Episotomy With 2nd Child?

Question

Two years ago I had a 3rd dergee near 4th dergee episotomy with my son 7lbs 10ozs. I also tore a little. I was not given an option. I am 29 weeks and I am begining to freak at the idea of another episotomy. I know it depends on my body and the babies size and so on, we are having another boy so I would expect him to be around the same size.

I was wondering if scar tissue from the last episotomy would hinder stretching? I am going back to the Dr. in 2 weeks and intend to discuss this with her also. But was interested in others expierences.

And spare me of telling me not to be worried because the pain from my son was nearly "UNBEARABLE" for WEEKS afterwards!!

Answer 1

I am a midwife, and I almost NEVER cut an episiotomy. I reserve it for cases where there is fetal distress, or some need to get the baby out in a hurry. It's impossible for me so say whether yours was necessary or not, and at this point it doesn't really matter.
I do not believe in cutting in order to prevent tearing. Usually, cutting actually increases the likelihood of tearing, because the incision will extend and become even bigger. That is probably what happened to you. Nobody cuts a 3rd degree on purpose. S/he cut a regular episiotomy (which is a 2nd degree), and it extended into an even worse laceration.
That's too bad, but it does not have to happen again.
First of all, you are on the right track -- talk to your doctor now. Let her know that unless it is really necessary, you do not want an episiotomy. Ask your husband or whoever will be with you in labor to (nicely) remind the doctor of your wishes when they are preparing for delivery. You cannot be expected to have the presence of mind to remember to say something at that moment.
Starting now, you can gently stretch and massage yourself, using a little K-Y or mineral oil.
I massage the perineum during the pushing stage of labor, and use mineral oil also. I believe this helps to prevent lacerations. You could ask your doctor about it, but I'm afraid it's more of a midwife thing.
Another factor is delivery technique. Unless there is the need for a rapid delivery, I have the woman pant or push very gently at the very end, as the head emerges. This prevents tearing, also. This technique works especially well with a second baby.
Many OBs prefer to just cut an episiotomy and get the baby out quickly. It's easier and faster for them.
Unfortunately, it is true that your may tear along your scar. But not always, and it certainly does not have to be like last time -- all the way through the muscle to the rectal sphincter (that's a 'partial' 3rd degree). A first degree tear of the skin layers doesn't hurt near as much, and heals in a few days.
Good luck! I hope it all goes well.

Answer 2

As you probably know episiotomies are less routine now, especially if you choose a midwife. Midwifes also have some special tricks at delivery to spare the perineum or at least minimize the tearing (warm cloths, massage, etc.).

I have heard that recovery can be more painful to be cut then to just let the skin tear on its own.

I had a 3rd degree tear with my daughter (2nd baby) and it was painful after in the postpartum weeks but perhaps it would have been more painful if I had an episiotomy.

Generally you shouldn't get cut "just in case," although if you and your doctor feel strongly based on past delivery and the estimated size of this baby you might consider another episiotomy.

This is just me, but I would just let my body do whatever it needed to do - tear if necessary and if that wasn't enough to get the baby out...ok then I would let them cut.

Many will tell you to gently massage or stretch the perineum or do kegels and these definitely help but I know from experience they DO not guarantee you won't tear or require an episiotomy. But by all means do what you can to put the odds in your favor!

Answer 3

Maybe your doctor will induce you early to avoid having to big a baby so you don't tear or need an episotomy. Or you could also opt for a c-section. I can't even imagine the pain you must of been in with that kind of episotomy.
I had a episiotomy with my 1st, then just tore a little with my 2nd( didn't require sutures) and then nothing with my 3rd. That is all the insight I can give you. I hope that your doctor can give the answers you need and it goes much better this time around.

Answer 4

An episiotomy is really not necessary unless the doctor needs to use forceps or a vacuum to help the baby out. it has been proven (read it several times, don't know the sources) that episiotomies do not keep you from tearing and whose to say you will tear? I would insist on not having an episiotomy unless the baby won't come out and you need the extra space (after trying to push first) or help is needed to get him out. The pain if you tear won't be any worse than the episiotomy and maybe it will be better if you don't tear much or not at all! The second baby is generally much easier since your body has already had to stretch once, so maybe you won't tear at all!!

Answer 5

I had a 5th degree tear with an episiotomy with my first son. I wasn't anticipating an episiotomy with my second child and I tore as he was coming out. It all happened so fast. I think if I hadn't had the episiotomy with my first I would not have torn with the second. The entire experience was better with my second, but the healing was about the same. I am not sure you have a choice. You may not have one, but you may tear anyway. Good luck with everything and remember the joys are well worth a little bit of pain.

Answer 6

I had a 4th degree episotomy and tore, and personally I didn't find it that bad... I couldn't sit right for a day or two, but it never really bothered me. This time you might not need it. But I would say an episotomy is better then a c-section!

Answer 7

I insisted with both children to not have an episiotomy. The doctor who delivered my first child was not happy about it but he obeyed my request. I told him I'd much rather tear. I guess it is harder sewing you back up if you tear but I truly believe you don't tear as much as they cut you. With my second my doctor who cared for me through out my pregnancy deliverd my son and also knew I didn't want an episiotomy. I say good for you. You don't have that much scar tissue from just one episiotomy. You still can give birth without having episiotomy.
If you do end up having another episiotomy then I recommend getting some witch hazel to dab on whenever it hurts.
After having my first son I did have pain down there even though I just tore. After my second I kept waiting for it to start hurting down there after the lidocaine wore off but it never did.

Answer 8

I guess it just depends on the doctor. When I had my son almost 6 years a go I was only 17 so I didn't think of asking these kinds of things. When it came down to it - it turned out that my docotr had a negative view on episiotomies. So I tore. when I had my daughter 3 years a go, I had a different doctor and I was sure to ask about his views and he said that if he feels I need one he will do it. and he did.... I didn't tear at all and it healed up fast. Definitely talk to your doctor.

Answer 9

I was in pain over a month and did not even want to have another child. I had such a long episiotomy and it took long time to heal. If yur doctor is good, they can determine the size of the baby and how much need to be cut. My baby was 9 lbs 1oz. So I know what you are talking about. But when you see your adorable baby yu forget everything.

Answer 10

With my first child i had a 4th degree epistomy and i was in pain for weeks i couldnt ride in a car with out crying i was in so much pain afterwards... I recently gave birth to my second child and i didnt haveto have an epistomy thank goodness, but i did tear in 3 places and sad to say the tears were more painful than the epistomy i had a labula tear and it its bout killed me! I can suggest how ever stretching exercises of the vagina they work... i believe there called keegal exercises try it it may work