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“I don’t know, we don’t keep track of those types of statistics.  Anyway, a small cut is better than a big tear, take it from me, I know.” – female OB to a mother who asked what percentage of women who birth at the hospital have an episiotomy.

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 August 11, 2010  episiotomy, OB, pushing  Add comments

  34 Responses to “"…A Small Cut Is Better Than A Big Tear…"”

  1. I love the way she gets out of that nasty matter of “informed consent” by giving no information and telling the mother what the mother prefers.

    BTW, has this female OB experienced both a big tear and a “small” episiotomy? And does her body heal exactly the same way mine does?

  2. “Really? Well, if you come near my vagina with anything sharp, YOU are going to be dealing with a big tear.
    Take it from me. I know.”
    *smile sweetly*

  3. Ugh. That just made me cringe. I’d rather tear. I did tear in three places with DS, I know I’ll probably tear with this baby too. I’m still more afraid of the episiotomy. I’m actually not afraid of tearing at all even though I know exactly what it feels like and what the recovery is like.

    So THERE Ms. small cut is better than a big tear. If it is so superior, do it to yourself and not me.

  4. I have learned that some things in my births may have caused a rectocile (sp). This means it is difficult to get a bowel movement out because it goes into my vaginal area as the wall is weak. Kind of like a hernia but inside the vagina. I believe interventions like purple pushing (coached count to ten) and the episiotomy helped cause mine. I have had 7 kids, had tears BUT did get an initial epis with my first birth. I also had a D&E after fetal demise, and maybe that contributed too (would have rather induced than do that…). So add all my experiences together, and I believe interventions played a role. Now I have to worry about bowels every day. I wish someone would consider long term damage done and ways to reduce it rather than just to get baby out fast. If baby is fine, can we not spare momma adult diapers? I’m 40 and I have to sometimes “help” myself have a bowel movement come out.

  5. Finish the sentence, please.
    Better to have a small cut that is guaranteed to go through skin, subcutaneous tissue, and underlying muscles and ligaments, than a larger tear that will most likely only tear skin?
    And you’re saying the first one will be easier to heal from?
    I have this bridge, real cheap…

  6. Which is why I’ll opt for tearing naturally, a small cut compared to the big tears that can result from episiotomy.

  7. Also…truth be told, don’t most people tear along the cut also? So they still tear, just further than the cut?

  8. When did this OB get her doctorate — 1957??? Does she expect moms to get enemas too because “it’s dirty down there”?? Uuuugh. And my OB wonders why I said I’ll birth in a ditch before I go to another hospital.

  9. I had horrible tears with my VBAC, both inside and out (she turned while in my cervix and I have a really sensitive cervix, so it tore). I don’t know if an episiotomy would have been better, but the fact is, they can’t guarantee that I would have torn–they can only say they thought it was going to happen. So it’s stitches that might not have been needed. (I was never offered an episiotomy, not that I’d have taken it–my baby just shot out during a contraction while I was relaxing).

    Personally, I’d rather give birth in the water and maybe avoid the whole thing :-p

  10. This is mine. I acutally live in Italy and was quite nervous about the hospital situation. I went to visit the hospital, after having done lots of research already about birth interventions and what statistics are ‘acceptable’ and this nonchalant answer (among others) sealed the deal for me that I could not have a baby in that (or any other) hospital. In my third trimester I moved myself from the medical model of care to the midwife model and never looked back. I had a home water birth which was great – perfect, even with some tearing. On retrospect, it also wasn’t clear to me if she was saying she ‘knew’ solely because she was a doctor (and may have witnessed a big tear) or because she actually had experienced a big tear personally with her own children.

    • I personally had a large tear during a hospital delivery (third degree). I would 100% prefer a tear like that over an episiotomy. If I’d had an episiotomy it likely would’ve been a far worse tear.

      Good for you for switching at the last minute. I wish I had done the same with my DD. I think my outcome would have been much different.

  11. Wow. Sorry chick but my male OB lets me tear instead of offering to cut. I tore pretty bad with DD but he did a great job stitching me up. I forgot he’d done it until I took a shower and the hot water hit the fresh work! We weren’t sure if I would tear with DS, but he said he’d only cut if DS were stuck and nothing else worked. Glad he wasn’t knife happy since DS popped out with no tearing at all!
    Even the books I read (WTEWYE) said that a small cut could cause a bigger tear-though it didn’t advocate one way or the other on epis.

  12. Ha! I had a small cut with my first, and FOUR big tears with my second. The small cut healed faster on the surface… but caused lingering issues with my sex life for about a year. The four big tears (think X marks the spot) with my second kid took longer to heal, perhaps because there were 4, and they were big… but healed completely perfectly and I did not have the lingering issues like with the first kid. So, in retrospect, over the long run, I’d actually have preferred two big tears.

  13. Here’s my statistic Kiddies. You cut me and there is a 100% chance that I’ll need stitches. You don’t cut me, and my chances of needing stitches drops. Oh, and I’m rather unconcerned about how “easy” it is to stitch up anything. YOUR JOB Doc, is to first DO NO HARM.
    Step away from the scissors…any sudden movements gets a boot to the head.

  14. 3 kids with no cuts and guess what no tears either. It doesn’t have to be one or the other.

  15. This would be a sensible way to look at the issue except it’s utter nonsense. A surgical cut is always bigger than it needs to be. If it’s not big enough, then it’ll just lead to an even bigger tear. A spontaneous tear is only as big as the birth requires.

    The real advantage, Doctor, to a surgical cut, I’m sure, is that it’s easier for you to sew back up. I’m not impressed with this “you’ll prefer my little cut to your big tear” business.

  16. The OB at my first birth cut me with no advanced notice. I had no idea and my epidural had stopped working, so I got to feel that. Then, the local wouldn’t take even though he shot me up twice and so I got to feel every single stitch.

    My second birth had coached, but not purple pushing like my first and that OB left me alone. I had a tiny little tear and it got a few stitches, but honestly I couldn’t feel it like I felt my first, even though I didn’t consider my first all that bad.

  17. I’ve done both. I’ve had the epi. and the “big” tear. I’ll take the tear hands down any day. It hurts SO much less when healing.

  18. I guess I should submit this for Thoughtful Thursday, but when I asked my OB how often he felt the need to cut he responded “Oh I never do that – it’s archaic and old fashioned. I don’t know why anyone does it anymore.” Apparently the last time he performed an episiotomy was 9 years ago and there really wasn’t any way around it.

  19. I had an epi before forceps, and although I had an epidural on board that could have paralyzed an elephant, I was worried the epi would hurt, so I was debating with the OB…in the course of which, she informed me that epis “heal better anyway”. I wanted to say, “don’t make me pull out the Cochrane review on you.” And yeah, mine healed so “well” I had to have surgery to un-fuse vaginal tissue.

    Thanks, but no thanks.

  20. “a small cut is better than a big tear” Not according to the evidence DOC, but then you wouldn’t know because you don’t keep track of such things. FAIL

  21. My friend had her first baby 3 weeks ago. She was cut and THEN she tore, all the way to her anus, just like a piece of fabric rips easier once you put a small cut on the edge. OUCH!!!!

    • Tell her to sue. It is a known risk of episiotomy and doctors NEED to stop doing them for just this reason. There is plenty of evidence against them. Go to the news. Get a lawyer. Sue the doctor. Sue the hospital. Heck sue the manufacturer of the scissors. Maybe Katy’s doctor (above) would lke to be an expert witness. You can’t just roll over and let them keep doing this!

  22. We’re expecting our 4th and are using a new dr this time. I’ve got to stop reading this blog, it’s terrifying me! I had about 30 stitches with my first, 5-6 with second and nothing with number 3. I’m worried new drs and new hospital will try to push things on me that I just do not want. Add to that that my husband works out of town and my mother is being less than helpful lately, and I fear I’ll be all alone with no one advocating for me.

    I’ve never had a drug, an episiotomy, an epidural, and with my second labour being under 2 hours, START TO FINISH, I can do very well without, thank you very much.

    I do have a friend who tore back and FRONT while trying to stop pushing!

  23. Obviously this woman doesn’t sew. A small cut generally leads to a big tear, whether you’re working with fabric or with skin.

    • You hit the nail right on the head.

      My first, due to being over-drugged because I had severe posterior/back labour pain (yes, forced to lay on my back…) I was unconscious. Led to forceps, and an episiotomy that was not only done wrong (was a direct anal line even though it was contraindicated), but also failed to do its job. The forceps split me open like a banana. 56 perivaginal stitches, a tear in my cervix and a full depth anal tear. Reconstruction 5 years later because Dr. Moron couldnt even stitch me up straight.

      My second, I was worried (they were not) that I would tear along the epi line, so a theatre was prepped for me JIC I did. I had only a very small labial tear, no epi.

      My 3rd I was much more confident, no tear at all (no grazing either!!) and no epi.

  24. hmmm interesting, funnily enough when my doctor was telling me about my c section she told me that they only do a small cut then tear by pulling the rest of the way because a tear heals better!! wouldnt it be nice if all docs were on the same page!

    by the way my incision has healed beautifully and aside from a light line small indent where the stitches were a little tighter you would never know i had a scar!

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