C-Section or Episiotomy?

[Anonymous]

Besides what the PP said about sono being NOTORIOUSLY incorrect when it comes to baby weight, I would also add that baby weight doesn't really have that much to do with whether or not you tear. So, beware of a provider who is putting too much stake in EITHER of those things. A really good provider should offer ideas about how they can keep you from tearing (ie, encouraging non-standard positions for pushing, encouraging you to push when you feel the natural urge, rubbing warm oil/warm compresses into the perineum, supporting the perineum, guiding your pushing a little bit right as the baby is emerging.) All of these things will make a difference regarding whether you tear or not. I personally know many first time moms who have pushed out babies in the 8, 9 and 10 (yes!) pound range who had only minor tearing because they used those sort of tear preventing strategies.

[Anonymous]

Anonymous wrote:I can only speak from my own experience but I would chose the vaginal delivery over a C-section any time! A C-section is a major procedure, takes time to recover from and leaves a scar.
If you're stitched properly it will only be irritating the first day or two when you pee but after that you wouldn't know you had the ep.

I admit, I only read a few of the responses, but I have to comment on this one. This poster is very, very lucky. I had two vaginal deliveries, one with a very small episiotomy, and the other without. The first, despite the episiotomy, I ended up with a bad 3rd degree tear. With the second, it was a second degree. Granted, both babies were over 9 lbs. But still-- I would say it was nearly 3 weeks before I felt back to myself (meaning, I could pop up and down from chairs without pain, and could go to the bathroom without wincing). I would say I had intense pain for a week every time I did the above-mentioned things, and the second week I would classify as very sore. And I'm tough-- I am not a wimp when it comes to pain.

That said, I would hesitate to do an elective c-section for a first baby, particularly if you plan to have more kids. If you have to do it, you have to do it. I do, personally, think the recovery is actually easier; it is certainly easier than my experience with a vaginal delivery(ies). However, once you have a c-section, your chances of changing your mind for later deliveries is slim (I understand fewer and fewer OBs will do VBAC). Plus, for example, my SIL who had three c-sections (first two were breech), can't have any more kids--per her OB--because of all the scar tissue. I also thing, assuming an uncomplicated vaginal delivery, that is the safer method for the baby. All the fluid had a chance to get out of the lungs, etc.

The thing is, no matter how you give birth, it isn't going to be easy. There will be a recovery period. Some people are fortunate and are right back up on their feet. I would be willing to bet I was at the bad end of vaginal delivery, given the size of my kids. But you never know which end you'll be on until it happens. I don't think you will ever "forget" about L&D; you will just realize it is all worth it and it is something you just have to go through to get your precious baby in the end. I say, prepare yourself for the worst and hope for the best!

[Anonymous]

I've had three 3 sections. First was breech, 2nd I was induced but baby was not coming - ended up being put to sleep for another C. Had my 3rd this summer. All three were easy but with this last one my uterus attached to my bladder. The more scar tissue the higher the chance the sac will plant in an odd place.

[Anonymous]

OP here. Thanks to PP 23:03 for your advice. I appreciate everyone taking the time. I took a prenatal class this weekend and learned that GU Hospital (where I will be delivering) does not do episiotomies unless the circumstances are extreme. I am hoping for a safe vaginal delivery and will indeed prepare for the worst and hope for the best.

Thanks, everyone!

[Anonymous]

I just wanted to weigh in quickly on this although most things have been said. I had a full episiotomy (which I really didn't want) with my daughter who was delivered by ventouse (vacuum). But a couple of things to note:

1) It is better to have an episotomy than to tear. It is clean, has less risk of infection, and my Dr. did an amazing job of closing closing me up - which leads me to
2) He did such a great job that sex has been better than ever
3) I do remember lying there on no drugs thinking, 'I would rather have an episiotomy than a c-section.' And this from the woman who was screaming 'get it out!'

I would also say that there is a far greater liklihood of tearing if you have a large baby. I have two friends who had large first babies (over 8.5 pounds) and relatively small second ones (less than 7) and they both said the second birth was completely different.

I am pregnant with my second and planning to be induced earlier (my daughter was nine days late) to try to hedge a baby any larger than 8 pounds 8 ounces (my daughter's weight) and to help have a 'normal' vaginal delivery, although I'm personally not sure if there is such a thing.

Oh, and a note on what someone wrote about not being able to take control. If you think you aren't in control before you head into having a baby (or any type of medical help) then you have already lost the battle. You are in control, your partner must help you do it, but you can't just give up and say that you had no say or control over the situation. I have managed incredibly complex health issues with my daughter and fought and won. Only you know your body, your wants and how much you can take. So go in there and have the birth experience you want to have!

[Anonymous]

Anonymous wrote:
1) It is better to have an episotomy than to tear. It is clean, has less risk of infection, and my Dr. did an amazing job of closing closing me up - which leads me to

This is absolutely untrue. All current studies have shown that it is better to tear naturally than have an episiotomy. Doctors who follow evidence based medicine know that it is better to tear than perform an episiotomy. ACOG recommends restricted use of episiotomy: http://www.acog.org/from_home/publications/pr...ses/nr03-31-06-2.cfm

[Anonymous]

Anonymous wrote:Birth plans are a bad idea. They get you thinking that you are in control of the situation - that the hospital, doctors and nurses should abide by what you want.

I'm here to tell you - it doesn't work that way most of the time.

Find a doctor you like and TRUST and then discuss options with the doctor, but understand that when the baby comes, everything is really up in the air and the important thing is that the baby is healthy (and that you are ok!)

I know many people won't like this post, but I'm saying it anyway. I know from experience and it literally kills me when I hear women talking about "hospitals abiding by their wishes" and their carefully prepared and thought out "birth plans."

Good luck OP!

It literally kills you? Did you post from beyond the grave? I'm sorry, but I disagree with you. I don't believe birth plans are a bad idea. And I do think the hospital, nurses, and doctors should do what the woman prefers whenever possible. There is no reason to take a baby away to bathe it, or to routinely push formula feeding over breastfeeding, and that's true of many routine practices in hospitals. And there is every reason to respect the mother's wishes when it will not cause harm to the mother or infant.

[Anonymous]

To PP 23:03 .. I was the lucky one I guess. I have to say I didn't deliver in the US but in London, UK. I really didn't feel a thing of the ep., the vonteuse delivery and the stitches never bothered me. My baby was almost 10 lbs and 56 cm so quite a big one and if I wouldn't have had the ep. I would have probably had a full rupture.
I am sure that it also depends on who's performing the ep. I guess no delivery is the same and I understand that some women have had bad experiences with the ep. but I still feel it's a better option than to undergo a c-section which is still an operation.

OP: good luck with your decision!

[Anonymous]

I ended up with a 3rd degree episiotomy at DD's birth two months ago. It was the thing I was most concerned about leading up to delivery and during labor. Everyone says it's not THAT big of a deal - they're right. Hard to be positive about it before delivery, and yeah, it's sore afterwards, but it's not unbearable. I will definitely fear that a lot less next time around. Try not to freak out about it as much as I did.

[Anonymous]

I would definitely choose a vaginal childbirth with natural tearing unless an episiotomy was absolutely warranted (i.e. bad shoulder distocia, delivery with forceps, other rare instances)

A great place to find evidence based risk information on vaginal birth, c-sections, and vbacs (remember, if you have one c/s you will have to fight to ever birth vaginally again!) is www.childbirthconnection.com - another is the white papers section of the International Cesearian Awareness Network (ICAN) website www.ican-online.org

I had one easy c-section, and the recovery from it was still a lot harder than my vbac (with 2nd degree tear). Vaginal birth was amazing and so different from a surgical birth.

Good luck OP!