personal experiences? -- episiotomy & tears

[zen_bliss]

episiotomy is the only thing that really scares me! it looks like wisdom goes in the direction that tears heal better than the episiotomies.

i will not have the benefit of a midwife/doula, but i am told that the nurse will do the 'massage' to help with stretching. i tried the perineal massage at home *once* since it was recommended in my birth class to get familiar with the burning sensation so you don't panic when it happens. ok, it wasn't so bad. but i did get a little tear that burned with peeing for a day. so that's the extent of my preparation. :)

ladies:
1.) may i get your advice on any suggestions for what i can bring/ask for that could help me avoid a snip? this is a traditional hospital birth with nurses and no doula/midwife. so far i am bringing a birthing ball, and requesting a jacuzzi tub and squat bar -- those are available. any chance they can swab the zone with a local numbing agent for the crowning? i'd going to see how it goes and try to avoid an epidural....

2.) i'd also like to hear personal experiences generally, especially 'worst' stories of both scenarios -- just to get my mind prepared:
both those that 'let it rip' and wish they'd had the episiotomy;
and tales of episiotomies that tore further.

TIA for the support. i just went back and read neve's 'personal after care' thread and found it MOST helpful!!!

[Karenn]

That's what scared me the most too! It was almost the only thing in my birth plan: avoid episiotomy at almost all costs! That was the main reason I knew I wanted an epidural. (I know, an epidural increases the likelihood of an episiotomy, but I figured if I might possibly have one anyway, I really didn't want to feel it. Probably faulty pregnancy brain logic but it's where I was at! ;)) Of course, I ended up having one because my doctor said the tears would have been much worse than the "snip." Who knows if she was right or not, but to tell the truth, it really wasn't nearly as bad as I had imagined. (Apparently, I actually ended up with tears and a snip.) My recovery was a little rough, but I honestly don't feel like the episiotomy made recovery that much more difficult- and it healed fine. Sorry I don't have any advice about avoiding one, or episiotomy in the context of natural childbirth, but if you do end up with one, know that at least the recovery is probably not quite as bad as you're imagining.

[mama2be]

mines not a worse scenerio case, but thought i'd share it...
i have baby in hands so excuse my lower case pecking.

by the way i found that thread you refer to a god send!!!
when i pushed my mid wife from the birthing center who was delivering said with like 3 pushes to go, "i am going to have to give you a small cut". Tristan was born at 8lbs 4 oz. She cut me during a push and i felt the slight sensation of a cut but there are so many sensations going on it was slight and "blended in"...

i think i had two stiches and my appt yesterday they said it totally healed. it never was my problem post partum.

i do realize it was small but wanted you to have a slight version of my scenerio incase...

hth,

[Melanie]

Okay, first of all small tears heal better than small cuts. No, I'm not a doctor, but research it, it's true. Think of ripping a piece of paper Vs. cutting one. Which could you glue back together better?

In preparation, I took 45 minute SKIN TEMPERATURE (no hotter) bathes every night (or close to) for the last MONTH. This gives you time to read all those baby magazines and books. Plus that's the last time I had a luxurious bath and Ds is 17 months! After the bath, squat with legs slightly (or as much as necessary) apart...don't bounce or anything, it's not for exercise, it's to stretch the perenium while it's soft from the bath. This was hard for me to do unsupported so I either held onto something or Dh.

I told them "NO EPISIOTOMY." That's it. No choice. Don't give them a choice. Of course we all know if it comes down to one or baby's health, you'll allow it. But act like you won't so they will work harder to avoid it rather than being wishy-washy.

The nurse did alot of perenial massage while I was pushing. I ended up with what the doctor called "skid marks" and let him do a half a stitch. I probably wouldn't have allowed any but I was preoccupied with my new baby and didn't care at that point!

[AngelaS]

When I delivered my first dd, I wound up with a small internal tear. Of course, I pushed for two hours, so that skin had plenty of time to slowly stretch. BTW, I had not worked on any stretching prior to her birth and I had an epidural.

When dd#2, I lounged in the whirlpool for more than 2 hours, then delivered dd in about 5 pushes. I didn't tear at all. I had no drugs with that delivery.

You really can't predict ahead of time whether you will stretch or tear. I think at the moment of decision, you will be willing to have them do whatever it takes to get baby out. (LOL) Don't panic about it ahead of time. Just know when the time comes, baby WILL come out. :)

My best advice?? Buy the numbing spray that Walmart sells to use post delivery. It will be nice to have on hand whether you get snipped, rip or nothing. :)

[August Mom]

I had third degree tearing (fourth degree is the highest, I'm told). An episiotomy was never suggested to me during the birthing process, primarily, I think because DS was ready to enter the world and we were waiting for the doctor to arrive. When she finally did, I gave 1 push and he was out. The nurse had been massaging, but I think sometimes these tears just happen. I was very sore for a week or two. It was hard to sit, especially on something really cushiony, like the sofa. I sat on an episiotomy ring (I think that's what the nurse called it -- it's a blow-up plastic ring) and on solid chairs (it was easier to get up). It was a pain (literally :)) to go to the bathroom initially. However, I think some of this was due to a vaginal birth generally, not just the tearing. I think you can and should voice your concerns and wishes to your doctor and to the hospital staff, but when it comes down to it, things you weren't expecting might happen.

[jubilee]

Well, I just had an episiotomy two weeks ago and they aren't that bad. (I had one with my first son too.) It's definately not something you'd have done if it wasn't necessary, so I had hoped to avoid one- but with a big baby like mine, it's hard to avoid it. I had an epidural, so didn't feel the cut actually but even with the epidural it was a very burning painful experience while Logan was coming out (especially when the shoulders got stuck). At first the nurse and doc tried to strech me out, but when Logan started crowning it was tear or cut time. We had a brief discussion on to cut or just see what happened, but the Doc said he was concerned I'd rip into my anus. That was enough to say do the cut! As for healing, the whole peri area was sore, but the Dermaplast spray did help for the first days and then I didn't need it anymore. The hospital supplied the spray but if they don't I'd recommend getting it. You spray the area after going to the bathroom each time. A small can of it is likely enough. I was told it's in the first aid section. The scary part for me was having the first bowel movement after the baby. I thought I'd re-rip or something. So I ate Raisin Bran faithfully, and never had a problem. Now, at two weeks I don't even feel the episiotomy at all. I hope you don't have to have one, but don't fear it- it's minor really.

[Tondi G]

I had a natural Bradley Birth COMPLETELY unmedicated!!!!

I pushed for quite some time... HARD! My OB massaged and stretched, used oil, you name it! I had a band that just would not stretch... she showed me and asked if I wanted it then we went ahead with the Episiotomy and man did that sucker hurt... I yelped... I had heard about pressure epi's in my Bradley class and figured I would have that... she didn't wait till I was pushing to do it! With the second of pain I felt from the actual cut I didn't feel it after that. DS basically spilled out on the table with that band finally snipped and I am SOOOO GLAD we did the EPI! I wish I had let her do it sooner and the next time around I will probably opt for another Episiotomy!!!! I had a few minimal stitches and I thought it would be really painful to pee etc... NO PROBLEM!!!! It actually healed up really nicely and very fast.... I've heard that tears can heal really lumpy and bumpy cause it is not a clean seam/cut! It may be because my baby was small 6lbs 10 oz or that we waited till he was really ready and I had pushed to the limit and just needed that little extra to get him out that I didn't tear... who knows... but I would do the EPI again and will actually ask for it earlier...... I pushed so hard that I broke all the blood vessles in my eyes and little ones all over my chest and arms and cheeks.... it almost looked like I lad blood pooled in my lower lid... YUCK! I looked like i had just been in a boxing match! The nurse who was in the Delivery room had been a MW in Russia and said she would have cut me MUCH sooner.... but my OB was following my birth plan and didn't want to let me down... I respect that so much and love her for that!

I might actually ask if they can give me a little numbing injection before the episiotomy the next time around though... she gave me a few when she was ready to sew me up.... then I really didn't feel a thing!

Good Luck and ask your OB to help you stretch and use oil etc... but go for the epi if you are going to tear! Honestly it doesn't hurt any worse than contraction during transition!!!!! Once you are pushing you just want the baby out already! I had a positive experience with the episiotomy and will go for it again if necessary!

~Tondi and Mason 7/8/01!

[bethwl]

Being in the water should help soften and stretch the tissue. Doing squatting exercises during pregnancy is also supposed to help. During the actual pushing, I have been told that you should not force pushing; if you don't have the urge to push, don't let doctors or nurses tell you it's time anyway.

[stillplayswithbarbies]

I have experience with both.

With my son, I had an episiotomy. I was cut through skin and muscle, and I believe through the rectum as well. As soon as the doctor cut, the baby slipped out. Recovery was sheer hell. I was in pain for weeks, I couldn't sit comfortably. Bowel movements were scary, and painful for weeks. I still to this day have troubles that I trace back to my episiotomy 12 years ago. I was scared to have sex again, it still hurt, and psycologically I was afraid it would tear. (I got over that eventually)

The episiotomy was the worst part of the whole labor and delivery. The recovery from that was worse than any pain I felt during labor and delivery. The numbing spray they give you did nothing for me. It burned when I peed, I cried when I had BM for weeks afterwards.

With my daughter, I was determined not to have another episiotomy. We started at 30 weeks massaging the area with vitamin E oil, especially the scar from the old episiotomy. When she was born, I had a small tear in the skin and got a few stitches. I had a totally unmedicated Bradley birth and that helped to avoid tearing as well. The other thing that helped was that my water did not break until she was coming out. The bag of waters is a cusion that helps to stretch the cervix and perineum gently and I believe that helped avoid tearing. I felt fine a few days after the birth and could hardly believe the difference this time. The stitches healed quicly and I had no problem sitting or going to the bathroom at all.

I would not have agreed to an episiotomy this time for any reason. My experience the first time was so bad, so painful, so much hell for so long, that I would not want to go through that again. Anytime anyone asks, I always explain that the healing from the episiotomy was the worst part of my experience and still affects me 12 years later. Avoid them!

Episiotomies are not routine these days. My ob/gyn says it has been 3 years since he has done one. Discuss it with your doctor, and ask why they do them. Do the research and see if you agree with their reasons.

I suggest taking Bradley classes, or at least reading the book. Having an unmedicated and non-iterventionist birth will help avoid tears and episiotomies.

...Karen
Jake age 12
Logan Elizabeth 3/25/03

[Windy City Heather]

My doctor and I talked ahead of time and both were on the same page. I did not want an episiotomy and he did not want to give it unless absolutely necessary. It ended up necessary and he cut me two different times during my labor. I pushed for an hour and fifteen minutes. After being cut twice, I still tore. I don't remember all the details but some muscle that you rarely see was showing. He wished he was at a teaching hospital to show it off, I was glad we were not. My daughter was only 6 lbs 14 ounces. With a small baby, I was surprised by all this. The after pain and discomfort was not too bad. I did ask for medication every 6 hours and I loved that dermaplast spray. I thought my hemorrhoids were worse. My discomfort was over within 4 or 5 days. What ever happens just remember that when it is all over you are holding a precious little baby.

[zen_bliss]

thank you so much for sharing the personal and painful details! i hope you'll keep them coming. the variety among personal stories really helps. it makes this more real and less hypothetical. my best friend from high school had the worst tale ever, which i know isn't relevant since we aren't in the same situation, but it still makes me shiver! 3 years ago she was 'sliced end to end' for her 5 lb preemie (too heavily drugged up with preeclampsia to protest) and got a 'few extra stitches for husband'. which just turns my stomach (she says it's BS, no difference.) eeek.

it really does help a lot. and i know it might just have to be done when i am in the moment. i'd gotten scared by the idea that i'd be bullied and it would just be *done* to me and i'd feel remorse afterward (a fear driven by my own OB being OOT right now and her stand-in being a very cold non-communicative person). karen's story is in line with what i was worried about. reading these tales i am just re-AMAZED by women's strength and coping. wow.

i have the bradley book from the library (i've been leaving it in DH's path for the last week) and i'm going to burrow in and read that cover to cover today!

[stillplayswithbarbies]

An important question to ask your doctor is "under what circumstances would an episiotomy be necessary and why". In my research this time, I could not find an answer to that question that made sense to me. There is no good reason to do an episiotomy, unless they need room for a forceps birth. In that case the next question to ask is "how can we avoid a forceps birth".

...Karen
Jake age 12
Logan Elizabeth 3/25/03

[gravymommy3]

I went into my first delivery totally clueless. We did not take Lamaze classes, breastfeeding classes, nothing. Looking back now, I see that I could have been a little more prepared. I have a midwife for the first birth and fortunately, did not need a epi. I had a small, 1st degree labial tear, that still hurts me to this day (can't imagine if it have been more extensive.) #2 no tears at all and #3 I practically sneezed and squatted and out she came.

The hospital gave me some type of steriod-based foam to use that helped (I did not know about dermaplast) and just instructed me to do Sitz baths. (may have been called epifoam???)

Is there any way you can have a doula? If one is not in the budget, can you find one in training that needs to attend x number of births to get certified? What about looking for the same in a midwife? Or will the hospital not allow that type person at all?

Good luck on your upcoming birth. Relax as much as possible, and keep focused on the end result, the healthy arrival of your little one.

[parkersmama]

I had a c-section the first time around so my 2nd child was actually my first vaginal birth. I was in labor for a long time but only pushed for half an hour. My doctor was there for 95% of the pushing and he (according to dh it was amazing to see) really worked hard to stretch me out so that I wouldn't tear. I had an epidural so I could only feel pressure and could easily tell when to push. I ended up with a 1st degree tear and the dr. said it was very small but 1st degree is the lowest on the scale so that's what they called it. I think I had one stitch. I was so worried that I was going to be in pain but it never materialized! I did the sitz baths at the hospital and used the peri squirt bottle thing while using the potty for a while but nothing other than that. I am with you...I desperately want to avoid an episiotomy but I'm also afraid of a bigger tear. My SIL just had her first baby and ended up with a 4th degree tear. Everything was fine and the head was 1/3 delivered so they tried to "breathe" him out which didn't work. Some relaxed pushing and still no head so the doctor said "Go ahead and push like normal" and she did and out came the whole baby in one push and she tore all the way back at the same time. I guess you just don't ever really know. I have a friend who is the head of OB nursing at my hospital and she says there is one doctor in my practice who is more likely to do the epis so I'm desperately hoping to avoid him!!!

[KathyO]

I was vaguely hoping to avoid the episiotomy, but it was kind of in the cards because I have some perineal scar tissue due to surgery for a Bartholin's cyst, and scar tissue just doesn't stretch as well as regular tissue.

The Dr. had gone very much along with my wishes in everything that went before, until he recommended the episiotomy based on how things were going, and I don't regret saying yes.

The pain afterwards was kind of general, and blended in with all the other various aches and cramps and whatnot, so it wasn't that bad. I had a bottle for spraying warm water on the incision, and that felt very good when I did it. I was terrified that the first bowel movement would rupture the stitches, but it didn't - the anticipation was much worse than the event! (Stool softeners are still a good idea, though, IMHO.)

Now my daughter is two, and I looked with a mirror the other day, and couldn't see the scar at all. And when I think back on my birth experience, the only other aspect of the episiotomy that I can remember is the doctor threading what looked like almost a yard of suture on the needle to stitch me up - I remember thinking "Ye gods, just how big IS that cut???!!! I'm not a cow!!!" And that's all.

HTH,

KathyO

[blnony]

I had an episiotomy and it wasn't nearly as bad as I had anticipated. I had talked to my OB about not wanting one etc. Audrey was premature and it was either have a vaginal delivery with an epis. or a C-section. I chose the first one. Since she was so early, my birth plan kind of went out the window. I had pitocin for 8 hrs. before I ever had a contraction (my water had broke about 12 hrs before) and Audrey was not doing very well. I had the option of letting the pitocin work for 2 more hours, knowing that with all that I would probably have to have an episiotomy because my body would not be able to transtion naturally, or have a C-Section if that did not work. I was happy with my decision. I also had a problem with delivering the placentia and that was the most painful part even with the epidural. My OB did give me a local before he did it, and I didn't feel anything. He also talked me through it to ease any fears I had. All in all, when the times come, you will be amazed how much you just really want the baby out. (I don't mean that in a bad way) but a lot of your fears are just from the unknown, and once you are there in the throws of things it all changes.
My healing process was fine, and I had to recover in the Peds Unit of the hosipital (on my feet all the time 24/7) because my DD was rehospitalized. It was painful, I won't lie, but not as painful as you would imagine. I did use the Dermoplast, (thats what the hospital used to) and it was great. I only had 2 stiches so I guess it wasn't as bad as what some have experienced. But really, it wasn't as bad as I had thought it would be. Even with all the hoopla, I was very happy with my birth experience. I even told DH the next day I thought I could do that again. :) (Before the sleepless set in...)
I think its great to do all you can to avoid it, but don't beat yourself up if you end up having one. Just try to keep an open mind so you don't have disapointment. I think in the end, having a happy birth experience is important.

[Kristine]

My grandma who was a nurse always told me that episiotomies were generally unnecessary and that along with giving birth while laying on your back, they were both tools to make things easier for the doctor and not you.

A lot of times you don't tear at all, so I would opt to not have an episiotomy myself. With the birth of my son, he just happened to have both hands up over his face while coming out, so he did rip me in several places. I couldn't feel it happening so it was no big deal. And I had a completely natural birth too. The midwife numbed me up down there completely and stitched everything back up. The only thing I felt was the initial needle and that was it. I healed up just fine and haven't had any problems with it at all.

I prefer doing everything in birth naturally as our bodies were meant to give birth. If you don't tear, you won't have to be stitched up at all. So it could go either way. But if you have an episiotomy, you've obviously decided to just go for the snip no matter what. I would personally wait and see how things go. In my mind, the less interference from hospital staff when it comes to my body, the less chance there is of something bad happening that I have no control over to begin with.

[mamahill]

My nurse did massage me, but due to complications, we had to use the vacuum, and vacuum=episiotomy. When my doc was stitching me up, I asked how many stiches there were. He answered, "A couple." I am so glad that was what he said. I made it clear then and there I did NOT want to know how bad it was bc I may never have the nerve to "get back in the saddle" (if you catch my drift;)) again.

The next morning, the new nurse came walking in saying, "So, I hear we had quite the episiotomy!" I shot her a look and said with narrowed eyes, "I wouldn't know." DH escorted her out and had a little chit chat with her.

6 weeks later, I was good as new!

ps - if you DO get an epi, make sure if you're using tuck's pads or something for hemmoroids that it is clear of the cut bc it can rub and the stinging is HORRIBLE.

[dogmom]

I had a second degree tear, the healing wasn't bad at all. I think it was only part of the whole "I just pushed out a 9 lb baby" pain. Some of my friends actually inquired how many stiches I had. I looked at them like they were insane. A word of advice, steal a lot of peri-pads from the hospital to take home. They are definately more comfortable than regular pads.

Jeanne
Mom to Harvey
1/16/03

[mharling]

I had 2 internal tears, but I don't know the size or how many stitches were required. (I didn't think that it was pertinent to find out while I was basking in the joy of our new son!) My recovery has not been bad, so I'm comfortable in saying that it was not affected in any way by the tearing and stitches.

Mary
Mommy to Lane 4/6/03