Tearing naturally vs episiotomy

DH & I were going over my birth plan the other day and he questioned if I'm going to tear, why would I want to tear naturally over the doctor taking a scalpel to my perineum. His theory is that an episiotomy would heal faster and better than a natural tear because it would be a clean cut.

When I tried to explain it to him, I found that I couldn't. I just know I would prefer to tear naturally (if that's the case).

So, tell me why is tearing naturally better than having an episiotomy? Which one heals better?

tears i believe heal better as they knit back together better as opposed to a smooth edged cut ITMS.
also epi's tend to go deeper into the muscle then just tearing.
having had both id go for the tear over the epi any day!!
you can also do lots to try and avoid a tear!

Tears heal better than an episiotomy as a tear is going down the weakest park of the skin and or muscle where as epis is forced to go where scissors are.

Perineal massage and optimum positioning for pushing (on all 4rs, sitting on toilet, standing etc) also can assist in reducing tearing or severity of tearing.

good luck

A tear will tear alongthe natural grain lines of the skin if that makes sense and so the knitting back together is more natural and therefore quicker and stronger. Also a tear will only tear as much as is needed for bubs to get through, no more......with a cut they tend go further than is really needed so making a larger than necessary wound to heal up afterwards.....the only time a cut is prfereable over a tear is if it is threatening to tear directly towards the anus...then you should go for the cut on an angle to reduce potential damage and anal fissures etc etc.......

Noooooo! Your DH has it the wrong way round! Tearing is much much better for you as you will only tear as much as you need to tear, and often the tear doesn't even include the underlying muscle and can be small and superficial, but with an epi, you are cut through muscle and all and it aint a small cut by any means. I had an epi with my first and was cut in the 4 o'clock position - if you were looking at a vagina like it was a clock face, it would have been about where 4 o'clock would be. I couldnt' sit properly for weeks and it felt like I was sitting on rose thorns because I could feel evey single one of the stitches. But when I tore with my next two, I never felt a thing, it healed really well and really quickly and the scarring is minimal.

Excellent, thanks ladies, just the info I was looking for! Now I should be able to explain it to DH a lot more clearly :)

I have been doing perineum massage and using an Epi-No to try and prevent tearing, so here's hoping I don't tear!

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.

Oh god no, don't have an episiotomy!

Best way to avoid tearing is not to push but to breathe the baby out - not guaranteed, but definitely the best way to minimise or avoid tearing :)
Tear over cut, any day!

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.

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 :o 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 :D

Take care and I wish you all the very best in the weeks to come xxoo

I've had both, episiotomy with ds and tear with dd. The tear healed heaps quicker and less painful than the episiotomy.

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 :wall: 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! :D

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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.

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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 :)

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. :)

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.

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!

Yeah, unfortunately stuff like that happens and it is totally out of your control but again usually they are only minor and they heal really well. 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.

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.

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

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.

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

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....

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.

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

Given the choice I would choose to tear naturally.

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???

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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???

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with my first thats exactly what happened, no questions asked... after that made sure they knew I prefered to tear

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.

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.

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.

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!

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 :)

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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.

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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.