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Childbirth Cubby

Episiotomies - Are They Necessary?
~ A Message Board Archive

From KiwiZ ~ I keep reading that episiotomies are unnecessary, but the great majority of my friends, even the ones who gave birth recently, still get them. Why is this? Did you have problems healing? What do you think should be done? I had a c-section myself for my first child and while my surgical site was basically healed by the 6 week postpartum visit, I still occasionally had some pain/numbness from time to time until about 9-10 months later when I felt completely healed. I've often wondered if episiotomy scars are similar in healing to c-section scars?

From islandmom ~ My first delivery was a forceps delivery (after pushing for almost 1 1/2 hours). I needed to have episiotomy. It healed very well. With my second delivery, I had a small tear, all of 3 stitches (not on my episiotomy scar) and it is taking longer to heal.

From scrapcmchristy ~ I think that sometimes they are necessary but I also think too often they are given too quickly. I didn't not have one with Jake. My labor and delivery nurse and the doctor were awesome and really worked with me not to tear or need one. I did end up getting an internal tear because of my son's foot on the way out but other than that I naturally stretched. Again, I believe that they can and are necessary at times but I also think doctors do them too much at the drop of a hat rather than work with the patient.

From ebabe ~ I didn't have one, but I ended up with a small tear that healed very well. My doctor doesn't do them routinely.

From DaneMom ~ I had to have one with all three, even my 3 1/2 pounder. That's the only way I could push them out. I had no problems with healing with any of them.

From lunchbox ~ I had a fourth degree tear and episiotomy - I guess Lucy was too big for me to handle down there. It took longer for the doctor to stitch me that it did to deliver Lucy. Since she was my first, I can't compare it really. I do know that either my stitches didn't hold or my doctor didn't do a good job because I have problems with fecal incontinence especially with tight pants or my girdles. I wish I could have surgery but I don't want to if I have another one. I'd rather wait until after that.

From daisygirl ~ I had a rough delivery with my first baby. I had a third degree episiotomy. I had the suction used that didn't work, and pushed for well over two hours, and actually had a nurse and the anesthesiologist in the room pushing on my stomach as I pushed to help get the baby out. I was very close to having a c-section. It was so big it took 45 minutes to stitch me up. Healing took a long time, and I was in a lot of pain for the first week after the birth. Hurt to walk, sit, have a BM, to pee for a couple days. UUggHh!! Sex hurt a lot the first few times too! We just had to work through it. It got better. I had to do Kegels every day to regain strength in that area too! It was over 8 months before I felt back to normal.

With my second baby, I had a small tear which quickly, and I felt 100 times better after the birth.

With my third, no nothing! I felt great afterwards.

I don't know if letting me tear would have been better that the episiotomy I had the first time. I can't imagine why I would have needed to be cut so much. I had a male doctor and didn't get the perineal massage; I had females with the next two and they did the massage. I think it helped. I always say I do not want one, after that first time. I had other problems during the delivery too; I was afraid when I got pregnant with the second time

From 2bighogs ~ I believe sometimes they are necessary and sometimes they are not. I had one with my first delivery, but I do not believe I needed one. I did not want one, but the doctor said that if she saw me starting to tear she would do one. You know how when babies are born they are cone-headed? Alisa had a perfectly round head, so that kind of makes me believe she cut me more than necessary. In fact, one of the weirdest comments I got after birth was someone asking if I had a c-section because my baby's head was so perfectly round. It took a very long time for me to heal, and those first 2-3 weeks were horrible. Coughing, laughing, sneezing, anything forceful (really, even standing and sitting) made me hurt sooo bad. But, I did eventually heal and I'm fine today.

With my second one, I did not need an episiotomy. I had a small tear, and that's because I just could not stop pushing when the doctor told me to. I think I had 3-4 stitches, and I was fine. No pain whatsoever, right from the start.

From Andrea_G ~ I had one with my first baby. If I hadn't had an epidural and hadn't been basically flat on my back, it wouldn't have been necessary. It was necessary because of everything leading up to that moment. It took more than a year to heal to the point where I didn't feel it or have pain during intercourse. I had a tear of the same degree with baby #2, and it healed beautifully in 3-4 months. No tears with Baby #3. Baby #2 was born naturally with me in a full squat and she came out like a cannonball. Baby #3 was a waterbirth at home.

Routine episiotomies are very old school obstetrics and most of them are either unnecessary or preventable by not having an epidural or an induction. More and more OBs are leaning towards NOT doing them, but they are still too common. If OB does one out of every 4 births, it's still too often. My midwife has delivered 1500 babies and has only ever done it twice.

Episiotomies and cesareans heal very differently. The tissue around your perineum is more like the tissue around your lips. When you get a cut on your lip, it heals differently than a cut on your skin. I was bit by a dog on the lip and the only visible scar is the one on my skin; there really isn't a scar in my lip area.

From LeahsMom ~ I had an episiotomy with my first and didn't like the experience very much (recovery, etc). So when I went to deliver the second time, I conveyed to the doctor and the nurse that I did not want another episiotomy. I tore. I'm not sure why, but for me, the healing time on the tear was worse and much longer than on the episiotomy.

From mom2jazzygirl ~ They are completely unnecessary in most cases. They are needed if baby is in true fetal distress and rapid delivery is essential, or if forceps are necessary. Unfortunately, many doctors still think its easier to cut. The simple reason is that to avoid a tear requires patience, and most doctors don't want to sit there and ease a baby out to avoid tearing.

From TangoMom ~ In my area, episiotomies are routine. No problem with mine, (vaginal with epidural).

From M&M ~ With my first child, my doctor was in the room for less than five minutes when she gave me episiotomy. She damaged a gland when she cut me. Four years later, I had to have surgery to remove the gland that she ruined because I kept getting cysts the size of ping pong balls at the site. She was in a hurry. My second baby weighed 9 lbs 14 oz. and had a huge head. My midwife delivered him with episiotomy and had just a small tear.

From Sweet Pea ~ I didn't have one, but tore anyway. I healed nicely though.

From djk42 ~ I had a few small tears with my first. With my second, I was cut, but she had a smaller head so I couldn't figure out why I "needed" to be cut when she said she wouldn't do it. With my third, the biggest baby of all, no tears or cuts, but I had a midwife who held a hot compress on me (so I missed the 'ring of fire' experience) and I wasn't on my back.

I am one of the ones who still has troubles. I read somewhere online that episiotomies can make orgasms very hard to get. I haven't been able to have them since my episiotomy. Before I read the article I thought I was "broken" and felt like it was all my fault. Now I can blame the doctor! (My husband was upset because he thought it was his fault so removing the blame and just being okay without them has helped our love life.)

From marion ~ I had one almost two years ago and am still having problems during intercourse. I had a fourth degree cut and it is sometimes really painful! It also hurts (is sore) around AF time! I will do everything in my power not to ever have one againi!!! It was not a good experience!

From DAmom ~ I never had one. My first son was posterior and ripped me third degree, an episiotomy wouldn't not have helped. I healed up fine from my tear. My second son was born normally and the doctor just used lubricant to help stretch me out; I had a tiny tear on the inside but not on the outside. So I didn't need one then either.

From MamaJAM ~ I had one with my first delivery. There was no way around it and even with one, I still tore pretty bad. The delivery was truly horrible and my body suffered greatly. The episiotomy took a LONG time to heal but so did everything else that was literally ripped to shreds during delivery. She was almost an only child (it was YEARS before we even thought about having more kids). BUT, she also truly 'paved the way' for her younger siblings. I have not needed an episiotomy since her delivery and haven't needed any stitches since. (All four of my kids so far have been vaginal births.)

From ukmum ~ I've had one 3 times as each of my babies started to get stressed and the heartbeat was slowing down. I never had any problems afterwards, healed good.

From Loril ~ I had one with my first. I healed quite quickly. It was the routine at that time to do them. With my second, I did not have one. Boy do I wish I did!!!! They were still the routine at that time. She came flying out on the second push. Took forever to get stitched. I asked the doctor how many stitches and his words were "I lost count." It took a while to heal, but the worst part of it was not even the healing; it was the actual tearing. I recall sitting up quite quickly screaming "You let me tear!" I felt bad about it after, but it did hurt oh so much!

With my third, I did not have an episiotomy either. I did discuss with the doctor what happened with #2, so at the point of pushing we made a point to not let her shoot out so quickly. I pushed about six times with her, to ease into it more. I did not get an episiotomy, only tore little bit and did not need stitches. The thing about my second baby was that she was the smallest of my babies! So size didn't mean a thing.

From Bosoxk ~ I had one with both my daughters. The first one wasn't a choice, and quite honestly, I didn't even know it had been done till afterwards, as I was naive and didn't know to ask about it. It healed just fine and had no problems with it. With my second baby, I requested one as it worked just fine the first time around and I had a fear of being "stretched" out too much when it came time for intercourse again. I guess there isn't much truth to that fear, but for me it was valid enough for me to have the same procedure done again.

From Lectra ~ I believe that my episiotomy was COMPLETELY necessary! I had a 10 pound 1 ounce baby that came out "the old fashioned" way. Had I not had an episiotomy, I would have either had to 1) have an emergency c-section or 2) tore in a horrible way all the way up to my butt. I am glad I had one, however the recovery took a while but probably less time than a c-section would have.

From bromsmom ~ I had an episiotomy (my OB does not do them routinely). I was glad to get it and would do it again if necessary. It was sore for quite some time after delivery, but hey, childbirth is no small feat.

From babydudesmom ~ I had to have one too ! 9 lbs,13oz's of baby coming out . . . he needed a little extra room! I had no problem with it healing. I would rather have a controlled cut than a tear like my sister had. Her ob didn't like to use episiotomies. She had a horrible tear and her baby was two pounds lighter than mine.

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From andrea_G ~ Just the question "Are episiotomies necessary?" is complicated by factors that could lead up to the potential necessity of an episiotomy. Induction, pain medication (narcotics and epidurals), birthing position, controlled pushing, etc. by themselves or in combination can lead up to the potential necessity of an episiotomy. If these factors hadn't happened, it increases the likelihood that an episiotomy wasn't necessary.

From jeanaj ~ I have never had an episiotomy and am very glad for that. I did tear with the first two, but honestly it was not that bad, and I was not in nearly as much pain or as uncomfortable as some of my friends that have had them.

From freckledmama ~

quote:
Just the question "Are episiotomies necessary?" is complicated by factors that could lead up to the potential necessity of an episiotomy. Induction, pain medication (narcotics and epidurals), birthing position, controlled pushing, etc. by themselves or in combination can lead up to the potential necessity of an episiotomy. If these factors hadn't happened, it increases the likelihood that an episiotomy wasn't necessary.
I don't think you can generalize quite this much. When I had Brianna, I:
~ Was induced (my amniotic fluid was beginning to deplete and I was overdue)
~ Had an epidural.
~ Was on my back in the "traditional" birthing position at many hospitals.
~ Was coached with my pushing.

I did not need to be cut, and I had only two minor abrasions. For the record, I am NOT a "wide" woman so to speak, and Brianna was an average sized baby. BUT I did my Kegels every day during pregnancy, and had talked to my OB about not cutting unless it was absolutely necessary - he was very understanding and supportive.

I think that even if you don't have a birth plan (I didn't) it's important to talk with your doctor about how they feel about cutting. Some doctors feel it's just routine. If you aren't comfortable with that, you need to know it early on and either work it out with your OB, or find a new one more in tune with your feelings.

Are they done far too often? Absolutely. Are they sometimes necessary? Absolutely.

From Andrea_G ~ All the research backs up that those points I made increase the likelihood of the necessity of an episiotomy. While your experience is an example of when the dice rolls in favor of NOT getting an episiotomy, it's quite likely that the woman across the hall who had the same issues precluding the birth (maybe just a different doctor) did end up with an episiotomy.

From Paper Tiger ~ I stated in the very beginning to my OB that I did not want one. He respected that. Come delivery time, he remembered my request. After two hours of pushing, I told him "get this baby out NOW!" He waited about 10 minutes, trying to move my son's head from behind my pubic bone, trying all kinds of different birthing positions, everything you could imagine. I at that point demanded he do something to get the baby out. He said "I'll have to cut you then." I said it was okay. He used the vacuum. It didn't work. He had to cut again to try to get the forceps in. He couldn't even get them in. Then, as if by magic, my son just popped out, approximately 30 seconds before I would've had to be subject to an emergency c-section. I asked after he stitched me up how many stitches he put in. He said, "Well, let's just say about 20." It took a long long time to heal. I'd venture a guess that it was 6 months before I felt completely back to normal.

You just never know what's going to happen in delivery. I was certain that I would do everything 100% natural. No epidurals, no cutting or anything of the likes. I didn't have an epidural, but I did have a shot of demerol, and that was terribly disappointing to me. But the end result was still my beautiful boy!

From freckledmama ~ My point was that it's a procedure that women need to be talking to their doctors about LONG before it becomes an issue. I just had my first OB appointment yesterday for the new peanut, and would you believe, it was one of the questions I asked? I wanted to know if she did them regularly and what her criteria was for doing them at all. Had my new OB told me she did them routinely or felt they were often necessary, I would have either worked with her to come to an understanding that I didn't want one unless it was absolutely unavoidable, or I would have found a new doctor.

We may have to agree to disagree (and I don't mind if you don't ) but I honestly believe that it's more each individual woman's body, the size of the baby, and each individual doctor's style that AT LEAST IN PART contributes to the statistics. And while I know there are studies out there that probably support your arguments better than they support mine, I'm just not biting. Once upon a time they said formula was better than the breast, or that it was safer to lay a baby on his belly, and so on.

From babydudesmom ~ I don't see why having a little cut is such a big deal. I mean in the whole scheme of the pain looking back, it was the almost 10 pound baby coming out of me that hurt more than a few stitches. Maybe I don't know how bad it can be.

From KimT ~ I was induced, had an epidural, and no episiotomies either time. No tears either.

From Andrea_G ~ Just a note - it has been well documented in episiotomy research that practitioner style really clouds episiotomy research - it's a very frustrating factor.

From rhwalters ~ I had one only because a vacuum had to be used to get Abby out. Even after the episiotomy I still had a third degree tear. It took nearly an hour to stitch me up. It was very painful for three months but now I have no problems.

From dbivens ~ I pushed for almost three hours and his head was just too big to come out. The doctor told me before we started that she only gave episiotomies unless absolutely necessary and unfortunately in my case it was. She had to put a suction cup on his head and pull him out. She said my hips were great birthing hips but his head was just too big. I was in so much pain the first couple days and then it started healing up. No problems with it.

From freckledmama ~ Yes, I believe that episiotomies are sometimes necessary however, I also believe that they are done far too often.

From catkrazy99 ~ I never had one, but it is my belief that it is easier and faster for the doctor to do the episiotomy than to wait and let the baby come naturally. I've been told by others that the pain from tearing and the pain from episiotomy is the same, but that it is easier to heal from a natural tear than a cut. It is my choice, when giving birth, to risk tearing (if the baby doesn't need delivered quickly due to problems) than to have the episiotomy and I even wrote that in my birth plan.

From hunter ~ I don't think they are generally necessary, but because most practitioners aren't educated in how to support a woman in a natural birth, and because most women still have interventions and medications that keep them from natural birth, episiotomies are done more often than they ideally should be. My history: five babies (including a vaginal breech), no episiotomies, two small tears (one healed on its own, the other was repaired with glue instead of stitches.) Here is an excellent, well-documented article.

From MichiganMom ~ I told my midwife point blank I would rather have a c-section than an episiotomy. While some of the women here haven't had any problems with their episiotomies, I heard too many horror stories. I did have a c-section due to the fact that my blood pressure was far too high and kept getting higher. While I know each woman is different, my sister went natural two months before me and it took her a lot longer to heal than it did me. By the second week it was killing me that I couldn't drive yet and had to "take it easy" (well OK, I didn't miss the house work or cooking any LOL).

From JacobsMummy ~ I haven't had one but they are a necessary procedure in some circumstances - like if the Mum can't push the baby out and needs an assisted delivery amongst others.

From pamiam ~ I have five children. The first three I had in a hospital with a male doctor. I had no idea what was going on with my first child and so I thought nothing of it when he cut me. The second and third, he sliced first and didn't even bother to check to see if we could do it without. I think it was just standard procedure for him. Still, I didn't give it much thought because I thought it was just what was done. After having the fourth and fifth at home with a midwife and no episiotomy and no tears, I have come to the conclusion that they are most of the time just done to save the doctor time. If my midwife would have just sliced me without working the baby out slowly, we wouldn't have taken quite as long with the birth but man oh man, it sure was nice to be able to go to the bathroom without pain after giving birth!

From CelticGirl ~ With my first baby, I pushed for almost 3 hours with no pain relief, her head would NOT crown, so I had a small episiotomy and she was born within two minutes. I feel the episiotomy was absolutely necessary here (hurt like hell though). With my second daughter, I pushed for almost 3 hours, this time with an epidural, but again she would not move down the birth canal. My choice was an episiotomy and ventouse delivery or emergency section. She was delivered in theatre after being given one shot only at the ventouse delivery. So again, the episiotomy was needed most definitely; the doctor that night saved me from having to have a c-section. Both girls were 9 lbs. Should I ever have a third child, because both babies did not progress down, then I'll be looking at a c-section, which I'm OK with as I'm not going through the deliveries I had again.

From mmcbride ~ My doctor's office has a really low percentage of giving episiotomies. They did a ton of massage with olive oil but it just wasn't enough. I ended up needing one, my son was over 10 pounds and had a big head. If it's necessary, I'd take one over a c-section any day. I was up walking within hours and had no restrictions.

From Quoth ~ Our hospital doesn't do routine episiotomies. I discussed my birth plan with my midwife (it's a midwife led unit, unless there are major problems) and explained I didn't want one unless absolutely necessary. I did lots of perineal massage and chose not to have an epidural to lessen the likelihood. I had wanted a water birth but unfortunately I was 6 days overdue and came out in a rash caused by my liver failing to process the extra toxins properly so they booked me in for induction. I wasn't allowed to use the birthing pool because of that, however when they examined me they found I was already having contractions, but my cervix was still long and not doing its job so they inserted Prostin gel to soften it up.

Charlotte was lying in an awkward position and wouldn't turn the right way or tuck her chin in so she was coming with the widest diameter of her head first. I pushed for 2 1/2 hours, changing positions to see what would work best. The midwives tried every trick in the book but she just kept slipping back. Charlie had a bm, and my waters were stained with meconium and they decided they had to get her out as she was getting stressed. They sent for the doctor to try ventouse and possibly forceps, but they were in theatre which bought me maybe 20 minutes to try and get that baby out! The midwife decided to try an episiotomy, seeing as I'd need one anyway if it was a forceps delivery, and she said it would be better if she did it rather than the doctor, who would just breenge in there! ITA!

So I had one of those ones that angle slightly outward rather than straight down, which provided the extra room required. Charlie finally made an entrance as the doctors arrived! I remember saying to the midwives that all that perineal massage had been a waste of time, but she said not at all; I probably wouldn't have stretched as much as I did without it. She was half expecting a horrible tear and she was sorry she had to cut me but there really was no other option. Hopefully next time things will go a little more straight forward and I'll get my water birth!

From DoulaAmanda ~ My whole reply is really disgusting, so if you are easily offended do not read it. My daughter was born 2 1/2 years ago, and I still have severe pain at the site of my episiotomy during AF (the extra bloodflow down there makes it very sore). Sometimes during AF if I stand or sit wrong for too long, it starts throbbing and hurting so much that I actually have to lay down with an ice pack between my legs! I also have a rectocele, which means when I have a bowel movement it sort of pushes up into my vagina instead of coming out straight. This is disgusting, but I wear a glove and put a finger inside my vagina to hold it straight so it can come out. If I don't do this, I get hemorrhoids and the bm stays pushed up by my vagina and can't come out. *barf* The surgery to fix this is around $5,000 and not covered by my insurance, so I suppose I will have to live with it for quite awhile.

I was young and dumb when my daughter was born, so I went along with the doctor's advice to have an epidural (for high bp) and she started the pitocin on her own. Very long story, but they ended up giving me a large overdose of pitocin and my uterus almost ruptured (it tore a small amount and I hemorrhaged, but not bad enough to need a hysterectomy thankfully). When they let me push (over an hour after they knew I was fully dilated, but I suspect about 3 hours after I was *actually* fully dilated--ugh--another part of the long story), my daughter was already at +2 station. However, the external parts did not have the chance to stretch.

*very graphic* With the first push I tore to one side of the labia, second push tore to the other side, third push tore to the first side again, fourth push tore up into my urethra and into my clitoris. At this point, the doctor decided to do an episiotomy which tore more than half an inch inside my rectum and more than an inch up my vagina, a complete tear all the way through the tissue there. It took way over an hour to sew me up, and I am fairly sure she did it wrong. I could not walk at all for about two weeks after my daughter was born and was on pain pills for over a week. Sex was painful for 2 years after she was born, and since then I have not had sex (I'm separated from my husband).

I absolutely agree that the circumstances during the labor have a major effect on whether or not you will require an episiotomy. freckledmama, it sounds like you were very fortunate to not need an episiotomy. Unfortunately the majority of women who receive the medical interventions that Andrea mentioned are not so lucky. I am positive that if I had not received pitocin (which I did not even need), I would not have had the extensive damage to my perineum that I did. I honestly think between the uterine tear and all of the tears/cut down there, I would have been better off with a c-section. Because of my daughter's birth, I was inspired to become a birth doula. I eventually plan to become a midwife, when my daughter is older. If I can prevent one woman from going through the hell I went through, it will be worth the struggle to become a midwife.

From Marianne ~ I had a forceps delivery, so I think it was probably essential. Healed up no problems. I'd rather have episiotomy than tear.

From hunter ~ Episiotomies Do Not Prevent Deep Tears
Episiotomies Do Not Heal Better Than Tears
Episiotomies Do Not Prevent Pelvic Floor Muscle Relaxation
Episiotomies Do Not Prevent Fetal Brain Damage

The authors of this article reviewed more than 350 articles, reports, and book chapters published between 1860 and 1980 and found no convincing evidence that episiotomy prevented tears into the rectum, damage to the pelvic wall, or trauma to the fetal head, or that episiotomies were easier to repair than tears.

From missmeg ~ I didn't have one with either of my deliveries, but my doctor almost did it with my second. When I told her my desire to tear vs. cut, she explained why:

With my son, I had a bad third degree tear. I don't remember how many stitches, but I tore both in and out. When I started to push with daughter, the doctor explained that there was the possibility I would tear just as bad *or worse*. The doctor would rather give me a small snip to the side than see me make a scar even worse. As it was, she did the massage, and I ended up with two tiny-tiny stitches. But I was grateful she explained the potential reason for doing it.

From Lesley ~ I refused to have one. My OB and I discussed this at some length and he said that current research shows that tears heal better after stitching than the cut does. Additionally, I felt like I still had a good chance of remaining "intact" if I let nature take its course. I did tear, it was a doozy, but it healed fairly quickly and was about two months before things were "back to normal" down there.

From Tylergirl ~ I've had two but didn't need one with my third and last baby who was over 10 lbs, and I didn't tear either. So, no, I don't believe they are necessary! I also will add that I felt so much better after delivering my last baby! The healing time was so much quicker, no extra incision to heal or recover from; I was just a little swollen down there for a while but that was all. I say NO! NO! NO! to episiotomies . . . if you can.

From silly mommy ~ I believe I needed one. My FIRST child was 10.5 and I am pretty small. I could not get him out. Finally, they used forceps. He also had shoulder dystocia. I am not sure how bad my tear would have been if they hadn't done it. I have healed fine.

More on episiotomies:
  • Get Through Childbirth in One Piece! by Elizabeth Bruce, MA, CCE
  • Preventing an Episiotomy by Nancy Sullivan, CNM, MS, FACNM
  • Episiotomy vs Tearing by Nancy Sullivan, CNM, MS, FACNM
  • Third Degree Tearing by Barbara Parker, RN, ARNP, CNM
  • Episiotomy Scar Problems by Barbara Parker, RN, ARNP, CNM

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