Episiotomy or tear?

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desmondkr's picture
Joined: 02/24/11
Posts: 114
Episiotomy or tear?

I thought I would ask you natural mommas about your episiotomy/tear history. I have had to have an episiotomy both times I gave birth vaginally. This time I am wondering if the healing would be better/easier if I just let myself tear naturally. What is your experience? Have you experienced a tear in one birth and episiotomy in another? Which was less painful afterward?

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

Oh tear for sure. Have you read "The Thinking Women's Guide to a Better Birth" If not your should. All an episotomy sets you up for a worse tear. Here read this:


Allie01979's picture
Joined: 10/10/07
Posts: 4706

I was extremely lucky with both, and didn't have either, but I told the MW and OB at both births I did not want to be cut, I would much rather tear (unless of course it was a life or death situation for my child) the recovery is said to be much easier. Def read the PP link Smile

Joined: 03/22/07
Posts: 259

IME - Simple.....a tear, a MILLION times over.

For my first labour I had a (mediolateral) episiotomy - it was awful, the pain when healing (which it didn't do very well admittedly) was worse than during labour. Seriously. DH had to hold DD1 against me to feed on a couple of occasions as it was that bad. I still had significant pain when DTD 8-9 months afterwards.

For my second labour I tore (around the edge of my scar tissue from the first time!). Grade 3 - officially worse than an episiotomy. Required hospital transfer for a repair (it was a home birth). But this was a picnic compared to the first time. I think we DTD about 5 weeks PP with a tear, pain free Wink

I know people have "good" experiences of healing from an episiotomy but I would not want to go through that again. I personally would rather tear. (Of course I would rather NOT tear, but YKWIM? ;)).


Joined: 01/22/07
Posts: 170

Ha, I noticed this on the birth plan you posted on the April board but didn't want to butt in.

I hope you get the info needed.

MrsMangoBabe's picture
Joined: 04/09/07
Posts: 2276

From what I understand, OBs who are up-to-date on the research will tell you that episiotomy should only be used in very rare circumstances (to hurry the pushing stage due to fetal distress or to redirect a tear headed for the urethra). My OB from my second birth, who was younger, said she almost never does them, while the older OB whose practice I left when pregnant with my first, said he uses them rather liberally. This article from an OB about delayed cord clamping actually uses episiotomy as an example of a procedure OBs used to do routinely that evidence proven not to be beneficial and has gone out of style: http://academicobgyn.com/2009/12/03/delayed-cord-clamping-should-be-standard-practice-in-obstetrics/

Injuries to the perineum are graded on a scale from 1-4. First degree is skin an dissue damage, 2nd degree damages the muscle, 3rd degree tears into the anal sphincter, and 4th degree tears all the way through it. An episiotomy is 2nd degree damage. With my first birth (with epidural), I only tore 1st degree, so an episiotomy would have damaged me more. I didn't tear at all in my second birth (unmedicated), and recovery was a breeze! I would never, ever want an episiotomy knowing that NOT tearing is a possibility. Giving birth in a position other than on your back, especially ones like kneeling or hands and knees where the perineum is not as stretched, reduces your risk of tearing.

kridda_88's picture
Joined: 01/28/08
Posts: 1798

I had an episotimy with both my boys but my first tore as well. I ended up with a third degree tear with him and it took FOREVER to heal. Both of my boys went into distress during pushing which is why my doctor did the episiotimy if it hadn't been for that I wouldn't have had to have them.

But personally I don't know which one is worse because I never JUST had a tear. Sad I do know that it took forever for the episiotimy to heal though.

Joined: 12/10/05
Posts: 1681

Doctors doing routine epis are WAY behind the times. Only one doctor in the mat unit I work in does them with any frequency.

I've never had an epis myself but I did tear with my first 3 kids. With my 4th I had a mw and my *goal* was not to tear. The mw was amazing guiding me when to push, breath, etc and I only needed literally one stitch where the old scar started to separate.

A tear might be inevitable with the scar tissue, but a good care provider should be able to minimize that...

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

With an episotomy you have 100% chance of tearing. Without one you don't. Smile

desmondkr's picture
Joined: 02/24/11
Posts: 114

Ok, I am definitely adding that I don't want an episiotomy to my birth plan. I told the doctor that delivered my second child I wanted to avoid one if possible. He "tried" to stretch me but then ended up cutting me anyway. This is the same doctor that pushed me into both c-sections and is NOT my current doctor. I will have to have this discussion with my OB tomorrow at my appointment. I would definitely rather tear, DTD was very uncomfortable for at least 4 months after both of my episiotomy's and I would really like to not relive that. Thanks for all of the help! Smile

Joined: 01/18/06
Posts: 1626

Unless my baby needed out NOW, like life or death for either of us, I would avoid episiotomy at all costs.

mandora's picture
Joined: 07/16/07
Posts: 262

I didn't tear with any of my babes, regardless of the fact that with every one of them the m/w attending thought I had or was going to because of how fast my babes come. If I had had an old school doc, I would have had 3 unnecessary epis. And my 'no tear' was definitely easier to heal from. Wink For me, it's like a PP said.... with an epi you're guaranteed to have trauma, but with a tear it's not for sure that it'll even happen.

Joined: 03/16/15
Posts: 53852

With DS#1 I had a 1st degree cut which tore to a 2nd degree and with DD I had a 2nd degree tear. I always just though it hurt less the 2nd time because I had been through it before. It was crazy the difference in the pain levels!

emommyof2's picture
Joined: 09/26/10
Posts: 310

I had a starburst tear (to the front) with my first, and it healed up super quick I hardly even noticed it... I mean... after the 60+ stitches or something crazy like that LOL. Never had any tearing with the others, no episiotomy either so I guess I'm pretty lucky.

Honestly, if you have a great midwife/doula they can help you walk through centered pushing and avoid both very easily. And reaching down to touch your baby's head as he/she is coming out helps you to control your pushing and avoid tears!

Joined: 11/29/06
Posts: 1316

"JorgieGirl" wrote:

Unless my baby needed out NOW, like life or death for either of us, I would avoid episiotomy at all costs.


joysiloo's picture
Joined: 09/04/06
Posts: 1054

I had a 2nd degree tear with DD, but I also labored really quickly and my body didn't have much time to adjust. Even with the tear, I didn't feel that the pain was that bad. It healed quickly...it felt fine long before my seemingly never ending post-partum bleeding was done.

With this birth, like a pp, I told my midwife that my goal is not to tear...I wouldn't let anyone near me with a scalpel unless the baby was in serious distress.

mommys's picture
Joined: 05/08/06
Posts: 6264

I tore with mine, and I must admit that it was quite a bit of pain in the 5 days after. I would do it again though. There were no lasting affects, just those first days as the stitches were healing.

pico83's picture
Joined: 09/06/06
Posts: 3014

With my first I had a "baby needs to get out now" episiotomy and ended up with 3rd degree tearing. It was amazingly painful and took a while to heal. (But obviously was worth it)

With my second I had a probably unnecessary 2nd degree episiotomy. Compared to with #1 it barely hurt and healed pretty easily. But, now I kind of wish the doc had held off a bit before doing it.

This time I have a MW practice (hosp birth) and they do not do episiotomies unless medically necessary. It'll be interesting to see what happens.

desmondkr's picture
Joined: 02/24/11
Posts: 114

I seriously have the best OB! I talked to him about this this morning and he said he basically doesn't do episiotomys. He said he has maybe one or 2 per year that he has to cut (only because of fetal distress or if he thinks they are going to tear to the clitoris). I told him that if it came down to it I would much rather tear. He said he doesn't like to brag but he can usually keep his patients from tearing also. Where was this doctor when I was having my other kids??? Biggrin

Mom2ThreeKiddos's picture
Joined: 09/15/09
Posts: 1380

That is great news.