Things Change

have you considered a doula? I work as a doula for Jan Mallak's Heart and Hands ###-###-#### good luck and take care!

There is this great thing called perineal massage where the doctor massages the vaginal tissue as the baby's head is coming out, and stretches the skin. I have it done several time, and it's so much better than an episiotomy.

I had a my oldest daughter at 19, she is now in middle school. I needed to be stitched up from 2nd degree lacerations. The 2nd baby (now nearly 2), came out with no problem, a few pushes and that was it. No stitching required. Even though it has been a while, the second one will be easier. Mine were 9 years apart. Now you have a built in moms helper and babysitter.

The lay public doesn't understand that when you are having a baby at a hospital under the care of a physician, his job is to get the baby out safely. Most cases it can be done with a mild tear that is stitched up easily. Sometimes, due to certain circumstances, you need to be cut for the mere safety of getting baby out. Posters can talk all they want about things being YOUR choice but ultimately...the doctor has to make descisions based on their training to get your baby out safely. REMEMBER...people sue and blame the doctor when their baby isn't perfect. Lay people always suggest finding a doctor to do things YOUR way...what you need to do is find a doctor who is willing to do things the SAFEST way!!! I have heard friends who have had vaginal deliveries tell me that their doctor is willing to let them tear except in the cases where the tear is not being controlled properly and going to cause rectal or urinary problems. It is in these cases that the doctor will opt for an episiotomy which is a more "controlable" situation.

Dear E.,
I had my first child in February this year. She was a week early and 8lbs1oz.
I did not want to have an episiotomy. My OB massaged the vaginal opening continuously between contractions. I did tear slightly and only needed one stitch above and two stitches below. In my experience, I would rather have a natural tear than risk extensive nerve damage from unnecessary cutting. Everyone needs to do what is best for them, but I recommend letting your body do it's job. We were made for it!
Best wishes,
S. J

Okay, I was very concerned about tearing down there. I had read about the peritineal (sp?) massage. You can look it up on the internet or in prenatal books. Basically, it is when you have your partner (using a little oil) gently massage and stretch the peritineum in preparation for birth.

I've heard that it works wonders and cuts down on tearing or the need for an episiotomy. My OB/GYN recommended it to us. Unfortunately, I can't tell you from personal experience whether it works since all three of my children ended up being c-sections.

You should check with your OB to see if there is anything else you can do to help.

Good luck! Hope this helps.

E. -
I had tearing when my daughter was born - As the OB said "She found her own way out"! However, I had an epidural & didn't feel a thing when it happened. Don't get me wrong... I definately felt the sensation of her being born, just not the pain. He stitched me up and I'm fine. OB's don't cut anymore because the healing is much more natural and better. Also, the tearing occurs where it needs to, not where an OB decides... which might not be necessary.
I did, however, have a little issue for a while as the scar tissue was bulding up.. now it's fine, tho, and I don't think it'd be any different from a episiotomy.
Good Luck - You'll be fine!

E.,

please don't freak out about not having an episiotomy. i'm sorry you received one in the first place - it is now standard medical practice to NOT do one unless an absolute emergency. unfortunately until recently we didn't know the damage we were causing for women later in life.

tearing is fine - seriously. it is a natural thing that will heal naturally. many women tear, and turns out the tear is usually way WAY smaller than the cut would have been. smaller slit, shorter healing time, more natural process, less scarring, less worry about incontinence and pelvic floor integrity later in life. if you tear so much they will treat you as if you were cut, not to worry there.

that you've been cut previously means you have a scar. depending on how that scar healed, you might tear differently (if at all!) than if you didn't but still - i would rather the tear than the cut.

there are plenty of articles out there to help you understand why the episiotomy is now not standard procedure... i promise i am not filling you with hot air - i am a 3rd year medical student and expecting my first in september. i've been reading and consulting with my OBs and my professors out the wazoo.

best of luck to you, and try not to stress.
C.
pax

It will all be Ok... trust your power and ability to laugh and injoy labor. read up about the different oils you can apply help you stretch. practice yoga and deep breathing. your labor will go smooth-- create a mantra, a phrase to repeat and believe, and it will definately help you feel secure, strong, and capable. remember that your daughter is learning about how to handle life and birth from you, so find & be your best power for your lineage : )
i'll be praying for you!
peace,
C.~*

E.,
I also had a large baby who was 9lbs 9oz! His head measured over 13 inches at birth!! By the way, I am not a large person to begin with! I did have minimal tearing and I think it was the result of several things. My midwife was in constant communication with me during the pushing process. So I was asking her how I was doing and if I was tearing and if I should push harder or less... It helps to have a great midwife or attendent who understands birth as a natural process. It also helps to go natural with no drugs. You have more control, you can guage when to push and when to ease up. I actually pushed in an interesting position as well. It may have helped with less tearing. Be sure your birth plan specifies that you don't want to be hooked up to machines so that you can have full range of motion and listen to what your body is telling you to do. Finally, my midwife put a topical numbing agent on and stitched me very well. I healed well and have no nerve damage at this point - two years later!
Best wishes for a great birth!!

Hi E.!

My first daughter was born in a birthing center, and I had a very difficult labor and delivery, and the OB DID give me the episiotomy, that was 1983. In 1991 I was going to give birth to my second daughter in the hospital with a different OB, and he did not want to give me the episiotomy, even when I asked repeatedly. Well, I tore, and then it was even more difficult for him to sew me up, and it hurt like hell.
In my opinion, if you had an episiotomy for the first...demand it for the second! Both of my daughters were similar in weight, just under 7lbs.
On another note about "not" having the episiotomy is that my husband and I could not enjoy making love in one of our favored positions. This was not good for us.
Having a baby is a wonderful, loving experience, and your OB needs to be on the same page with your wishes. If not, you may want to choose another one.
I hope this helps!
M.

I had an episiotomy with my first, but I did not need one with my last 3. The first doc was known to just cut and I tore after he cut. The docs that delivered my last 3 (2 different docs) did the massage instead which helps with the stretching. I was thankful to not have another episiotomy.

Every delivery is different. My oldest had the biggest head of the bunch too, so that could be one reason why I needed to be cut.

I am sure you will do just fine. Talk to your OB about your concerns, ask him/her if they do the massaging or if they just do an episiotomy. Many that I know are trying to massage and cut only if needed.

HUGS!

Dear E.,
I am happy for you that you have found a doctor who doesn't routinelty perform episiotomies. I have not had one myself, but have a friend whose cut continued tearing like a sheet once you start. She was in so much pain. I have had small tears giving birth, but understand that is preferable to being cut. For me, I couldn't really tell, the medical professionals told me I had torn a little, I wouldn't have known from the way it felt. You will be ecstatic about your baby. Healing from a natural birth is much much easier than from a cut. Also, the birth itself can be much easier because you have opened up before. If you don't forcefully push, you will be less likely to tear. When they tell you you can push, just let your body do what it is ready to do. Be very gentle. There should be no sense of urgency. Your baby will find the transition easier, too, if the birth is not so abrupt. Good luck, and enjoy, take your time.

The advice I have to offer is learning about squatting to give birth. My first child I labored in a tub due to severe back labor and hardly progressed that last cm. I decided to get out and it was like WOAH!!! I progressed and then had to proceed to learning how to push her out. I used a midwife that is very skilled in helping you push slowly so that you don't tear and I didn't.
Then my 2nd child I vowed to labor on a ball and give birth with a birthing stool so I'd be in the squat position. I got to the hospital at 5am and delivered at 730am with much ease. I thought I was having a boy and remembering opening my eyes from pushing once it was out and looking down (in between my legs) to see what it was and it was pretty darn awesome and it turned out to be a girl!! Not one problem and they even think it helped to turn her to the right position as she was backwards at first. Good luck to you!!! (Oh and we took the Bradley Method Childbirth classes prior to the first birth.

Hi, E.!
Congratulations!
First, I would start w/ a great childbirth ed class (a free-standing one NOT a hospital-based one).

Also, keep in mind that the risk of you getting a 3rd or 4th degree laceration is about 70% HIGHER with an episiotomy than if you just tear naturally.

You can also do some perineal massage 1-2x/day to help stretch & prepare your muscles & tissues.

Good luck & I hope you have a wonderful, beautiful birth!
A.

Hi! Yes, things do change. While it used to be that OB's routinely gave episiotomies with almost every birth, that is not the case now. Studies have shown that often episiotomies heal slower than tearing and there are more long-term problems with incontinence, etc, after episiotomy. So now, most OB's do not automatically do this. However, there are cases where it is necessary - if the tear is going in a direction that may cause secondary problems or the use of a vaccuum extraction or forcepts usually require an episiotomy. With this in mind, I would agree with the others who say to discuss it more with your OB, who can address your concerns and explain how she will make that decision in the delivery room.

I would definitely recommend that you take a birthing class (Lamaze, etc). Even if you aren't as interested in the natural birth methods, the classes do give quite a bit of information on things like episiotomies, ways to deal with pain, and other options during labor that might have changed since your first time through this!

(I mentioned studies, so I'll include here a link on the topic from the American College of Obstetrics and Gynecology, the organization that sets the standards for OB's - http://www.acog.org/from_home/publications/press_releases...)

Good luck and Congratulations!

HI E.,
My son is 5 and I had an episiotomy during delivery. I'm a little confused--Is your OB refusing or are you against having it? How can they say they won't do it until they see if it's necessary during the delivery? My OB also had to use the vacuum extractor to deliver and I was very afraid of that--but no problems with it.
They tell you to do a birth plan to make sure your OB knows what you do and do not want done and used. You always have the flexibility to change it once things are underway. (For example if you don't want an epidural or medication, then change your mind as your labor progresses).
Good luck to you!

Well I can tell you that I had an episiotomy with my first and not with my second 2 years later. And the second baby was bigger than my first. So, I would discuss with your OB, does he/she not do episiotomies at all or only do them last minute decision if needed. My OB with my first was like that he had told me that he doesn't do episiotomies and I was worried about tearing so I asked him and he said that he would do it if I needed it but doesn't automatically do episiotomies every time. So fully discuss it with your OB, maybe there was a little misunderstanding or tell him/her that in the moment if it looks as though you may tear I would prefer another episiotomy than a possible tear. I can't imagine that they wouldn't cater to your worries its not like its a major process, its the difference of a pair of scissors and a some stitches. And hopefully you won't need it at all, good luck. PS If you have the option, I had an OB for my first and a midwife for my second and I would choose midwife over OB any day! They seem way more personally pleasing than the OB, at least in my experience! Good luck, J.

Hi E.,

I had an episiotomy with my first delivery, and a small tear with my 2nd. Both my girls had large heads, and the 2nd's was actually bigger. From my experience the episiotomy hurt far worse and took longer to heal than the tear. I had a natural birth with the 2nd, and did not feel any great pain related to the tear. Her delivery was quicker & easier for me. I hope this helps ease your mind. Best wishes and congrats on the baby on the way!

I had an episiotomy with my first in 2006. That, combined with an awful epidural reaction, put me out of commission for about 6 weeks. I found out this doc would do episiotomies to make the deliveries easier for him, not the laboring mother.
With my daughter, born in late 2007, I found a doc who did episiotomies only when necessary. I did end up tearing, but the natural tears healed a lot easier and quicker. I felt that the natural tearing combined with no epidural made my recovery very quick.

Most serious lacerations begin as a cut. It is harder to tear than it is for a cut to extend. I use a visual for moms that I work with. Take a piece of paper or finished fabric and try to pull it to cause a tear. Very difficult. Now put a little snip in it and try to tear it, very easy. Imagine the same thing with your skin. Some ways to avoid tearing are to allow your body to direct you when to push and don't do the strenuous doctor/ nurse directed pushing. and don't push laying on your back. Also, definately try perinatal massage. (if you want directions, let me know.)
Studies show that an episiotomy really only shortens labor by 1/2 hour at most. So, unless time is of the essence, it is not necessary.

Some OB's and midwifes do what they call a Perenial(sp) massage. The OB my friends and I go to do this massage and most of un didn't tear or only needed one stitch. I had my first child with a different OB that didn't do this and I ripped from front to back. My new OB did the massage with my second and I didn't tear at all. I would definatly ask you OB about this. It's a simple technique even your husband could do. You insert your pointer and middle finger just inside the vagina and continually massage in a circular motion with pressure to naturally stretch your walls to make the baby sqeeze through more easily. Good luck to you and your new addition. I hope all goes well.

Can you go to a birthing class at your hospital? While it scared us a bit (first time parents), they go over every procedure and process with you. It might facilitate asking your doctor more questions. Also, I agree - how can the doc say they won't cut? There are ways to try and stretch the perineum (sp?), but I ended up with an episiotomy anyway with my daughter at 8 lbs. 1 oz. I did have an epidural (loved it!) and they had some great tricks to help me succeed with breastfeeding. If you need some books to read about the subject, send me an email and I'll send you a link! Good luck!

Search online for vaginal streching. They are strechs that you do to your perinum to prevent tearing. I was informed of them when I was expecting my 3rd (now 3 mo). Many of the women on my DDC on www.babyzone.com were seen exclusivly by midwives and were very up on vaginal preping to prevent tearing.

E.,

This is just my personal experience, I am not an expert and ultimately you have to do what is best for you. I have three children all around the 10 lb mark. The first two I was cut and healed wonderfully and had no problems. The last one I was allowed to tear all sorts of directions and had many more stitches and I had pain for a long time. It wasn't pain that kept me from daily activities but it did hurt and was not as easy to recover from as the the first two were. If you are unhappy with the doctor's decision I think you should really make them talk to you more about the subject. Good Luck

actualy you have a better chance of not ripping if you are not cut. try doing the excercises to stretch your self out before hand.
my midwife said to do this with all 3 of my babys and i have never been cut and didnt rip.

Hi E.,
I also had an episiotomy with my first, almost 10 years ago. I was in extreme pain after my delivery, my stiches didn't dissolve the way they should have. When I had my second son 6 years ago they did not cut me, and I did tear along the scar of my episiotomy. I hardly knew, I recovered much quicker from the tear then from them actually cutting me. Within a week and a half after my second delivery we traveled 6 hours away by car. That would not have happened with my first I was in too much pain to sit that long :)
I also tore with my third son and again the pain was not as much as with my first.
Everyone is different and I hope I helped you alittle with your nerves :)
Best of luck!

I agree with all PPs here that you really should clarify with your OB whether they don't want to plan to cut or whether they won't cut at all, although the latter seems unlikely. I had an episiotomy with the delivery of my son and was told that that didn't mean I would need one with any future deliveries; that, in fact, having, um, stretched out once, it was less likely to be a problem the next time. Also, there are newer studies out there that show that most natural tears that occur are smaller and easier to heal than episiotomies, so unless you're going to tear badly or in a bad direction (towards the rectum, for example), there's no urgency to cut any more. Best of luck!

well first congrats on your expected baby. i have two children, a four year old and a 3 month old. when i had my four year old she was only 6lbs and they performed an episiotomy on me. with my second, different doctors, he was 7lbs 6oz and i did not need an episiotomy. the nurse, and doctor, massaged me with mineral oil, in and around the vagina area, prior to me pushing and that helps to open you and make it easier for the baby to pass. i had no tearing.
wishing you much luck and happiness.

Hi E.,

congrats on your baby-to-be. I believe newer studies show that a woman heals quicker after birth if episiotomies are not performed. Natural tears actually heal must faster and with less scaring. I would suggest talking to your Dr about your fears and ask them to show you some articles that you can read to ease your mind.

You will do great! Congrats again.

J.

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My daughter was 9lbs. 6oz. and I gave birth to her with no tearing. I had a really good midwife. There are many new things out there but I can tell you it can be done. It hurt but not too bad (only realized that one after having my second) but I had an epidural and did just fine. My son was 7lbs. 11oz. and I did not tear either, same midwife. As long as you have a good doctor you should be fine. There is a way they can massage you to help you push the baby through the vaginal area without tearing. Also some people are prone to tearing, it just depends on the type of person you are. This is your second, be prepared, some people say it gets easier and some say it gets harder. My labor was shorter but very hard, I woke up at 2:45 am got to the hospital by 5:30am and had my son by 6:47 am. I thought I was going to die and there was no time for an epidural for me because when I got there I was already 7cm dilated. Good luck and hope this helps and wasn't just me rambling.

Yes, things change with medical practices over the years, but the one thing that doesn't change is the PAIN!! No matter whether you are cut or tear naturally, it will hurt during birth (you already know that!) You may end up tearing down the same cut line as the episiotomy. Don't worry about it. Enjoy the last few weeks and good luck to you!

I don't understand why woman think that they need to be cut in order for their babies to come out, without injury to their vagina. My midwife delivers 80+ babies a year and will maybe have 4 woman tear at all... if you do kegels, squats that strengthen and stretch your perinium and your care provider has you pushing really slowly while supporting and putting pressure on that delicate, stretchy skin, you should be able to deliver your baby without harm to yourself. My friend works in labor and delivery and says that 90% of first time mom's "NEED" To be cut and I completely disagree with that. My mother in law delivered my husband who was a 5 lb baby and the doctor said that she "needed" to be cut. My good friend delivered two babies, in a birth center with the help of a midwife, both babies well over 9.5 lbs and she NEVER TORE! ;) My advice, Do your research on episiotomy and trust that your body, when you deliver properly, not laying in a bed but in positions that help you while pushing and while pushing slowly, your chances of tearing are less. AND, whose to say that if you get cut you might also tear too, so the doctor has to sew up a cut AND a tear! Awesome right?! I'd be more afraid of being cut than tearing, but that's just me.

Have an epidural,you will be more relaxed when you deliver. i did not have an episiotomy because my son came out with his hand next to cheek. i had three stiches but i was sore after the epidural wore off. i am glad i had an epidural if made the birthing process so much better. i felt good after i delivered, and ate a whole tray of food because i was starving. may be this baby will not have a big head. good luck you will be fine. remain positive,this is best for you and the baby to be.

Hi E.!! The first thing you need to do is relax! You know that the more stressed you are the thougher everything will be. Then you need to realize that you have been through this before and your body has opened up once already and the second time, even though it's been a few years, will be easier! Sure a lot has changed over the years....for the better! Better for you better for your baby!! Make sure you really talk to your doctor and let him know about your concerns/fears. Ask him every pointed question you can think of and need the answers to. I'm sure it will be great for you in the end! Congrats! Good luck and best wishes.

I had an episiotomy with my first child who was 7lbs 14oz, and I did not have one with my second who was a whopping 9lbs 3oz. it was merely a difference of doctors and how they do things. but I have to say that my recovery from my second was MUCH easier and less painful even though I did tear a bit in a couple places. So I would say don't worry too much about it! you could always tell your doctor that if it is apparent that you're going to tear very badly you'd like him to do an episiotomy, but you'll be surprised by what your body can do on it's own.
Good Luck!!

When I had my 21 year old, he cut me. My son was 9-10 when he was born. 8 years later when I delivered my 13 year old, the doc would NOT cut me. I tore. My husband and I did not understand this idea and why the shift has gone to tearing vs cutting. Tearing obviously doesn't heal as well as cutting. The only option you have, since the doctor will do what he believes is correct, is to find a doctor who will cut and not allow you to tear. Good luck!

K. B
mom to 5 including triplets
http://groups.yahoo.com/group/HarrisburgPAChat

Hi,
Getting the cut is not that big of a deal. With my first I didn't need one (6lbs 13 oz)but I did have a tiny tear. With my second I had a fourth degree (8lbs 10 oz) that healed up nicely after about a week. With my third I had no epidural and no cuts or tears (8lbs 6 oz). With my fourth it went the same as my third (9lbs 15 oz). I would rather have the cut than the tear(the tiny tear hurt more than the fourth degree cut). The ob will probably not cut you unless you have to be, but they can't really know that until it's showtime. If you don't need the cut, then they probably won't. Take a class, talk to your ob about your concerns and make sure your labor coach knows your wishes . Good Luck!

You should find a doctor willing to cut you if necessary! that is a strange position for your doctor to be taking, and you should let him/her know. I would get a different doctor! I needed Episiotomies with both big babies! You need to be comfortable with your delivery-no added stress. Talk this over with your OB and see what he/she suggests.

E., I too had my first at 18. I did research and I absolutely refused to let them give me an episiodomy. My son was born (8'11oz) and tore me very little. I needed one stitch. They would have cut me 4 inches!!!!!! I probably would have never been the same. I had my next child at 28 and never needed an episodomy (she was 8'9oz and 2 years later- my newborn was 8'13oz). All of the research I did told me that a woman's body naturally tears in a zigzag pattern that avoids major injury to the area. Doctors cut a 4 inch hole from your vagina to your rectum. That just doesnt seem natural to me.

I wish you the best of luck. I was terrified too but found the second delivery sooooo much better than the first (age, experience maybe? I was def. less anxious about it b/c I knew what to expect and figured it couldnt be any worse than the 1st one (which was horrible!). I figured I made it thought that so this one wont break me!

Good luck, A.

Just had #2 Dec 07 and my OB let me tear rather than cut. I had bad episiotomy w/ first baby in 03. WAY WORSE to get cut than to tear. I had a week of discomfort with the second and the tear. WIth my first I was sitting on an invalid donut for more than a month because the pain from sitting was so bad. Don't worry - be glad that your OB isn't a cutter!!!!

Congratulations on the impending arrival of your new baby. I also had an episiotomy with my first child and was not excited about the prospects of a possible 2nd. I did not require a 2nd episiotomy but I did tear (I also tore some with my 3rd). In reality it was not a big deal. There was very little pain, during the stitching or after. I was able to return to walking normally a few hours after delivery (unlike with the episiotomy where i felt like a geisha) and was able to have intercourse without pain once cleared by the md (again not true with the episiotomy). I don't think I am lucky either. My friends seem to have similar experiences. I hope that this helps and you can rest some prior to your baby's arrival.

First baby in 2001 I had an episotomy with no problems.....The second baby in 2005 my son was actually smaller than my first child by about a pound, The mid wife opted not to cut. My son broke my tail bone on the way out, and I tore into my rectum. Don't mean to scare you, but know what can happen going in, and voice ALL your concerns with your doctor NOW and AT DELIVERY. Best of luck to you and your family! The tear really did not hurt much, but the tail bone was horrible, and I can still feel it today, 3 years later

Well things do change! My son was 8 12 when he was born with a head in the 90%. :) I did not get cut before hand either... the nurse/midwife (I'm not sure who - I wasn't paying much attention) did a lot of "massage" in that area while I was in labor to relax the muscles and try and "stretch" the skin. It really helped... I did still tear a little bit, but to be honest, I didn't realize it until they told me afterwards. All the different types of feelings and pains involved in labor and delivery are merged together in one moment. It isn't as if you feel a tear as a separate pain...
I would definitely not cut... hope for the best!
Good luck!