Had Episiotomy with First Child...?

Question

If I were to have another baby vaginally, would I tear or need another episiotomy? Does it make me more susceptible to having an episiotomy, tearing, etc.?
If anyone has experience, please fill me in. Thanks!

Mrs. B--Thanks for the info on stretching the perineum, I should try that next time. I actually did need it. My daughter was stuck in the posterior position. I had been pushing for two hours and was so exhausted that I was closing my eyes and falling asleep during contractions. Once the doctor came in, he put the vacuum on my daughter's head and gave me the episiotomy and she was out in two pushes! I hardly believed she was out at first. I'd been working so hard and could hardly stay conscious enough to see her beautiful face. :(

Thank you so much, Jill! It's great to get the opinion of an RN. :)

Answer 1

It depends, but just because you had one doesn't mean you will need another one OR that you will tear. Generally once you've had one child, the tissues stretch more easily the next time around. But if there has only been a short time between deliveries (less than a couple of years) the scar from the epis might be weak.

I had an epis with my first, and did not need one with the last two and I also did not tear at all with the last two. Tell your doctor you would like to avoid another epis if at all possible.

Answer 2

You don't HAVE to have an episiotomy. If you don't want one, tell the doctor NO. You may or may not tear, it all depends on your labor. With my daughter, I tore very little (one stitch). My SIL recently had her 3rd, and tore badly because she went from 4 cm to pushing in about 20 minutes and he was out in about 10. My daughter, I only pushed 20 minutes, so there goes the whole "episiotomy shortens pushing" theory lol. He came too fast, thus the tearing. Just make sure to specify exactly what you want ahead of time and write it in your birth plan. Here's some info on what the "purpose" of it is.

During labor, when the baby's head is exposed to a diameter of 3 to 4 centimeters, the attending physician will pick up a pair of sterile scissors and snip the stretching skin of the perineum downward toward the anus (median episiotomy) or downward and sideways (mediolateral episiotomy) to enlarge the vaginal opening and make it easier for the head to emerge. Most physicians sincerely believe that episiotomy shortens the pushing phase and thus reduces the chance the baby will suffer from oxygen deprivation, that it protects the fetal skull and brain from damage as it is "thrust against" the pelvic floor like a "battering ram," and prevents ragged perineal tears and "permanent relaxation of the pelvic floor with its possible sequelae of cystocoele, rectocele, and uterine prolapse" (Pritchard et al. 1985:339). Another reason given by many doctors in support of episiotomy is to maintain vaginal tightness for the enhanced pleasure of a sexual partner. According to several physicians I interviewed, so strong is the medical community's belief in the value of episiotomy that many obstetrical residents are not trained to deliver babies without performing one.


Physiological Effects

That episiotomy protects the fetus from damage is an unproven assumption revealing physicians' deep-seated belief that the fetus, their product, is in danger from malfunction of the mother's birthing machine. That birth without episiotomy will result in prolapse of the uterus, or in weakened support for the bladder from excessively stretched muscles has also never been proven (Cunningham et al. 1989:323; Harrison 1982:98; Thacker and Banta 1983). Moreover, should the woman desire enhanced sexual pleasure for herself or her partner from increased vaginal tightness, she can achieve the desired results by exercising the pelvic floor muscles after birth.

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Episiotomy: Can you deliver a baby without one?
An incision extending the opening of the vagina — an episiotomy — was once a routine part of childbirth. But episiotomies aren't always necessary.

An episiotomy is an incision made in the tissue between the vaginal opening and anus (perineum) during childbirth. Here's what you need to know about the procedure.
The episiotomy tradition

An episiotomy was once a routine part of childbirth. It was thought that an episiotomy would help prevent more extensive vaginal tears and heal better than a natural tear. The procedure was also thought to reduce the risk of incontinence after childbirth and keep the bladder and rectum from drooping into the vagina.

Sounds reasonable, but researchers have found that routine episiotomies don't prevent these problems after all. In fact, routine episiotomies offer no benefits. Recovery is uncomfortable, and sometimes the surgical incision is more extensive than a natural tear would have been.
The new approach

Researchers say there's no need for a routine episiotomy, but the procedure is still warranted in some cases. For example, your doctor may recommend an episiotomy if extensive vaginal tearing appears likely, if your baby is in an abnormal position or if your baby needs to be delivered quickly. If you need an episiotomy, you'll receive an injection of a local anesthetic to numb the tissue if you haven't had any other type of anesthesia or your anesthesia is no longer numbing the area. You won't feel the doctor making or repairing the incision.
The role of tissue massage

To soften the vaginal tissues for delivery, some health care providers suggest massaging the area between the vaginal opening and anus (perineal massage) in the last weeks of pregnancy. Although there are no guarantees — and you don't have to do it if the idea makes you uncomfortable — stretching the tissues may reduce vaginal trauma during delivery.

Start by washing your hands thoroughly with soap and hot water. Make sure your nails are trimmed. Then rub a mild lubricant (K-Y jelly, Astroglide, others) on your thumbs. Place your thumbs inside your vagina and press downward toward your rectum. Hold for five to 10 minutes. Repeat once a day until delivery.

Your partner can help, if you wish. It's normal to feel a little burning or other discomfort as you stretch your perineum. Stop if you feel sharp pain.

Answer 3

There's no rule that says you have to have another one. I had an episiotomy with my first and it was very painful, and looking back now I realize it was unnecessary. The healing afterwards was very difficult.

The surgical cut actually carries a much higher risk of pain, complications and infections than tissues that tear naturally on their own.

I tore naturally (2nd degree) with my 2nd and 3rd deliveries and it's amazing how fast they healed compared to the epsiotomy, and there was less pain.

Maybe it made a difference that I had a midwife with those two deliveries. They have great techniques for avoiding episiotomies and lessening the severity of your tear.

Try perineal massage and also find a doctor or midwife who will give good support during labor.

Answer 4

Every time you havre a vaginal birth if needed you will have to get the Episiatomy I had one with both of mine .Plus they used the Vacume thingy on my last, my lil conehead..lol jk.
Some women even with the cutting still tear some I know I did but then both mine had big heads n shoulders. If your really worried about it make sure you talk to your doctor about it when you see them again. They can best answer any and all fears you might have about your next pregnacy.Hugs hun no matter the next child is gonna be worth it.

Answer 5

on a personal note, i had episiotomy with my first baby, and didnt need it with my second. most of the time women need it with their first, but by the second and so on, they dont, unless theres a huge gap between pregnancies.

Answer 6

I had one with my first son, and didn't with the other two afterwards. It just depends Talk with your doctor and get their opinion.