Episiotomy & how to avoid it

[tran_m]

Although the rate of episiotomy has decreased significantly over the years, there is still a reasonable amount of the procedure being done- especially with a first child.

I understand there is a 'device' that an expectant mom can use to help dilate and minimize the need for an episiotomy. I first heard about it in Germany but cannot remember what it was.

Does anyone know what this 'device' is called or how to help minimize the chances of having an episiotomy?

Thank you for trying to help me avoid the pain!!

[luvbeinmama]

Sorry, never heard of this device. However, it would be a good thing to talk to your OB about his/her views on episiotomies. I've heard that some drs will do one before it's necessary (easier to sew than a tear, I think), some do it only if it really becomes necessary. I've also heard that doing Kegel exercises helps in avoiding them. Good Luck!

[Elaine]

I've never heard of a "device" to avoid episiotomy. I can't believe there is such a thing, except as a great waste of money to frightened mothers-to-be.

The BEST way is to tell your OB right up front that you DO NOT want to have an episiotomy! Plain and simple. If you aren't comfortable with your OB respecting your wishes, you need to find another OB. It is within your rights to refuse it flat-out.

I began talking to my OB about this very issue at about my 6th month. I spoke to him about it at every visit, reinforcing my opinion that it was NOT to be done except under the most dire circumstances. During delivery, when all his "equipment" was brought it, I reminded him yet again and he said "Ok". I had no episiotomy, had a tear requiring about 4 stitches, and literally had no pain at all other than mild soreness for about 3 days post-partum.
By contrast, my friends who had episiotomies because they "needed" them, all complained for weeks and in some cases, months afterwards, about discomfort.

I urge you to speak to your OB about this and make him/her well-aware that you do not want this done to you.

[ct]

I've never heard of any device either. I did want to mention that I think the whole episiotomy/no episiotomy decision is a bit of a crap shoot. I had one, but 2 of my friends did not. They both had tears requiring stitches and had much more soreness for a much longer time than I did (we all delivered around the same time). Likewise I am sure there are plenty of people who didn't have episiotomies and had tears and didn't have much problem, etc. I think it really matters how bad you tear (and who can determine that ahead of time?), how quickly your body heals itself, and if you go with an episiotomy, I think it depends on your doctor's technique. The nurses at my hospital knew who my OB was based on how he did my episiotomy - and they all mentioned that his patients had fewer problems than other doctor's patients at that hospital so it must work (lucky me :)). Of course if you don't go with one and are lucky you won't tear either. Again, it's really just a gamble. This doesn't answer your question, but you should definitely talk with your OB about this decision. Best of luck to you...

ct

[egoldber]

I agree. When I discussed this with my OB, she said that the time to make a decision about an episiotomy was when the baby's head was crowning and she could see how the perineum was stretching (or not). Otherwise it was just an academic discussion with no real bearing on me and my situation. (I ultimately ended up with a C section, so it was moot anyway :) ) My sister had a HORRIBLE episiotomy and was sore for months. But I have a mommy friend who had a horrible tear and had trouble for weeks afterwards. So everyone's experience is different. Most people have relatively little trouble with either a small tear or an episiotomy.

HTH,

[nina]

I think it's person-dependent. Everyone seems to have different stories and pain thresholds afterwards whether with an episiotomy or regular tears. Also, as the other posts stated, some OB's make it a practice to routinely perform episiotomies, while others do not.

I am petite (5'2 and 100lb pre-pregnancy) and I delivered a 7 lb 3oz baby boy with relatively no issues. No episiotomy, but a little tear requiring only 2 stitches. I think what helped me the greatest is routine kegel exercises, walking as much as you can for exercise, and for a few weeks before delivery, I did squats. I held onto a counter, and just squatted down and stood back up about 10 times every morning (i did this while blow drying my hair because I would forget otherwise!) This helps to sort of "loosen" the perineum area / muscle. Of course I'm not sure that these things helped, but I think it did. I firmly believe that being in shape before you go into labor cannot hurt but only help you. (I don't know about others but I sure felt like I had run a marathon or something after labor was over!)

You'll be just fine... Most importantly, try to relax. Best of luck!

[jojo2324]

I haven't heard of such a device to avoid an episiotomy...I've only heard about Kegels, which I did sporadically throughout my PG. After 2 hours of pushing and 21 hours of no food, I asked the OB to do anything to speed up the little bugger's entrance. I was thinking along the lines of forceps or vacuum. (Hey, I was desperate!) She said she could help me, and then out came the tools and I freaked and started to cry and begged her not to do it. (Unlike Elaine, my OB was from a group practice and I had not met her before the delivery; there was no chance of really discussing the issue.) But I guess I was tearing up, not down, and the nurse said those types of tears are much worse. So I was snipped, and honestly, didn't have any memorable pain after. (This was my first child.) I know that is not the case with most women. I hope that with the next bambino there won't be any necessity for an episiotomy. Good luck!

[blnony]

It is impossible to know how your delivery is going to go. I had imagined what my experience would be like and my delivery was nothing like what I had expected. I had worked out and stayed in shape throughh preg. but DD was born almost a month early and all my planning went out the window. My water broke, but I wasn't in labor. Only after 6 hours of pitocin did I even begin to dialate. I ended up having to have an episiotomy because my labor was completely induced by drugs and sped up. I had talked with my OB ahead of time and voiced my concern about not wanting one unless it was absolutely necessary, and of course it became necessary! But I recovered pretty fast and the pain was minimal. It wasn't as bad as I had imagined, but again I think this can differ from person to person a lot.

[dd_ani]

I can't help much on the how to avoid one part -- I didn't have one, but I had complications that led to a tear about as bad as they come. Not exactly what I had planned, but then I didn't really plan on much except having the best doctors I could find and trusting them. That, like others have said, really is the key. Find a doctor you are comfortable with and discuss your concerns ahead of time. Then, when it comes down to it, trust what they recommend.

As far as avoiding the pain -- I am a huge wimp, so I definitely understand where you are coming from. I dreaded the delivery. Luckily, there are a lot of very safe options for pain management these days. (NOT having drugs was most certainly NOT an option for me!) In my case, having an epidural avoided an emergency c-section and probably avoided some nasty complications for my daughter.

Talk to your doctor about pain management post-delivery as well. Most of them are very good about helping out there, which is when it *really* matters. (Although if I could have talked them into keeping my epidural for about 3 days, I would have been happier!)

I think the jury is still out on the pain of an episiotomy vs a tear. Probably either one is worse than nothing, so if you can find a way to avoid it, great. Personally, wimp that I am, I had a lot less pain than I ever anticipated, even with the way things worked out.

Good luck and best wishes! :)

Michelle

[mamahill]

I don't want to scare you by adding to what others have said - but you really can't predict the episiotomy thing. I exercised, did my kegels, worked on the "stretches" the doctor told me about, had a nurse massaging me to stretch all through labor, and when push came to shove (haha - pun intended, i guess), dd's cord was wrapped around her neck and heart rate wouldn't come back up so they had to use the vacuum to get her out and vacuum=episiotomy.

The one thing I did learn later was to make sure if you're using Tucks pads or similar to ease hemmorroids (sp?), to make sure they are clear of your stitches, or they really burn. i thought the pain was just from the hemms, but turns out the pads were irritating the stitches (even a week later). once I figured that out, the road to recovery was a speedy one. Good luck - you'll be fine!

[Rachels]

Research consistently shows that episiotomies usually cause substantially more damage than natural tears, but many doctors believe the opposite. It's critical to find out what your doctor really thinks. The World Health Organization specifically recommends against routine episiotomy. If your doctor has an episiotomy rate of more than 10%, find another doctor. You might also consider hiring a midwife. Midwives can deliver in hospitals, birth centers, or at home, and are specifically trained to use techniques that help stretch the perineum. My midwife used warm-water compresses and olive oil, and I delivered my daughter with no episiotomy and no tears. You can also help by refusing to give birth while lying on your back, which can decrease the diameter of the birth canal by up to 30%. If you're upright or semi-upright, you'll have an easier time pushing, too. Hope this helps! It's important to know that childbirth doesn't have to involve injury.

-Rachel

[Melanie]

ITA with Rachel & everyone who said repeatedly remind your OB. I took 40 minute skin-temperature baths daily (or as close to daily as I could) in the last month. Then after I did squat-stretches. Both were recommended by my midwife. When we ended up at the hospital last-minute I told the nurse & then the doctor. The nurse did perineal massage during each of the early pushes. I ended up with a "skid mark" which I relented in my post-partum bliss to allowing a "half a stitch." In retrospect, I should have asked for suture glue, but I had other things on my mind then. =)

Think about cutting a piece of construction paper Vs. tearing it. Now you have to glue it back together. Which would be easier?

Also, whatever ends up happening, I give thumbs up to the peri bottle with iodine, and the spray-on numbing stuff.

Good luck!

Mommy to Jonah

[Rachels]

Re: the construction-paper analogy, it's true that a cut is sometimes easier to stitch than a tear, but again, all the research on the subject shows that most tears cause LESS damage to the perineum than episiotomies. It's not about what makes the straightest line-- it's about what produces the least deep injury. Episiotomy is proven to cause greater injury, so the fact that it's easier to stitch doesn't make it okay to do routinely.

[loewymartin]

I too didn't want an episiotomy, and wrote that into my birth plan. My doula had me labor on my side, and we lifted my leg for each contraction so I could bear down. I had back labor, so laboring on my side was a big help. Also, the doctor, doula and nurse said that they are better able to prevent tears with the mother in that position...either way, I only had a small tear with 3 stiches. I did kegels sporadically throughout the pregnancy and walked a lot.

I haven't heard of a device - sorry!

Michelle - Alia's Mom

[Melanie]

Rachels - My analogy was meant to support just what you said! I guess it wasn't clear enough. I was thinking more along the lines of the greater surface area of a tear would be more likely to heal back together better, than the straight-edge of an epi. My thoughts weren't of easy of stitching for the doctors.

Sorry if I confused anyone!




Mommy to Jonah

[Rachels]

Sorry I misunderstood! I've heard this analogy used in the reverse direction.
:)
-Rachel