epsiotomy vs natural tears

[zyxwv]

Not sure I follow the epidural v c-section question. Is your OB suggesting that if you think you might want an epidural you should just have a c-section instead? If so, I agree that this is rubbish!

One thing that I would be wary of with the epidural is topping up too soon. With my first (2nd due in Oct), the nurse/midwife told me that once I started to feel pain again I could get a top up, so I did. When the OB came to check up on why he hadn't been called back in (was expecting me to progress faster), it turned out that my contractions has slowed waaay down b/c my body relaxed so much. He explained that this is when you can run the risk of needing an emergency c-section, as my water had broken many hours before. This didn't stop the nurse (at Matilda) from offering me yet another top up a couple of hours later when my contractions had come back full force and I was definitely feeling it. I declined and delivered not long after.

All told, it was @12-13 hrs of labor, which isn't bad and several of which weren't painful at all. The actual delivery was painful but pretty quick. This time, I am going to hold out as long as I can before having the epidural and not take a top up.

I had some natural tearing which hurt during delivery but with the pain meds after, it healed without my even noticing it. Was too preoccupied with the struggles of breastfeeding!

I think you really need to be able to trust your OB on this one. I thought I was big on natural tearing only but OB explained that if the tear is going to be really bad, an episiotomy can help make it more uniform and ease recovery. What kind of tearing you are having is, of course, a mid-delivery judgement call. They will try to get you to stop pushing so the skin can stretch naturally, but this can be hard to do too! My tearing turned out to be natural only but had the OB said that he felt an episiotomy had been necessary, I would have trusted that this was he right medical decision.

 

[LOJITT]

I would def go back to your Obs on the "epidural = c-section" thing. Put it this way- apparently 90% of women who have a vaginal delivery at the Matilda have an epidural, and most of them dont end up having c-sections. That said, if you're giving birth in a public hospital, my understanding is that they don't have "mobile epidurals", only the more old fashioned ones which do significantly reduce sensation in the legs considerably and can slow labour down/ increase risk of c-section. However, with help from the midwives/ Obs you should still be able to push a baby out- many women do.

Re the episiotomy- ultimately it's a judgement call on the day but I'd be concerned if my Obs was assuming I'd definitely have one. Most Obs see minor tearing as preferable to episiotomy but episiotomy as preferable to major tearing. They're only going to know that when the time comes.

Have you done any antenatal classes? It really does help you feel more prepared and understand your options on pain relief and intervention so you can have an educated discussion with your doctor.

 

[Violet A]

Both my midwife and doctor told me that natural tear was always better than episiotomy - and I had natural tear with my first baby (second degree tear.. which required a bit of stitching) which healed quite easily in about 6 weeks.

 

[ssheng]

I went for a natural tear and still had to get stitches. Have nothing to compare it to, but I have also heard that it is out of favor in most developed countries, and that a natural tear heals better. I don't really see an advantage to an episiotomy - you might not need stitches with a natural tear whereas you certainly need it with an episiotomy, and if you do need stitches with a natural tear, then it was no worse than an episiotomy. Also, note that you can tear only the outer/inner layer of your perineum with a natural tear, but need to cut through all the flesh with an episiotomy.

As for the epidural, I had one and I was a chicken so I was completely numb when I was pushing the baby out. It took awhile, probably just over an hour, and I was exhausted, but I was trying as hard as I could and I don't think having no epidural would have changed that. I mean, again, can't compare it to anything. My doctor was funny, she said for her first child she had an epidural and for her second child she decided to do no epidural, and then decided afterward, hmm, next one, I'll do an epidural again! Like other posters said, you can always let it wear off a bit and if it's too much pain, then get it topped off.

Also, I remember my roommate at Matilda had to get a C-section (at least, she was convinced to), and then she couldn't properly feed her baby in certain positions because it hurt her, and couldn't lay the baby on her stomach. Don't know if that was just her; maybe others can give their opinions?

 

[sophwillsmum]

It is certainly true that having an epidural will make it harder to push the baby out and thus being more likely to end in a tear or episiotomy. I had both of my babies completely drug free but did so for 'vanity' reasons I have to say as I didn't want to be cut either by c-section or episiotomy.If you think about it logically it all makes sense. If you are able to stand upright and walk around the room then the babies head is able to push down more effectively, naturally stretching the perineum and generally making for a quicker easier birth just as nature intended. Just imagine you were trying to do a bowel movement lying flat on your back numbed from the waist down and and then magnify that to include an average size baby. In simple terms it becomes easier to imagine why statistically such a large number of mothers who have epidurals end up needing intervention. Add to that the fact that when you are lying on your back and the baby is unable to press down as effectively, it will often go in to distress as the labour begins to drag on. Of course all of this means once again that you are more likely to need quick intervention in order to get the distressed baby out. Hence a cut to the perineum or worse a c-section.

I am not saying that my labours didn't hurt...they really did. But I would have to say that the few hours of pain were definitely worth it to be able t0 keep my perineum intact and my stomach flat now 9 and 6 years down the track. Also being able to get up minutes after the births and shower and feel normal again was priceless...call me vain but I would do it all the same in a hear beat.

 

[LeahH]

I used an 'epi-no delphine plus' (a machine that you use to slowly stretch the perineum daily 2-3 weeks prior to EDD) to minimize the possibility of tearing, epi-no's are used a lot in Holland and other parts of Europe where they have a high % of home births. You can get them here in HK - details are on their website.

Also had an epidural with both kids, which wore off in time for active labour once I was fully dilated. In the beginning it tempered the pain and allowed me to get some much needed rest, by the time I was fully dilated I was able to move and could easily squat supported by the OB and my husband - gravity did quite a lot of good to get things moving!