Pros/Cons of Episiotomy?

Question

Sure as heck would not want to tear dramatically, but I've heard episiotomies can also wreak havoc on a woman's privates post delivery...anyone have experience?

Answer 1

Easier repair and improved healing: The deep tears episiotomies can cause are certainly more difficult to repair than the minor ones that may occur when no episiotomy is done. A study looking at healing in women with and without episiotomies reported that delayed healing occurred four times more often in women who had episiotomies (eight percent versus two percent) (16). The difference remained even after removing women with an intact perineum (no injury to the block of tissue between the vagina and the anus) from consideration, which suggests that spontaneous tears heal faster.

Reduction in pain: The random assignment trial evaluating midline episiotomy reported that women with no tears experienced the least pain in the postpartum period, followed in order by women with spontaneous tears, women with episiotomies, and women whose episiotomies extended (13).

Improved newborn outcome: None of the trials randomly assigning women to liberal or restrictive use of episiotomy have found any differences in newborn outcomes (2, 12, 19). Two studies of premature babies found that episiotomy did not affect the incidence of brain hemorrhage or low Apgar scores
Facilitation of instrumental delivery: Studies have shown that reducing the use of episiotomy with forceps deliveries decreases the number of anal tears (7, 10, 22).The American College of Obstetricians and Gynecologists recommends not doing an episiotomy with a vacuum extraction until the head is "almost delivered" (1). But if the head is almost delivered, there isn't any reason to do one.



What are the potential problems of episiotomy?

Compared with not doing an episiotomy, episiotomy increases:

Blood loss (4)
Pain in the postpartum period (13)
Infection (9, 11, 23)
Long-term or chronic pain and/or pain with sexual intercourse (13)
Rectovaginal fistula (an opening between the vagina and the rectum (11): This is generally precipitated by an episiotomy extension, an infection, or a combination of both.
Anal incontinence (9, 18, 23): Since anal injury often permanently weakens the anal sphincter, gas incontinence, urgency, or fecal incontinence may occur immediately or later on with aging and further childbearing.
You can expect some discomfort in the first few days after childbirth even if you have not had an episiotomy. It is common for there to be some general soreness or even a small injury to the perineum. However, having an episiotomy will greatly increase your chances of having enough pain to interfere with walking or sitting comfortably. This can hinder breastfeeding and caring for your baby. You may also experience intense stinging with urination and moving your bowels can be very uncomfortable for the first few days.

If you are unfortunate enough to have one of the complications of episiotomy -- it extends or infects -- you could be looking at a prolonged period of pain, or problems such as anal incontinence that could seriously or even permanently affect your quality of life, especially in having sexual relations.

The harm done by episiotomy may also not show up immediately. Urinary and anal incontinence may only begin years later when aging and further childbearing add to the toll taken by episiotomy.

Answer 2

they usually just let you tear as that way you have the chance of not tearing at all or having a very minor tear. an episiotomy is an incision that is quite large and will need stitches. sometimes you can get a couple tiny tears and need no stitches. i had an episiotomy as my son was stuck (shoulder)and had to be vacuum extracted, it was from top to bottom, my doctor joked about how she almost stitched my butt shut my cut was so big. the tear usually recovers much faster which is why they dont often do episiotomys. you can get a bad tear but on that note you'd probably need a nasty episiotomy as well. either way you don't feel the pain until after, tears happen in pushes where the pushing and contraction is the only pain you notice and the cut the episiotomy in a contraction, the pain after sucks but it will heal. i did my entire birth drug free too... so when i say you dont notice the episiotomy i mean it :)

Answer 3

Try to avoid an episiotomy at all costs. i have ahd two girls and did not rip or anything. No stitches or cuts. Most of the time when you go to tear and the doc wants to cut you- It would be less traumatic to the area to just letit rip a littlt. Episiotomy's can be overdone sometimes. I know a girl that had a level 4 episiotomy and she has a large raised purplish scar.

Answer 4

I'm having natural labor for the 1st time next month. I do not want an episiotomy. Cutting me seems like it would cause MORE pain! There are a lot of good Q & A already on here about episiotomies, so be sure to type "episiotomy" into the "Search for questions" window above and click search for lots of info. Best wishes to you!!!

Answer 5

You know, with my first baby, I had one, and with my second, I didn't. The weird thing is that neither doctor asked me. One was just apparently in the habit of doing them, and the other was not. Or perhaps they decided once labor was in progress whether it appeared to be necessary or not.
But either way, I didn't have any problems. If you tear, they'll stitch you up. If you have an episiotomy, they'll stitch you up. So same difference. I did have some tearing during the delivery without the episiotomy.

Answer 6

I had one with my first two children. The first time you were sore after having the baby, which could be because of the baby or the stitches. The second one felt fine not as sore. The third one I had a new midwife and she refused to give me one and I had internal tares that need stitches then she decided not to stitch and let me heal. I was in worse pain that way then when I was cut and stitched back up. I recommend them, don't listen to what the doctor says choose your own judgment. If you know you are having a big baby I would choose being cut over tearing. It hurt worse to heal and to go to the bathroom.It also hurt worse later on having sex.. Whoever wrote the book up there has no clue sometimes it is better to ask women who went through it instead of reading things out of a book., and just to let you know either way the vagina will be loosened just from having a baby. It doesn't matter if you are cut or if you tear.

Answer 7

Ok i have heard that it is better to tear than to be cut because the tear is natural and will heal very well. Now i have been torn all the way to the top and those kinda tears dont heal all that well. But i only tore this way because of the way my son decided he wanted to come out. Tearing on the bottom is much better on the body. And i dont know anyone else that has tore but from where mine was i still have some pain every now and again my son will be 3 in dec so it really depends on how bad the tear is.

Answer 8

Having the episiotomy makes it easier for the doctor to sew as opposed to tearing which reduces the risk for infection and creates better habitat for easier healing. As with any medical procedure doctors are not 100% perfect and could cut too deep or too long causing complications in the long run.

Answer 9

I had an episiotomy with my first (had a epidural and they ended up using forceps). I had absolutely no trouble recovering from it.

I tore with my second (no epidural, no drugs, no nothing). Had a lot of pain afterwards and a lot of trouble healing.

Answer 10

In my case I wish they'd done one! I tore so badly that it took 27 stitches to put it back together half-way ok!
To this day, I have sensitivity problems, and if my husband isn't careful (like he gets a little carried away), I tear a little - 14 years after delivery!