Episiotomy vs tear

Brittany - posted on 04/25/2012 ( 143 moms have responded )

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Hi there,



I'm currently pregnant with baby # 2, and not quite sure whyyy this is bothering me so much, but I've been researching like a crazy person.



With my first I didn't tear, or have an episiotomy. Although I also pushed for over 4 hours..



When I was pregnant with him, the thought didn't even cross my mind, the possibility of tearing was never presented to me, until after I had him I didn't realize how lucky I was not to have torn. I was also only 17 at the time and didn't do any research...



My question to mommy's is - if I didn't need to be cut or didn't tear the first time, can I expect the same this time?



How did you feel after a tear/cut? Should I insist on one or the other?

Thanks in advance!

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Chrystal - posted on 04/25/2012

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With my first they cut me before hand and I then tore further along where they had cut. From the look on my mothers and one of the poor residents that was in attendance faces it was pretty bad. Took about 20 minutes to repair the damage and 12 weeks to fully heal. With my second birth I didn't get cut or tear but it was a natural complication free birth which my first wasn't and she was more than pound smaller than her brother. Most stuff I've read says that the cutting a doctor does really doesn't stop you from tear if your going to so IMO I'd let nature do it's thing and if you tear than you tear. Oh and if you do get cut or tear; right after birth get the nurses to fill a newborn diaper with ice chips and put it you know where; helps so much with the swelling and pain that comes right after the numbing meds were off.

Linda - posted on 04/25/2012

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If you didn't tear with your first, I would think it unlikely you would tear with a second. I tore a little bit with my first, but I did not tear with any of my subsequent 3 children. I would absolutely tell the doctor to keep his scissors at home! :)

Alison - posted on 04/25/2012

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You probably didn't tear because you were pushing for so long (it stretches things out more slowly). I tore some with my first (also pushed for several hours), but not with my second.

From what I have heard episiotomies are out because you may not have to tear and because the tear heals better. Personally, I would run the other way if a doctor every talked to me about an episiotomy.

Kaitlin - posted on 04/25/2012

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So, my first child was 9.9- woah, right?- and I tore like the Dickens. It took me a while to recover, and I didn't want to get up and walk around for those days in the hospital. I was petrified of tearing like that again. They told me I would probably tear again, in the same spot (since the tissue was weak) but not that bad. They were right. I just needed one little stitch after my second son, and was up and walking around as soon as I needed to pee (woops, tmi, sorry!) and sex after this birth was fine. Neither time was I offered an episiotomy (though they were at different hospitals with different OBGYN's- we moved between kids) because tearing is more natural and heals better (though some say it's the other way around). I am currently pregnant with number three and hoping for a delivery similar to my second (duh).
Obviously, you're worrying about it so much because we have those hormones that make us research junk on the internet (er, I might be doing that RIGHT NOW too....lol...) I wouldn't worry too much about it since it's your second child anyway- the, er, chute, is used to that already ;)

Melissa - posted on 06/17/2012

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Kim there is a procedure where the doctor can inject locals into the area to desensitize it. It may take several times and it is really painful but it improved things to where I can have sex again.

143 Comments

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Melissa - posted on 08/30/2013

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You are less likely to tear with this one especially since you didn't with the first one. Make sure your doctor or midwife know that you didn't tear or have an episiotomy with your first baby, this way they will try harder to keep you intact. FYI I am a childbirth instructor with 22 years experience.

Kim - posted on 06/17/2012

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I know this post is a few months old, but I've been researching complications from episiotomies. My experience has been horrible. I had a vaginal delivery with my now 2 1/2 yo twins. While pushing with the first, who was only 5lbs 10 oz, the doctor suggested an episiotomy to "speed things along". I had been pushing for 2 hours. Not really that long for a first child.

So...after the healing process was over, I attempted to resume sexual activity. To only be stopped by a horrible papercut like pain where I was cut. A year later my doctor performed a corrective proceedure to remove a band of skin which she claimed healed too tight. Now...over 2 years later, I'm still experiencing pain during intercourse. I honestly don't know what to do. I'm frustrated, and too damn young to not enjoy sex anymore.

If anyone reads this that can offer any advice what so ever, I would appreciate the help.

Valerie - posted on 05/07/2012

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I tore with the first one, but was cut with the second. The first was worse. I guess everything was harder with the first. I don't think there is a definitive answer because it depends on your health, size of the baby, how fast you deliver, etc. Sometimes you don't need either.

YOLANDA - posted on 05/07/2012

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My son was 8.5lbs. I tore with my son...He clawed his way out literally!! He had my flesh under his nails when he came out. But I did not tear down like the way they give an episiotomy. Which I am told is quite painful to heal from. Took Dr 15 min or so to just to stitch me back up. He gave up trying to lidocaine all the places he had to stitch, I was still numb from the birth so wasnt feeling the stitches anyways but I felt the lidocaine though!! I had very little pain after even with the abuse my son chose to inflict on me!! :) No donut pillow or sitz baths after like with an episiotomy.
A good Dr can tell as you progress if you are likely to tear in a "bad" spot or not. So my thought is leave it up to them.

Chinwoke - posted on 05/07/2012

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Yes dear there is possibility of not tearing or getting cut i have 3 kids of my own the first two weighing over lbs be positive about and dont let it bother you the most important thing is to have a normal healthy delivery and even if you do get any tear or cut you would be fine in less than a week.

Mazy - posted on 05/07/2012

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I didn't tear with #1 & he was almost 9 lbs. I didn't tear with #2 either, & he was over 9lbs. #1 was lodged in a funny way, so my labor/pushing was about the same as yours. #2 came fairly smoothly & quickly though. I wasn't worried about it though & opted to go ahead & tear if it came down to that since #2 was born at home. Here's a tip though, in the two weeks leading up to your EDD you can massage down there with evening primrose oil (you can buy capsules anywhere, even Walmart & puncture them). I also had my husband use extra virgin olive oil during labor as a lubricant to help smooth & stretch things out.

Melody - posted on 05/07/2012

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Very little or no pain after episiotomy. Miserable pain following tear after my second that lasted for several weeks!

Coreen - posted on 05/06/2012

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If the baby is coming too fast, the doctor should (if he is good and has enough time) make a cut which is better than tearing b/c tearing takes a lot longer to heal and you may feel pain or discomfort to sit down for the next six weeks with a tear. I had a tear when my first son was born and had a cut done with my second son- I prefer the cut to be done which heals much faster and neater.

Ashley - posted on 05/06/2012

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Well with my 1st baby I had to have an episiodomy because my blood pressure was really high and we needed her our as soon as possible. It wasn't that bad just sore for a few days. With my 2nd little girl I didn't need one, but the scare from my episiodomy tore when I had her. It wasn't enough for stitches but I was sore for awhile until it healed. Id say if you don't need to get one, don't. The stitches don't feel too good even when they numb you up down there.

Richelle - posted on 05/06/2012

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I am pregnant with #4 and with the other 3, I have let let nature take its course. There is so much more to think about. I tore horrible with my first but not at all with the other two. So I am curious what will happen with our last one.

Mary - posted on 05/06/2012

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One can never tell about what will happen at birth as every one is different. I can tell u that id much rather be cut then tear. I was cut when I had my son and I can tell u its so fast and so much is goin on that u don't even feel it. And afterwards the healing process was rather fast as well. With my daughter I tore and it wasn't pretty...I didn't feel it at the time of birth but after birth it was sore...take the pain meds lol and the healing time took a lot longer..the tear area was very tender for a few weeks. :-) but all in all its worth it cause u have ur beautiful baby!

User - posted on 05/06/2012

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You remind me so much of me, my son is now 11 weeks old :) but seriously i must have cried worried myself ill for 99 per cent of my pregnancy just thinking what the pain is like as my first was a section 14 years ago, I had a tear with my new baby in feb and I can honestly say I didnt feel a single thing while it was happening in fact i wasnt even aware :) afterwards is sore as expected but you can keep on top of things if you know what i mean, tmi but rather give this advice than not coz it really does help... while you are going to the loo you can pour tepid water to your flow to dilute the wee, if you do tear at all dont be afraid to ask your midwives for tips, i have a few more but dont wanna push the intracate detail although i will if you need me to lol i really wouldnt worry about it at all love, and im the strongest of ladies, just relax honestly x and congratulations :)

Rhonda - posted on 05/05/2012

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Occasionally they cut a nerve and sex hurts for 6-12 months! Tears repair and reduce the possibility to not effect nerves. Sitting, walking and moving is painful when you're cut. Vit E applied directly to the scar tissue after a week repairs the tissue and strengthens it for the next time. Choose natural!

Kate - posted on 05/03/2012

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Heya, In Australia here, episiotomies are rarely performed. They have discovered that you heal better from a tear than you do an episiotomy as the cuts tend to go deeper through muscle. My sister recently had a water birth and didn't tear (her bubs was huge) - Even the midwife said that it was most likely due to the fact that she had been in the water for so long. She also had her partner massage and stretch her perenium regularly for about a month beforehand.
I tore both times with my bubs. The first time - they got infected and it was not pleasant. the second time was not so bad. If I were you - don't let the medical staff go anywhere near your bits with a blade! Leave it to nature. If you tear - it's cool, just put water on a panty liner, throw it in the freezer and use it to ease the sting afterwards. get a hand held shower head and wash a couple of times a day. Let your midwife inspect it a few times in the week.
Good luck! Exciting times!!

Bobbie - posted on 05/02/2012

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first of all the tear will occur, if it occurs at all, while the skin is so stretched that it is paper thin. Since you didn't tear the first time I would think that something coming out of the same opening a second time will have a little bigger path, you know what I mean :) If you do tear it will feel like a light tingling. Nature has a way of numbing us when we need it. I felt a tiny bit of mild stinging and I was told I had a lot of tearing. I had a 10 pound baby boy without the aid of any drugs. The doctor took a great deal of time to mend me. He must have used a topical numbing agent though as he saw me begin to tear because that mild first sting was all I felt.
Does that help?

Crys - posted on 05/02/2012

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I have three kids. Honestly, from the immediate moment that I realized labor was quickly approaching with my first, I was absolutely horrified at the thought of tearing or getting cut. I prayed deep in my heart that I wouldn't have to do either and did every technique my doctor suggested to help avoid it. Fortunately, I found myself rather lucky. My first I had a tiny scrape that he put a single stitch on. My other two times, I didn't even need the one stitch. So that right there leads me to believe that if you didn't tear the first time, chances are, you won't the second. I may be wrong, but I have yet to hear otherwise. If it comes down to the choice though, I have heard many times from women who have experienced both that tearing is definitely a much less painful and physically damaging way to go.

Taunya - posted on 05/02/2012

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I have had two cuts(epi) and two tears(naturally) and one with no problem. I would much rather have a tear than a cut. Most of the time, a tear doesn't need stitches if it isn't real bad. All cuts require stitches. Massage vitamin e oil in the perineal area about six weeks prior to delivery daily. It helps with elasticity. You may, and probably are worrying over something that won't happen. But, if the baby is bigger, turned differently or some things just vary from one delivery to another, you may need the bigger opening. DO NOT let them let you push for 4 hours again, that is just downright ridiculous! I pushed 3 with my first daughter and ended up with a cut, and a forcep delivery. I refuse to allow the vacuum to be used on any child of mine. I've done a ton of research there and that is one thing I will not allow. Best of luck to you!! We want to see pictures. I have tons of useful advice, email me if you want directly at taunyasaner@fuse.net. I'd love to stay in touch with you :) I have done this 5 times!!

Lisa - posted on 05/02/2012

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I say go with tearing rather than cutting. I would freak if any doc comes near my tenders with a sizzer at that moment ("Watch the feet!!") Pushed for 25ish minutes with my first tore pretty badly needed 9 stitched. With my second didn't push at all she came so fast with just contraction and not even fully dialated midwife wasn't ready had to cetch her myself didn't tear not a bit she was 8.10!! Alls i know is i better have a choice in the matter cause they aint ever cuttin me. You just heal so much faster if tear. You can always do paraniel massage to help with the relaxing and stretching of tishue just to be on safe side. Use olive oil no real expencive stuff needed just what you can get, use your thumbs apply some oil to the area and press down towards your bottom and slide out and around. do this every so often and by the time, time comes you should be nice and stretchy to aid in not tearing or needing to be cut. (PS Good thing to do with hubby if you know what i mean Hint Hint!! ;-)!!)

User - posted on 05/02/2012

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wow it seems like you have a lot of comments on this. I will be brief my first born I begged for episiotomy because I was uneduacated. I regret it terribly. If you will tear they can fix that if you cut it could be worse. Think of scissors and wrapping paper once you make that inital cut it goes more easily! Vagina was meant to give birth. It sounds like you did great before! By the way I used a birthing bar with my fourth and it was very helpful for pushing :) I hope that hepls God Bless

Carrie - posted on 05/02/2012

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I had an episiotomy with my child and maybe I just had a better experience with it then others on here, but it was no big deal for me. I was a little tender there for the first couple of days, but isn't that is to be expected anytime you have stiches??

Carol - posted on 05/01/2012

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Most moms will have neither tear nor episiotomy if the birth is handled well. With my first vaginal delivery (after a cesarean) I told the doctor I didn't want an episiotomy unless it were really necessary. But it was lunch time and he was in a hurry. He said, "You're a little tight here" and slash, it was done before I knew what happened. This was my smallest baby, 6 pounds 9 ounces. Next baby was much bigger, 8-4, and I delivered at home, sitting in bed. I had a small tear high inside from his big shoulders. It healed fine without any stitches. But the old episiotomy scar bothered me horribly for almost a year! Last baby was biggest of all, 9-2, and I delivered at home, squatting, with no tear at all. It was so easy. If I didn't need an episiotomy for a baby over 9 pounds, I certainly didn't need one for my littlest. I strongly recommend never having an episiotomy except in the direst of emergencies.

Frances - posted on 05/01/2012

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I had an episiotomy and a second degree tear with my first one. My doctor did not do them routinely, but my baby went into fetal distress when I started pushing. I found out later that I had a marginal placenta. That probably caused the problem.

J - posted on 05/01/2012

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Tore "as far up as you can go"... was what I wasl told with child #1... after that... no problems!

Amber - posted on 05/01/2012

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Just read other replies and it sounds like most say the episiotomy is much worse. I had a very different experience, but I suppose maybe I just got lucky.

Candice - posted on 05/01/2012

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My first child was a tear. Labour progressed very quickly and even though she was small (6lbs 5.4oz)I had to have around 40 stitches. I healed very quickly, taking around 4 sitz baths a day. I didn't even feel myself tear, so all in all it was not a bad experience.

My second labour was quite different. Not quite as fast, but I went from a 4-5cms to 10cms in 15 minutes, so it was a lot more painful. He was a bigger baby(8lbs 1.6oz) and was coming out sunny side up. He actually got stuck and his heart rate dropped, so I had to have an episiotomy and a vacuum assisted delivery. The episiotomy itself didn't hurt as the Dr. froze me first, but the healing process was terrible. I only had 6 stitches but it took longer for me to heal and I would cry when going to the bathroom.

From my experience, tearing was less painful and took less time to heal, but that's me. If either does happen, sitz baths will be your friend!

Victoria - posted on 05/01/2012

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I have. to admit my first delivery was c section. but my 2nd delivery was natural, and towards the end of labour I was told I would probably tear. Well, in the event I had an episiotomy - now the area was numbed but I gotta tell ya, I yelled as the doctor was doing it - in fact I told him off because after the whole awful, undignified labour which started a week prior, I thought he was adding insult to injury by hurting me - only a bit. Maybe I wasn't numbed enough. My personal feelings are a) if you tear,you tear, and so what ?, you get a beautiful baby out of it, but b) if you do have an episiotomy at least it'll be a nice tidy stitch-up with less scarring (like it really matters, I know). In any event I wish you all the best. As a mother already you know it's not the birth but everything after which is the most challenging, Hope this helps VW.

Alisa - posted on 05/01/2012

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DEFINITELY go for the tear over the episiotomy!!!
the episiotomy is left to the discrestion fo the doctor, and they tend to cut as they feel necessary, which is usually larger than needed.
The tear, happens where the skin is weakest , and only to the degree necessary for delivery.
The recovery period was night and day between the two. When I tore, I found out that it was not NEARLY as difficult for recovery!!!!.
I then did 3 tears, and NONE of them were ever as difficult on my body as the episiotomy!!

Julie - posted on 05/01/2012

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use a teeny bit of Vaseline in that area and ask the birthing person to help you stretch that area during the birth. We women are built SO amazingly!

CONGRATS on #2 ♥ ♥

Wendy - posted on 05/01/2012

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I had episiotomies with my first 2 (#1 9lbs ,#2 7lbs 8oz) and was let to tear with #3 (6lbs) and I healed some much better with the first 2 than #3 and #3 was way more painful.

Vickie - posted on 05/01/2012

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it's unlikely you'll tear if you didn't the first time. However, if you get a insane dr. who's a control freak like my first dr., you could stand the risk of getting cut.

By and far, a tear is preferable to cut. It's easier to heal, and the dr's more often than they're willing to admit, do nerve and other damage by cutting, that is hard to repair. Not so with a tear.

Suzi - posted on 05/01/2012

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I too did not tear or need an episiotomy with both my children the first I pushed for 6 1/2 hours the second I told my concern of stitches to my dr and asked her to do perineal massage my 2 nd was born in 3 pushes with in 5 mins and I did not rip due to the dr helping streatch that area I recommend talking to your doctor because this too weighed on my mind with my second child!!!!

Jennifer - posted on 05/01/2012

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I was cut wih my first and I wanted to kick the doctor in the face! She didn't even ask, she just did it. She also scratched the top of my daughter's head when she did it. She is now six and still has a scar. With my second I told my doctor (a different one) not to cut me and I healed much faster and was way more comfortable after birth than the first time. I am completely against being cut unless medically necessary.

Colleen - posted on 05/01/2012

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i had fairly quick labors with both my girls. I did have episiotomy with both of them. Neither was big only a few stitches. I was a little sore but not too bad. The diaper with ice works great.

Kinder - posted on 05/01/2012

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My OB absolutely refused to cut because it can cause rectal issues later on in life. A tear is much more natural and yes does heal a lot better. With my son, I was in labor for 3 hours and pushed 4 times. He flew out! I ripped 3 ways and had 9 stitches. It took a few weeks to heal and sex sucked for a few months after it healed. With my daughter I was induced but still only pushed for 2 contractions. She was much much smaller (only 5.2 lbs compared to my son 6.14 lbs) but I still tore. Not as bad only 3 stitches. It is up to you in the end. Do not let your doctor make the decision for you. Doctors dont know your body like you do.

Grace - posted on 05/01/2012

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Most second babies are easier. Having said that, if this baby is bigger, or comes down the birth canal in a different way (ie, head turned a different way, or a hand close to the head), you may tear. However, don't worry. Many women have small tears. If you do tear, your healthcare providers can give you medications and tips/tricks to help keep you as comfortable as possible while you heal. In a few days, you should feel almost back to normal. Also, your doctor should only perform and episiotomy if he absolutely has to use forceps to get your baby out quickly due to distress, and your tissue is tight.

Elizabeth - posted on 04/30/2012

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If they are not against ACOG guidelines yet, they ought to be. There is a mountain of evidence that they cause much more harm than any good.

Elizabeth - posted on 04/30/2012

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I had "routine" episotomies with my first two babies. Not with my third & 4th. My 4th baby was the biggest was posterior, very difficult, 4 hours of pushing and I had NO episiotomy. With preparation, proper care, warm compresses, gentle, patient non-intervention birth tearing is minimal and not painful. Heals quickly stitches or not. The episiotimies were HORRIFIC. I would never, EVER consent to be cut like that if I had only known then what I know now. It's not EVER necessary and does harm rather than any good whatsoever. I just wish I and my doctors knew better back then. Good luck.
God Bless.

Angela - posted on 04/30/2012

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Hi Melissa,
I am surprised to hear that they are still done in California. My OB/GYN explained to me that episiotomies are against ACOG's guidelines. I didn't mean to misinform Britanny, just stating what I've been told.

Melissa - posted on 04/30/2012

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Angela, that is not accurate, episiotomies are still done by some doctors in California, I am a doula and I see them still. Yes each pregnancy is different but if you remained intact with your first baby you will likely be intact this time too.

Angela - posted on 04/30/2012

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Brittany,

You cannot expect your second pregnancy to be the same...Each one is unique. As far as episiotomy goes, they are no longer performed in the USA. I had my baby 2.5 years ago, and I when I asked my OB/GYNs about episiotomies, she said they stopped doing them 5 years ago. There is more damage to mother's parts with the cut than a tear.

Barbara - posted on 04/30/2012

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it's no big thing some mom's don't even know they did dr. stiches it and the stiches fall out by themsleves. Little sore but nothing you can't handle.

Janice - posted on 04/30/2012

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I worried greatly about tearing and I did due to a forcep delivery. However, the reason they do used to do routine episiotomies was because they thought that it would be better to stitch a clean cut. However, once they became the norm 3rd and 4th degree tears became more common. It turns out that once there is a cut it is easier for you to tear further. I know women who had tears that severe, you do not want to up that risk!



I don't know if you will or won't tear this time but I personally would rather chance tearing than be purposefully cut.

Jennie - posted on 04/30/2012

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Hi, this was something I was also fearful. I was in England so had midwifery care, my 1st baby was 9lb & I only had a graze 2nd baby was 7 1/2 lb & facing the wrong way & I didn't even gain a scratch. Midwife care is far better as they understand exactly what is needed to b done to keep a lady in tact while pushing and delivering baby. In my birthplan I had chosen to tear over being cut (if u cut a nik in a towel u can give it a tug & it will tear easily, same applies to that overstretched delicate area) & I wood every time but there are things u can do to stop tearing, perineum massage (basically stretching it urself, gently n with care, some use olive oil, some use a lubricant but from about 30 weeks regularly do it) also getting ur birth partner/husband to put pressure on the area with a towel when delivering baby, certain birthing positions will also enable a tear free birth, squatting, standing, whatever u do don't stay laying on the bed, this is the worst position to birth, difficult for baby to position properly and birth easily, it's also easier for a doctor to snip n deliver if ur on ur back, ur not likely to argue when in pain, tired and about to deliver! Good luck! X

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I had an episiotomy both times because both deliveries were forceps so it wasn't a choice. It was uncomfortable afterwards, but I figured it was better than a cesarean! After my second, my midwife gave me a recipe for helping me to heal. I was to have a warm bath once a day. Into the warm bath, pour 1 cup of full fat milk and six drops of lavender oil. She said my stitches healed faster than normal so I guess it worked. It's all part of giving birth. We can make lovely birth plans, but we have no idea how it's going to turn out. Good luck and hopefully it's as easy the second time for you as it was the first.

Nicole - posted on 04/30/2012

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I'm also pregnant with baby number 2 and the first time I had to have the snip.

I have asked the midwife if there is a chance I will need the same episotomy but she told me its very unlikely and that. It should be more stretchy this time. So I wouldn't worry too much!! Hope it goes well

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