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epsiotomy vs natural tears

  1. #1
    lg969 is offline Registered User
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    epsiotomy vs natural tears

    hi all

    Im due in 8 weeks and I would love some advice regarding epsiotomies versus natural tears. I am opting for a natural birth and my doctor has suggested that I get an epsiotomy and not let it tear naturally. What method hurts more and what heals faster?

    also, she suggests that its better go directly for a c-sect if complications occur during the natural birth as getting as epidural relaxes your lower body and makes it harder to push....does anyone have any past experience with this?

    i am super freaked out and would love any advice/experiences.
    thanks

  2. #2
    jvn
    jvn is offline Registered User
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    Ummm, I don't have experience of natural tearing, I had it on my birthplan but then when the time came the doc did an epesiotomy. With hindsight I'm a bit p1ssed off about that but the reality is when you're in the midst of giving birth you don't have that much free brain space for decisions so you pretty much do what someone tells you to do. At least that was my experience. Having said that the episiotomy wasn't *that* bad and I don't think it would have been worth the fight to stick with my original request - you have stitches, you get better, you move on. There's so much else to think about.

    On the c-section, I'd say that is worth fighting and from my personal experience I'd say your doctor is feeding you a line. Of course it depends on the nature of the complications, some c-sections are absolutely necessary but that you can't push with an epidural is rubbish. I had a walking epidural which was topped up every few hours as the effect faded and the pain came back, they would then usually let it wear off as you go into labour proper and by then you're in the zone and you don't need it. I had an epidural and my baby was out in five pushes.

    A c-section is easier for the doc, bigger pay packet and a short time frame, this is where your husband needs to be your advocate because if she starts to push you to have one when you're in labour it could be distressing. You need to coach your husband/birth partner with what you want and get him to ask why she is recommending a cs, is the baby distressed? Are either of you in any danger? Would it be ok to wait until the epidural wears off a bit and try some more pushing? I had a meeting with Hulda at Annerley to talk through all this, she's pro natural birth and knows a lot about the doctors and hospitals in HK, if I were you I'd book a meeting with her and make sure your husband can attend too and you can discuss all your worries and scenarios.

    At the end of the day, no matter what happens as long as you are all safe and healthy at the end of it, that is what is important but I'd also not let a doctor's personal opinion take away the natural birth you are looking for if you can possibly avoid it.

    Good luck.

  3. #3
    Frenchy is offline Registered User
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    An episiotomy shouldn't be automatically done, only in cases of a big baby, baby coming bottom first or a short perinea, also it will take longer to heal and it's more painful than a natural tear. Maybe you won't need an episiotomy at all, or the tear will need only 1 or 2 stitches.
    Concerning the peridural and the fact it's harder to push, it's true, but easy to reverse, as you can just not ask for the last "shot" of pain killer so you can feel the birth and it's easier to push. Don't be afraid by the pain, it's just part of the natural process, and it stops as soon as the baby is out.
    I can understand your stress, but your doctor seems to be a bit "pushing". It's the most wonderful experience for a woman, make it yours !
    And congratulations ;)

  4. #4
    nicolejoy's Avatar
    nicolejoy is offline Registered User
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    My first born, I had an episiotomy and it hurt like CRAZY for probably 2-3 months while it was healing. My second born, I had a 2nd degree natural tear and it did still hurt a bit, for about a week - and then it was totally fine. My daughter is only 3 weeks old and the scar doesn't hurt at ALL. It took me soooo long to get to that stage with my first...

    I know that probably a part of it might be because it's my 2nd, not my first - but I do think that the natural tear did help. I heard that doctors prefer episiotomies because a) it can shorten labour a bit, and b) it's much easier for them to stitch up afterward...

    Yes an epidural can make it harder to push - but seriously, even if they have to use the vacuum to help you, it would be much better healing wise than a c section!! My 2nd, they used the vacuum (without the episiotomy) and it sped things up a lot because I'm a really bad pusher (or maybe it was just the effect of the epidural, but I wouldn't have NOT wanted the epidural...) - the vacuum wasn't as bad for me or the bub as I thought it would be...

    My experience is that a natural tear seems to heal much better than an episiotomy, and that even with an epidural and assisted birth, it's possible to have a very fast recovery. I've never had a c section but I'm sure I wouldn't have recovered as fast from one of those - I'd do ANYTHING to avoid that...

  5. #5
    southside852 is offline Registered User
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    I am due in 4 weeks with #2. WIth my first, I had a 3rd degree natural tear. My doctor here said that I could do an episiotomy, but it goes against the natural grain of my skin so could hurt in fact even more. The percentage of me tearing again with #2 is quite high and especially in the same exact spot which was not fun the first time around - painful, longer recovering time and more bleeding. My baby is bigger this time around so both my OB/GYN here in Singapore and in the US suggested a c-section. Episiotomies have also been decreasing over the past years in the US . . .

  6. #6
    banane76 is offline Registered User
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    I would go for the natural tear unless it's absolutely necessary and we had that in the birthplan plus I kept emphasizing I didn't want to tear or have the episiotomy to the nurses and they said they didn't want me to either. I would recommend doing perineal massage every night now though so you can stretch the area down below and then you can kinda mimick how the stretching will feel like when you push. You can just use some olive oil and your partner can help you as well. We used the Epi-no but we weren't diligent about it. I had a first degree tear and it took about a week to feel normal. The nurse said it was a very little tear and she stitched it up with the dissolvable sutures. Also when I was pushing, the nurse would massage the area with KY jelly to reduce tearing. A good ob/nurse midwife will also help you control your pushing and let your body naturally stretch out so they may stop you from pushing (when you don't want to, but listen to them!) so you don't tear as much either.

    About c-sections, they're usually unnecessary and I think unless it's a medical emergency, your doctor is just trying to make their lives easier. Watch the Business of Being Born...VERY eye-opening. Also, ask WHY whenever a procedure is mentioned. If not you, your husband/birth partner!

    Good luck!

  7. #7
    Taitam is offline Banned
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    I would say try to do it without episiotomy to begin with but if it's just not coming then trust your midwife's/doctor's judgement as to whether one is necessary, I had two episiotomies for my first child and they were both very superficial and healed really well and quickly. Lot's of women get them so don't stress too much and I do think they are preferable to getting a very deep tear in terms of healing.

  8. #8
    banane76 is offline Registered User
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    P.S. I got an epidural after 40 hours of back labour and I was still able to push my baby out. Once I was fully dilated, they turned off the epidural and syntocin so that I could get the feeling back!

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