Will I Need an Episiotomy?

Hi~
I had 4 babies (1977-1988) and had episiotomies with each and no problems from them. Hope you don't need one, but it shouldn't be a big deal. They usually do it if they need to and don't if it's not needed.

I had an episiotomy with both my daughters. It was not all that bad. I just suggest you soak in a warm bath a few times a day for a few days afterward giving birth.

A. B.

I am a 44 year old Mother of 2 teen daughters and a stepdaughter and two stepsons.

Episiotomies are among the most over-used "surgery" (yes, that's the technical term, since it's cutting into healthy tissue) in America. Many doctors have high rates of them; most midwives have rates of 5% or less (some can count the number of episiotomies they have done, it's so low). Perineal massage *during labor* has not been shown to be beneficial. There was a study undertaken in which one group of women was given perineal massage during labor and another one wasn't, and there was no difference in tearing and episiotomy rates. You can also check out this link (http://prepforbirth.com/blog/ -- scroll down to the post that talks about episiotomy) for more information on aggressive massage. That said, there may be some benefit to *pre-labor* perineal massage. Finally, studies have shown that most natural tears are only 1st or 2nd degree tears, while an episiotomy by definition is a 2nd degree cut. You *might* get a 2nd degree injury if you don't have an episiotomy, but you *will* get a 2nd degree injury if you *do* have an epis. Also, most 3rd degree and 4th degree tears were from an episiotomy cut that extended and tore worse. How many times do you cut your pantyhose to avoid tearing them? If you cut your pantyhose so that your leg fits in easier, do you think your hose will tear more or tear less?

Probably the best thing you can do to avoid an episiotomy (aside from choosing a care provider with a low rate of them), is to avoid giving birth lying down. Being in an upright position helps to avoid episiotomy in numerous ways. First, it makes pushing easier and faster. Second, since your vagina isn't in such easy view and reach of the doctor, it makes him less likely to grab the scissors and cut. Get "The Thinking Woman's Guide to a Better Birth" for more information on evidence-based practices in birth.

It is rare that anyone needs an episiotomy, and, there are a lot of things you can do to help you stretch. Try perineal massage AT LEAST once a week - if not every day. You (or your partner) can take lubricating jelly (if needed) or olive oil...etc, and with two fingers you insert into the vagina, push down and kind of make a "U" wish your fingers in a back and forth motion. Do this for at least 5 minutes. The more you do this, the more stretchy your perineum will be, and the more easily it will stretch during birth - with less pain, and most likely prevention of a tear or the need for episiotomy. Remember, its usually easier to heal from a tear anyway - so, I would suggest no episiotomy unless absolutely necessary.

Also - be sure you're using baby-friendly pushing techniques and labor positions. Try all -fours, and sqatting are the best. DO NOT get on your back, even a semi-reclined position (as in almost all hospital births) puts a lot of pressure on your perineum. Get upright as much as possible to help the baby move down.

Also - many women are actually pushing too much, instead of relaxing and letting their body do the pushing. If you are pushing too hard (like directed pushing, too long...etc), you actually are tensing up your uterine muscles, and it makes it harder for the baby to move down - and equally adds additional stress to the baby (increasing heart rate...etc). When you "push" you have to "let go" and surrender to your body. Don't push too soon (not until you get the overwhelming urge) and push as you need to - not as other people tell you to. Make sure your bottom stays open - scrunching up your face and bearing down as hard as possible does not lend itself to an open bottom. You need to keep your face, and especially mouth, relaxed - as a relax mouth is linked to your bottom. For instance, when you kiss with an open mouth, your bottom is relaxed. Try it - open your moth and just relax your face, you will feel the difference in your bottom. Let your uterus expel the baby, don't be forceful.

D. B., CBE
www.esalibirth.com

Different schools of thought on that one.
There are many who believe that with tearing "naturally" the chances are you will have less damage done. I know many conventional people would say that is horse-hockey.

You can request to not have one and always change your mind. You might just pop the baby out, but if you are close & pushing forever, you Dr might tell you if I could give you a little cut the baby will come right out... you might want that.

Every birth is different & there is no way to predict. Talk to a lot of people & get their story. It will help you think what you might do in that situation.

I went all natural (no drugs) for my almost 9lb girl. Yowza- that was hard work. I never felt her crown, I had 3rd degree tearing but never felt it. (having no drugs my body could release the endorphins needed to get through the job)

Read info from the bradley method of birthing if you want a more left of center view.

Whatever you choose I wish you a wonderful birth experience and a happy healthy baby!

P.

I second the facts that Kathy P. has shared. There is no evidence to support the extreme overuse of episiotomies but there is evidence that shows they do more harm than good when compared to tearing naturally. To avoid an unwanted cut the best thing to do is to choose a midwife for a low risk pregnancy or an OB who does not routinely perform episiotomies. The second best thing is to utilize gravity through positions that open the pelvis so the baby can come out easier. Squatting, hanging from a rope or bar, being on all fours all help open the pelvis. Hiring a midwife and possibly a doula (professional labor supporter) will decrease the risk of an episiotomy (as well as birth assisted by forceps, vacuum extraction or cesarean). The third best thing you can do is avoid an epidural because if you choose to have one you will have no choice but to be on your back which makes the baby's passage harder because it goes against gravity. Read, research, ask questions and above all, choose a care provider who matches your birth philosophy. If you have a care provider now and you are not happy with them remember that you are a paying client and have the right to shop around for what fits your needs best.

I had one with my first one for the same reason. It was very bad and I still have issues from it. The second child was the same size but didn't take as long and I didn't have to have an episiotomy. I did tear a little but it is easier to heal from tearing than from an episiotomy. Having a second child was so much easier, you know what to expect and it's not as scary, it can go much smoother.
So relax, everythings going to be fine.

Hi there! My first son was 10 1/2 lbs and I did not need one, but my second son was induced and I had to have one because he came so quickly! He was only 9 1/2 lbs!! lol! i think it just depends on the babys timing. I healed much quicker with my first son!

It really depends on the labor and how big the baby is. I had one with my first two but not my last. The chances are better that will need one, but doesn't necessarily mean you definitely will. Good luck!

You will need it if you need it. The only way you will know i when you are crowning. You can condition the outside of you VG for the stretching but I am not sure that will help. I, myself, have teared with my second one and had been cut with my third. Don't tear cause it can be much more damaging. Don't worry, you heal down there and most often than not it is just fine.

i had one and i never felt a thing. Of course, I did have an eipidural. I don't know how you feel about that. My son was 9lbs 11 oz and there just wasnt' enoughr oom! :) but, i've also heard that putting olive oil on the area during labor helps with stretching and also helps sooth. Good luckand COngrats on the new little one!

Here's a good link: http://www.babycenter.com/404_how-can-i-avoid-an-episioto...

I used a midwife with mine - homebirth. I massaged daily. No tears.

Bless you and good luck!!! Have a wonderful birth!

Only God knows!!!! Good luck!

I had an episiotomy with my first, my second labor was really quick (2 hours), I did not need one then. My third was one did not need one either but I had been in the hospital because I started labor but it did not progress. As soon as they were ready to send me home the contractions
started up again. Since my first labor was 8 hours and my second 2 hours they would not let me go home. 16 hours of the on again off again thing he finally decided that it was time, 1.5 hours! Good Luck and God Bless!

I had a level 4 episiotomy (over 25 stitches) with my first child and did not need one the second time. Don't worry, it could be TOTALLY different this time! Good luck!

I had one with my first because his head was stuck, but my second was much smaller and came out with some minor tearing.

Hey K., I just had my 3rd baby 3 weeks ago. It's really hard to know because each child and each birth is different. I didn't have to have an episiotomy with any of mine but I did tear with my first 2. My 3rd was significantly smaller. I thought for sure I'd tear again since the muscles down there were already used to it and my babies have been so close together, but I didn't have any tears or rips at all.
You know you can ask the Dr. or nurse to do a message before and during labor to stretch out the area to eliminate the need for an episiotomy, that is what we did with our first.
I hope that helps...and good luck!

episiotomys are much better than tearing its harder for a jagged cut to heal. i would ask your doctor on this i needed one with both my girls but never even noticed honestly. good luck and congrats!

The short and simple answer is maybe maybe not. Each pregnancy and birth is different. My two couldn't have been more different while my aunty's were pretty much the same. There is no real way of knowing what will happen in the labor room.

Hey K.!

I had an episiotomy with my first baby and had a really long, painful recovery. Long, meaning 4-5 months! Where they cut me would rip open every time I had a BM... Ouch!

I just gave birth to my second baby last weekend and did NOT have an episiotomy. I felt great afterwards! I tore a little bit on my own and had some stitches, but they didn't bother me at all and they've already come out. The hospital even let me check out a day early because I felt so "normal" and was excited to take my baby home. I've been telling all of my pregnant friends to talk to their doctors about not doing an episiotomy unless it's really necessary because it really does make a difference!