Womb to Bloom - Maternity & Beyond

Submitted Question · 02/22/09, 6:48am

Is it better to tear or have an episiotomy?

WombToBloom · 02/23/09, 5:11am

It is far better to have an episiotomy than it is to tear. When you tear, you can tear anywhere, including the labia and obliquely along the perineal body, the collection of tissue between the vagina and the rectum. An episiotomy is generally done by making a vertical (up and down) cut from the vagina part way to the rectum. If the episiotomy doesn’t tear much further, it just needs a few internal stitches. If the episiotomy tears further, it may tear into the muscle of the perineum and the muscle itself needs to be repaired. If it tears into the rectum itself, the rectum must be repaired first and then the muscle and finally the soft tissue.

There is no hard and fast neat way to repair tears. They can involve any tissue and can be very painful when compared to an episiotomy. Internal sutures are still used and the tissues are still approximated but the repair is more complicated and it may not heal as fast as an episiotomy. Some doctors and midwives may disagree with this and say it is better to tear than to have an episiotomy but from a repair aspect and from a pain aspect, the episiotomy is much easier all around.

journeybirth · 03/24/09, 3:41pm

Sorry, I'm going to have to disagree! If you have an episiotomy, you are guaranteed a second degree tear (which is what an episiotomy is). If you don't have an episiotomy, you might tear, you might not. Also, you can tear with an episiotomy - think of a piece of fabric. Hold it up, and try to tear it - it doesn't tear too easily. Make a little snip and then try to tear it - it's easy to do. Also, to try to avoid a tear, you should avoid purple pushing - the pushing where the nurses and doctors have you hold your breath and count to ten.
As a personal aside, I've had both. The episiotomy was a much harder recovery than the two 1st degree tears I had with my second. And with my third, who was my largest baby by a full pound (and 2.5 pounds bigger than the one before her!), I didn't tear at all. Go figure!

WombToBloom · 03/24/09, 3:59pm

Great insight and I did say some would disagree. Personally, I'd want neither!

journeybirth · 03/24/09, 4:13pm

Quote:

Originally Posted by WombToBloom

Great insight and I did say some would disagree. Personally, I'd want neither!

Definitely not tearing or getting cut is the best option! I'll agree with you on that!

Knoxville Doula · 03/25/09, 12:25am

I would have to say that it truly depends on the circumstances. Having attended over 100 births I have seen some terribly unnecessary episiotomies, some very tiny tears that would heal in a day or so, and everything in between. The thing is, you aren't going to know until that very last second, but you CAN do things to prevent having to have an episiotomy, such as not having an epidural (so you can feel to push), not laying flat on your back while pushing, having a midwife or doctor who will help support and stretch the perineum, etc. These are things you should be thinking about now during your pregnancy and discussing with your health care provider.

DoulaJamie · 03/25/09, 1:14pm

If you are far along enough away from your delivery date you and your husband can do something to stretch out the perinum...it's called perineal massage...you can google it or go to the book store and get the book called The Birth Partner...it will explain how to do it...

It basicly gets that area ready to stretch so you may not end up either!!...

Good Luck!!

labor doula · 03/26/09, 8:04pm

Thank you Knoxville Doula best said. I have attended well over 100 births and over 1/2 had nothing no tear or cut. and the ones who let thing go natural were so small. all that were cut had 3rd - 4th degree cuts

Chesapeake Birth · 03/27/09, 2:46pm

Don't forget warm compresses to help avoid the tear too in between pushes.

Doula Jenny · 05/08/09, 10:45pm

Quote:

Originally Posted by WombToBloom

It is far better to have an episiotomy than it is to tear. When you tear, you can tear anywhere, including the labia and obliquely along the perineal body, the collection of tissue between the vagina and the rectum. An episiotomy is generally done by making a vertical (up and down) cut from the vagina part way to the rectum. If the episiotomy doesn’t tear much further, it just needs a few internal stitches. If the episiotomy tears further, it may tear into the muscle of the perineum and the muscle itself needs to be repaired. If it tears into the rectum itself, the rectum must be repaired first and then the muscle and finally the soft tissue.

There is no hard and fast neat way to repair tears. They can involve any tissue and can be very painful when compared to an episiotomy. Internal sutures are still used and the tissues are still approximated but the repair is more complicated and it may not heal as fast as an episiotomy. Some doctors and midwives may disagree with this and say it is better to tear than to have an episiotomy but from a repair aspect and from a pain aspect, the episiotomy is much easier all around.

I strongly disagree! episiotomy is not the better way to go! an episiotomy can be cut where one wouldn't be needed at all. a mom could have been given a 4th degree episiotomy when if left alone she might have only been lift with a skid mark, when the perineum is properly supported if there is any tearing at all it should be minimal! I have seen many OB's just sit there and let a baby's head just "pop" out instead of using counter pressure and perineal support this is what causes tearing. warm compresses and EVOO are the way to go.

I also wanted to add that both my boys had 14-1/2 inch heads with not so much as a scratch because, I had a crock pot of wash cloths stewing in water, EVOO & grated ginger and a midwife with great support.