One of my biggest fears before giving birth was getting an episiotomy. Scissors near my vagina? No thank you!
An episiotomy is when the perineum (the skin between the vagina and anus) is cut to make the vaginal opening larger. It can be done midline or medio-laterally (diagonally), or less common laterally or J-Shaped. It was thought that by making the opening larger, birth would be quicker and there would be less trauma to the vaginal area. Natural tearing during the childbirth in general is less severe than an episiotomy and healing time is typically quicker. Further, episiotomies often are a cause of incontinence, postpartum pain and sexual disfunction – the very things it was designed to to prevent! Luckily, routine episiotomies are on the decline. A nationwide study in the US stated about 31% of women received one in 1997, down from 56% in 1979! (and this is almost 20 years ago!)
So, how can you avoid an Episiotomy?
Tips to Avoid an Unnecessary Episiotomy
Check Your Hospital & Doctor’s Protocol
Your hospital’s procedures are going to be the biggest predictor of whether you receive an episiotomy. If an episiotomy is part of their standard labor protocol, it is likely you will end up with one. If you are able to, try switching to a different hospital where it is not standard procedure. If you are unable to, try speaking with your doctor about it. They may surprise you. If not, try presenting some of the most recent research studies advising against routine episiotomies. Lastly, try switching doctors. This is YOUR birth; you need to be on the same page as your care provider. Check out The Leap Frog Group‘s survey on episiotemy rates to see how your hospital compares.
Put It Your Birth Plan
Make your wishes known on your birth plan. Something simple such as “I would prefer to tear than have an episiotomy.” Let your birth partner know as well. They will be your biggest advocate during labor when you are unable to do so yourself.
Learn to Push Effectively
Take a natural childbirth class to learn how to push effectively. Conserve your energy during early labor for the pushing stage. This can help you prevent fatigue during the pushing stage. Avoid coached pushing (may not be possible if an epidural is received). Instead push with your contractions and breathing. Allow plenty of time to push. Some woman are lucky to get baby out in a few pushes, others not so much. But performing an episiotomy after 20 pushes is not enough time.
Learn to Breathe Baby Out
Speaking of pushing, another great way to avoid an episiotomy and even tearing during child birth is to go slow and wait for baby’s head to fully emerge before you start pushing. This allows the perineum to stretch – and the head is the largest part of the body. Much easier said then done, but a great strategy.
Gently massaging and stretching the perineum may reduce the risk of tearing in first time mothers. Essential Baby has a great tutorial on it. This is best when started around the 32nd week of pregnancy to get the body used to the delicate skin stretching, although it can also be used in the pushing phase by a skilled midwife.
Try to Get Baby to Turn
Although it is possible to safely deliver a breech baby, many doctors and midwives are still nervous about the possibility. Getting baby to turn before attempting vaginal delivery may help prevent an episiotomy. Mama Natural has some great ideas on how to get a breech baby to turn.
This isn’t to say all episiotomies are bad. There are cases where episiotomies can save lives – both the baby and the mother. Such as fetal distress, abnormal position by the baby, if the baby needs to be delivered quickly or if a natural tear actually would cause more damage than an epistemology. An episiotomy may also be easier to recover from than a Cesarean. Weigh all of your options as best you can when deciding if the procedure is right for you.