Q: I gave birth to my daughter in February at home with a certified nurse
midwife. The midwife made me believe an episiotomy was necessary due to a
long labor and fatigue. It was devastating to have to go through this after
many months of preparing for a normal birth for both my baby and my body.
Unfortunately, the CNM didn't assess or repair my perineum or my rectal
muscles correctly. I had to have another surgical procedure to have my body
put back together.
I want to heal as completely as possible with minimal scar tissue in hopes
of having future homebirths without being cut. Is the herbal supplement
gotu kola safe to take while breastfeeding? My research has shown that this
herb is great for skin regeneration. However, half the information I have
found states that it is safe for anyone to take, and the other half states
not to take if you are breastfeeding.
The OB/GYN who performed my repair surgery said I will always have to have
an episiotomy with all future births. I don't want to believe this is true.
How many midwives out there can tell me if they have had clients who have
had a similar situation, or have had clients who have had a fourth degree
episiotomy and have gone on to have births without having major tears?
-N.E.
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A: I had a hospital birth with my second child with an obstetrician who
performed an episiotomy that tore to fourth degree. Total recovery to the
point where I was once again comfortable during lovemaking took
approximately eight months. For my third child, I had many fears about my
episiotomy scar holding up. I did tons of kegels, and we did perineal
massage approximately twice weekly during the last two weeks of my
pregnancy, using sweet oil, and planned a home waterbirth. I had a
precipitous waterbirth, and tore 1/16 of an inch, with no perineal support.
This child was a full pound bigger than my second.
-Anita W.
AAMI student, Missouri
ICAN Chapter Coordinator
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In spite of being very fit and attending exercise classes right through my
first pregnancy, I had a very extensive episiotomy with my first (9 lb 2
oz) baby; the doctor (in a country hospital) did a high rotation with
forceps delivery for impacted shoulders; the episiotomy did not heal by
first intention. Twenty months later I had my second baby in a mother
friendly unit where midwives did most of the deliveries and was very
pleased to have no episiotomy, tear or grazes (8lb 3oz baby).
In spite of being most conscientious with pelvic floor exercises, two years
later I had to have a vaginal repair for a prolapse and 20 years later a
bladder neck suspension. I have always wondered if the two operations would
not have been necessary if I had had an episiotomy the second time around.
-Laurelle (registered midwife)
====
Don't lose hope! Last month I attended a birth where the mom had a very
slight skin split AFTER she had a fourth degree epis/tear at her first
birth. She was repaired incorrectly the first time, (the family doc didn't
realize it was a fourth degree). She then had reconstructive surgery. The
couple was faithful about perineal massage five weeks prior to the second
birth. It was an awesome birth--mom could not be any happier.
-Anon.
====
Kudos to Gloria Lemay for her response to the young woman's concerns about
her episiotomy and what she can do to prepare for her next birth. Gloria's
words
were balanced, kind and fair, and full of wisdom and good advice. This is
the sort of approach we should all model when trying to make sense of a
troubling story. Too often we take sides or jump to conclusions, when we
can't see all sides of the stories. I loved her words about being the
midwife for a difficult first birth, and how easy it is to look (and feel?)
like a heroine when the mother gives birth the second time. She has taught
me a lot.
Thank you, Gloria, and Midwifery Today for sharing her spirit with all of us.
And I completely agree with her about a woman's ability to give birth over
an intact perineum after a traumatic experience. I have seen this to be
true over and over again. A good diet, a positive attitude, and a patient
midwife can do the trick!
-Penni Harmon, CNM
====
As a labor and delivery nurse, I have personally seen women who have had
previous 4th degree lacerations come in and deliver a baby over an intact
perineum. And not a 5 lb baby--some have been 8 and 9 lbs. It really
depends on a patient birth attendant (whether doctor, CNM or CPM) and the
birthing woman listening and working with the birth attendant. With
perineal support and slow, steady pushing, it can and does happen.
-Michelle Smith, R.N.
Reprinted from Midwifery Today E-News (Vol 2 Issue 21 May 26, 2000)
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