Nikki  notes:

<<As for  healing, a natural tear heals more quickly  than a cut; a cut has
been  identified as a cause for greater tearing. While it  is possible to
have
a 3rd or 4th degree tear spontaneously, the chances are much   greater to have
a terrible tear like this if the perineum has been cut. It's  the  same
process
as nicking the edge of some material to make tearing  easier.>>

************************************************
Right on, Nikki!!

I don't have the statistics in front  of me, but when I was the director
(head nurse, if you will) of the out of  hospital Family Birthing Center in
Southfield Michigan from 1979 to 1982 when I  left to move to Chicago, we certainly
kept track of the above.  Back then,  episiotomies were absolutely the norm,
though our physicians were trying to  avoid them.  I think, if I remember
rightly, we had about a 60% episiotomy  rate.  I can say that the ONLY 4th degree
tears into the rectum (or 3rd  degree, for that matter) were when an episiotomy
had been done first.   There was NEVER a "spontaneous" 4th degree.  Now, I'm
only talking about  the first 3 years of the birthing center's existence.  I
won't speak to the  next 20 years, because I don't know what happened and don't
have the stats for  those years.

I also know that the moms I currently  see in the hospital that end up with
an episiotomy have far more discomfort than  the moms with a laceration.   They
also have a much harder time w/  comfortable positioning -- it's incredibly
difficult to concentrate on  breastfeeding when your bottom hurts so much that
you can't stand  it.

Jan Barger, RN, MA, IBCLC
Wheaton  IL
www.lactationeducationconsultants.com

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