There are many simple solutions to avoiding episiotomy which is warranted in less than 10% of births.
3 American women has an episiotomy. It is among the
surgeries performed in the US. Over 1
million unnecessary episiotomies are performed annually.
The first course of action is to discuss what measures
care provider employs for avoiding episiotomy. Find out the percentage of births episiotomies are performed and under what
circumstances. "Not very often" is not an acceptable answer. If your
care provider is evasive, he may practice episiotomy as a routine procedure, especially for first-time mothers. If you can't get a straight answer and you are
planning a hospital birth, the hospital should be able to provide statistics on the number of episiotomies performed as it is in the public domain.
If your care provider used episiotomy as a routine
you can discuss your desire to avoid it and gently remind them that the
American Academy of Obstetrics and Gynecology (ACOG) does not support
the routine use of episiotomy. Your care provider's support
is vital to helping you avoid episiotomy.
After securing your care provider' support, the
for avoiding episiotomy are using good perineal support measures before
during birth. These include:
Perineal massage assist the mother in learning to relax rather than tense muscles during crowning
and it lets the tissues become more flexible and can prevent tearing.
How to Perform Perineal Massage
Wash hands thoroughly
Trim nails to remove sharp edges.
- Apply the lubricant of your choice to the perineum
oil, KY jelly, sweet almond oil, vitamin E, etc.)
- Place the thumbs into the base of the vagina up to
first joint, making sure they are well lubricated.
- Using gentle but firm pressure, move the thumbs from
base of the vagina up the side walls as if you were making a
remembering to avoid the urethra.
- As you feel a tingle or stretching, hold the
it subsides and then continue upward.
- Return the thumbs to the base of the vagina and
Kegel exercises are also effective at developing awareness
birthing muscles and in preserving the integrity of the pelvic
floor. They were originally developed by Dr. Arnold Kegel in
1948 to improve incontinence in women after childbirth by strengthening
the pubococcygeus or "PC" muscles.
- These exercises are not recommended for avoiding
you already have
urinary stress incontinence.
- It can be taxing to identify and isolate
muscles of the pelvic floor. Particular care must be given to only
contract the PC muscles rather than the abdominal or thigh muscles.
1. Empty your bladder.
exhaling, tighten the pelvic floor muscles.
for a count of 10. Relax for a count of 10.
Perform 10 repetitions three times daily.
These pelvic exercises can
be performed any time and any place. Many women will perform them as
part of their perineal massage routine. It may take 4 to 6 weeks to see
improvement; so the earlier you begin, the better. As you become more
proficient, you may want to start varying the duration and intensity of
the PC squeezing from a long hold to many short bursts.
Pushing flat on your back stresses the perineum and
the pelvic outlet as much as 30%. Directed or
pushing” where you are flat on your back with nurses holding
as someone arbitrarily counts to 10 and tells you to hold your breath
is quite possibly the WORST thing you can do while birthing.
It makes absolutely no sense at all. It is called
pushing” because if you do as you are told, you will indeed turn
purple from the strain.
The best way to push is to follow the urge yourself
be in any position other than flat on your back. Remember the
contraction is to do the work of pushing your baby out. You
truly don't need to add much extra effort.
PERINEAL SUPPORT for Avoiding Episiotomy DURING BIRTH (HOT/COLD
Using hot compresses on the perineum during crowning
tissues stretch as well as helping you stay relaxed.
- Cold compresses can reduce swelling and
provide numbing to the perineum.
- Manual support can be provided by your care provider
directly on the perineum as the baby crowns. Perineal support
can be applied with oil to promote slow stretching of the tissues.
- The baby should be allowed to slowly descend until
feel the uncontrollable urge to push. Full dilation does not
necessarily mean that you need to start pushing. Follow your
body to decide when it is time for you to push.
In your birth plan, you can specifically state that you
avoiding episiotomy. If one becomes medically indicated, you
request a pressure episiotomy. This is done as the
head is crowning and the perineal tissues are slowly
stretched. It usually allows for a smaller incision that
heals better with less stitching. Also, the pressure exerted
by the baby's head has a numbing effect, so you may not feel
even without a local anesthetic.
Carroli G, Belizan J. Episiotomy for vaginal birth. Cochrane
Database of Systematic Reviews
1999, Issue 3. Art. No.:
CD000081. DOI: 10.1002/14651858.CD000081.
Beckmann MM, Garrett AJ. Antenatal perineal massage for reducing
perineal trauma. Cochrane Database of Systematic Reviews
2006, Issue 1. Art. No.: CD005123. DOI: 10.1002/14651858.CD005123.pub2.
Kettle C, Hills RK, Ismail KMK. Continuous versus interrupted sutures
for repair of episiotomy or second degree tears. Cochrane
Database of Systematic Reviews
2007, Issue 4. Art. No.:
CD000947. DOI: 10.1002/14651858.CD000947.pub2.
Hedayati H, Parsons J, Crowther CA. Topically applied anaesthetics for
treating perineal pain after childbirth. Cochrane Database of
2005, Issue 2. Art. No.: CD004223. DOI:
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by Catherine Beier, MS, CBE