what they think, read some books and see where that takes your heart! :D

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i had no issue with healing - i don't even recall any stinging/pain after about the first two days. i was offered pain relief in hospital but had one lot of panadol & that was it. i didn't find it difficult to clean in the shower or painful when i did so. they had prepped me for a c-section so i'd had an epidural before the epi was done so i can't comment on the pain of the epi itself. i'm pretty sure we'd resumed DTD within 8-12 weeks but can't remember now! it was a little uncomfy at first but nothing painful & i've had no pain or issue since.

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Oh yeah, forgot all of that, but that was pretty much the same for me too. Except I didn't have the epidural, the ob gave me a local before he gave me the episiotomy.

Wanted to add too, if this is the path you end up taking, DO NOT let your DH be at that end of the bed when this is taking place!!!!!!! DH happened to be there and he freaked :ROFL:

I've had two epis now. I'm not happy about it, but if we are fortunate enough to fall pregnant again, then I will be having a vaginal birth again, fingers crossed that I won't need to be cut again (first was forceps, second baby had head sideways - ****ty luck, hey?)

I felt the exact same way, Fiona.

It is major abdominal surgery, yes - but there is no significant difference between VB and CS when it comes to pelvic floor dysfunction. Episiotomy is another matter and has far worse results in terms of PFD compared to even tearing naturally.

They were never going to get a pair of scissors near my perineum and I am pretty certain they knew as much too. lol.

Episiotomies are very preventable. Here is a great blog post I came across today, all about tearing and episiotomies. Things like forceps and vacuum can damage your pelvic floor but it is a fallacy that only normal birth damages your pelvic floor. It is the prolonged weight of pregnancy that can result in pelvic floor issues - women who have c/s have pelvic floor issues too. I also posted a youtube clip on painful sex and c/s today.

Bellies and Babies: Would You Rather...

An episiotomy was one of my biggest fears too, second only to induction, so I can understand where you are coming from. One thing to remember is that an episiotomy should only be used to expedite delivery so if your OB recommends one it is usually because they need to get baby out straight away (and not always with forceps, sometimes the epis is enough on it's own) so at that point it may be risky to delay things and opt for a CS. Of course you can always say no to any medical procedure, they do need your consent to cut you. Hopefully this will all be a moot point though and you will need neither :)

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Wanted to add too, if this is the path you end up taking, DO NOT let your DH be at that end of the bed when this is taking place!!!!!!! DH happened to be there and he freaked :ROFL:

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:yeahthat: DH went white and had to sit down for a minute- and he does not have a weak stomach! :rofl:

I had a very good c-section for my first, I healed well, it wasn't very painful at all It was a pre-labour emergency c-section because of lack of movement but bub was 9's despite having some cord issues. I didn't have to suffer through contractions and I was up and walking around within 12 hours.

With my second I had a VBAC. It was 36 hours of labour plus 1.5 hours of pushing. I tore in three places - front, back and on the cervix, I haemorrhaged and needed a catheter for three days post birth because the tear was up near my urethra. For a good week I to hobble around with a purple and swollen vagina. It was uncomfortable and going to the toilet was a little scary and painful at first. It took me about 2 weeks before I no longer was aware of something going on down there. We didn't DTD until about 3 months post birth and it was a little uncomfortable at first until the skin stretched.

However, if you asked me which one I preferred, I would go with the tearing or even an episiotomy EVERY time because it's not just about the scars but everything else. I feel SO different this time around. My child's health is different this time around. Since having my c-section I've had issues with thrush and UTI's that were never an issue before. I found I got the lovely elephant ear of skin that hangs across the scar site and doesn't go away no matter how much I exercise. I had to go on medication in order to breast feed and had constant supply issues after a c-section where with this one I shoot milk across the room if I'm not careful. The mode of birth isn't just about scars but you and your babies hormone production, babies immune system coping the good bacteria from coming out of your vagina, the wringing effect on their lungs. There's a lot more to consider.

BTW I have found DTD after a VB amazing! I never had an issue with O beforehand but after, OMG - so much quicker and powerful afterwards, much easier to go multiple times too. Sex is such a relative thing, and I think the idea that tearing etc. during a VB will ALWAYS have a negative effect on your sex life is just as relative. For me was it obviously not true.

If it helps, in my birth plan I stated that in no way was I to be cut, I wanted to tear naturally.
I also said no forceps were to be used during the birth and if it came to that, I would prefer a c-sect to forceps and an epi.

Luckily I needed neither!!

You don't hve to consent to anything they suggest! So as long as you know you dont want an epi, you shouldn't hve to get one.

Xx

I had an epi with DD1. I didn't have an issue with it. She was in distress and by the time the on call OB got to me for a caesar it would have been too late. Sure it hurt afterwards but it was only for three days. I healed fine down there and we were DTD 6 weeks later. I could lift things, I could drive. I was so grateful to my midwife that she made that call and at the time I didn't care what they did as long as my baby was safe. My friend who tore had a worse time recovering than I did and all my friends who've had CS had a much worse time recovering than I did. Each to their own though. Like a PP said, do your research and don't go by people's experiences because different people if put in exactly the same situation will experience it differently. Pain thresholds differ etc. The actual process of the epi wasn't a problem for me. I had local down there and didn't feel any pain. Two pushes and she was out after four hrs of pushing prior to that (she was posterior).

PakRakMG my hubby burst into tears when he saw the midwife do mine. He really shouldnt have beem looking hehe. I was perfectly fine with no idea what was going on. And he does not cry easily.

Arimeh's Eden made a good point though. Epi = may happen with no guarantee of scarring (I have no scar there, I've looked ;) ) versus c-sect = will happen and will scar. good luck with whatever decision you make. Birth is such an individual thing x

I had an epi with my second birth.. I was very young, and no idea about changing positions etc... so after almost 2 hrs of pushing, I was put on my back, feet in stirrups and an epi, then forcepts.

It was stitched up, and I barely noticed it again.

I had salt baths in the hossy, only stayed one night, and healed fine.

The thought of a c/section scares the crapola outta me!! :lol:

Since then I have had 5 more births, all natural, no tearing at all.
4 full terms, all over 8 pounders,(one almost 9) and a stillbirth.
So the epi hasnt affected me at all.

The only other thing to consider is your future birthing options. After a csec it can be hard to go for vbac...I also urge you to consider the risks to your own health csecs cause, such as an increase in hysterectomy.

Vaginas are made to stretch, tear and heal. An episiotomy should be a last resort and asalready mentioned, by that point, a csec might take too long or be too difficult (since bub is in birth canal).