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With the 4 that I had naturally, I had an episiotomy with each one and also tore past it with each one. I hadn't heard that they have decided that is a factor...good to know and I am not surprised! All of my babies were sunny side up though (facing up instead of down) and that is supposed to increase the risk of and extent of tearing. And yes, the aftermath of it hurt, although I didn't feel the cut itself nor the stitching. There are no long-term problems that I have ever noticed though.
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