Let me start by saying, I wholly acknowledge that I'm not in any way a poster child for episiotomies, having experienced rare complications from one myself. However, I don't know any expectant mothers who would prefer an episiotomy for their birth plan. I mean, it hardly fits in with a typical birth "wish list," such as "I want aromatherapy in the room, warm showers, and walking in labor. Oh, and I'd like that highly sensitive area between my nether regions sliced open as my baby is about to be born!" Nope, not the dream scenario.
However, we all know about our best laid plans, and the realities can differ greatly from those. There are times an episiotomy just can't be avoided, with emergencies popping up and a need to immediately get back out for health reasons. However, much of the time, cutting, and even tearing naturally, can be avoided with some preparation in pregnancy and some special measures during labor and delivery. Being able to stretch and adapt during labor to accommodate baby during birth means a much nicer recovery postpartum, which in turns means an easier time enjoying the newborn without the pain, possible medications or trouble getting comfortable sitting with baby. Or sitting at all!
15 Eat Nutritiously
There are all kinds of compelling reasons to eat healthy foods while pregnant, but many don't know that this wise lifestyle choice can actually aid a woman in being able to avoid an episiotomy in birth. By eating nutritiously she can help her skin be healthy, and that can keep the perineum in good shape and thereby reduce the risk of the surgical cut. Also, if a pregnant woman eats a healthy diet and maintains a good weight throughout pregnancy, odds are much better that baby will not grow beyond a healthy weight or size, either. One reason for episiotomies is the difficulty a woman can have in delivering a child that is large for gestational age. While having a high fiber diet, rich with lean proteins, and loads of a variety of fresh fruits and veggies may not guarantee a cut-free birth, it certainly will at least help.
14 Stay Fit And Exercise Regularly
Sometimes it's helpful to think of childbirth as an olympic-type event of motherhood. You are training for that day much in the same way a runner would for a marathon. Indeed, some have calculated some similarities between marathons and childbirth in terms of energy expended. As part of that preparation for birth, expectant moms should stay active and exercise regularly. Of course, before beginning any workout regimen, a woman should talk to her care provider to determine any limits or caveats about physical limits. Even a woman who has some special medical considerations should be able to do some type of physical activity. Walking is a great one, as is swimming or even gardening (just be sure to wear gloves! Certain bacteria in the soil can cause illness in pregnant women). By staying fit, a woman will build stamina needed for labor. One exercise that is ideal in preparation for an episiotomy-free birth is squats. Squats help build the muscles in that area and will make tearing or requiring a cut much less likely.
13 Perineal Massage While Pregnant
If a woman is lucky enough to get regular massages in pregnancy from either her partner or a professional, she is ahead of the game. But that's not exactly the kind of massage we are discussing here. Perineal massage is massaging the area a woman wants to stretch during labor as opposed to tearing or getting cut. A midwife or some medical providers should be able to instruct mom-to-be on how to do this. Generally, lubrication such as Vitamin E, lube or cocoa butter is applied to the perineum, and thumbs are placed about an inch or so within the vagina, while pressing down and outwards. She is to stretch gently until feeling a bit of burning until it becomes rather numb. Avoid the front region where the urinary opening is, though. Aim for doing this daily for the last month or two of pregnancy to help prepare the perineum for birth.
12 Get Medical Provider Onboard With The No-Episi Agenda
While doctors may roll eyes at the detailed to-do and not-to-do lists of first-time expectant mothers, it is a woman's right to find a medical provider who supports her views on a healthy, happy birth. Of course, you need to hear feedback on your demands, and there may be some compromises here and there. But having the goal of avoiding an episiotomy shouldn't be a no-go with any provider. It's not that the woman won't go for it should a situation arise that necessitates it, it's just that patient and provider should agree on what those situations would be. And they should agree on the methods they will utilize in order to avoid that cut to the most tender of lady parts. In fact, this should be an early conversation between the doctor or midwife and mom-to-be to ensure that they will be able to work together on a birth plan that works for the expectant mom.
11 Hire A Midwife
When looking into medical care for the pregnancy and birth, one factor to take into consideration is that just by using a midwife a woman significantly reduces her chances of both episiotomy and c-section. The reasons are really about the whole dynamic involved in a midwife-attended birth and the way midwives respect the natural flow and speed of a labor. Midwives do not attempt to speed a woman's body to match some set timetable, and during visits, midwives are more likely to spend more time instructing patients on care as well as learning about them and their birth choices. Midwives are comfortable with letting mom take the lead in labor, and therefore, it's a more comfortable and relaxed birth for mom. Mothers who are relaxed and educated about birth are more likely to have good birth outcomes. Midwives are also committed to avoiding unnecessary interventions of all kinds, which are liable to lead to episiotomies or even c-sections.
10 Kegel Exercises
For the uninitiated, Kegel exercises are pelvic floor maneuvers that help build the muscles in the vagina and around it, which in turns makes for a better birth, less urine leakage problems before and after birth, and better sex. Kegels are performed by contracting the muscles that stop a woman's flow of urine. To do these exercises, a woman should concentrate on only contracting those muscles, while her legs, butt and abs are relaxed. No one should be able to tell you're doing them, so it's simple to do anywhere, from driving, to sitting in a waiting room, to during commercials while watching TV. To begin, she should hold the muscles for short counts of 5 to 10, and work in some longer ones of 10 to 30 counts. Some advice and extra exercise directions for pregnant women is, for example pretending to go up in an elevator and stop at each level while doing Kegels. By working this muscle area, you are getting your bottom ready for birth and it should be far more in shape for the big day and less likely to have trouble stretching.
9 Practice Breathing And Relaxation Skills
While pregnant, many women read a lot of books, or browse the web, go to a birthing class and decorate the nursery. However, one big investment of time should be regular (preferably daily) practice sessions for birth. During these sessions, moms-to-be should visualize their child's birth and prepare for the labor by learning how to do breathing techniques and practicing those exercises. She should also learn how to be totally relaxed, or even meditate. The pay off for that time investment is a big one; being ready for whatever happens and being able to work with her body as it goes through the birthing process, instead of tensing and fighting it. By learning to know how to relax, and to recognize any signs of tension in her body, a woman will be prepared to breathe, relax and focus through the pain and discomfort. It doesn't have to be some crazy breathing patterns that require reams of notes, or near hyperventilation to master. Being able to go limp, focus on something lovely and breathe slowly and deeply are effective ways to labor and avoid needing an episiotomy and later stitching.
8 Apply Warm Compresses
So much for pregnancy preparation, now let's look at how to handle labor effectively so that the perineum will stretch adequately for baby's passage. One big tool that many midwives use regularly is applying warm compresses to that area between vagina and anus. The warm, moist compress will encourage relaxation in the area and will help the thin, tender skin to stretch under the huge demands of childbirth. The American Congress of Obstetricians and Gynecologists issued a bulletin against routine episiotomy, and recommended warm compresses as one measure to prevent lacerations.
7 Oil And Massage In Labor
Once in labor and a woman's cervix is fully dilated, she is in the second stage of labor. This is the time to apply warm compresses to the perineum to prepare the skin and muscles in the area to relax and stretch for birth. The heated pack can be applied between pushes in order to help prevent tearing or the need for episiotomies. Some midwives also apply oil to the area, usually sweet almond oil, mineral oil, olive oil or Vitamin E to help encourage relaxation and stretching. Often a midwife will also gently support the area as well, in order to try to protect the perineal tissues. Sometimes a husband, partner or birth support person can do this with instruction and support from the doula, midwife or doctor as well. Of course, the compress needs to be sufficiently warm, without being too hot, in order to relax both the woman and the tissues.
6 Water Labor
Water births have become increasingly popular options for expectant mothers. A water birth today doesn't have to necessarily take place at home; nowadays it can happen at a hospital or birthing center, in a birthing pool. While it's become more acceptable to spend the first stage of labor in water, once a woman's cervix has fully dilated and it's time to push and deliver the baby the practice becomes more controversial. ACOG states there are many unknowns and it should be considered an experimental method of birthing with implied risks. However, there are studies that indicate the laboring in a pool reduces the risk of tearing or need of an episiotomy. Also, the relaxing nature of the water and the buoyancy just seems to be a natural pain-reliever. Personally, I gave birth before easy accessibility to birth pools, but I did labor for a good deal of time in my bathtub and found it to ease the discomfort of contractions considerably.
5 Skip The Epidural
While approximately half of all US women opt to have epidurals in labor, it should be noted that there are downsides to what many call their "lifesavers." For one, epidurals are known to significantly slow, or halt labor. If labor stalls too long, and the bag of waters has broken, doctors typically start a countdown clock and if baby hasn't been born by a preset time, measures will be taken to move things along artificially such as augmenting labor with the drug Pitocen. Often when labor is augmented, it sets a woman up for needing more interventions such forceps, vacuum extractor, and eventually a c-section. Whenever more interventions are used, the risk of episiotomy goes up sharply. Also, when an epidural is administered, women cannot be free to move about and aid with labor and have the advantage of using gravity to help baby along. If possible, a woman should avoid getting an epidural if she desires a cut-free birth.
4 Walk Around And Move In Labor
When women are free to move about while in labor, they are more likely to be relaxed and the movement, especially upright positions such as walking or standing, are likely to keep labor moving along as well. Women should become familiar ahead of going into labor with all the many positions available to her when giving birth. While she may not need to use all of them, of course, knowing the options will come in handy when she just can't seem to find a comfortable position. Squatting, on hands and knees, sidelying, or sitting on a birth chair or ball are all excellent ways to use gravity and help the perineum be relaxed. Positions where women are on their backs for any period of time, or have their legs in an unnatural raised position make that skin area taut and more likely to tear, plus they are basically working against gravity and pushing baby uphill.
3 Don't Rush Labor
A key in the strategy to avoid an episiotomy is the whole attitude of a relaxed, take-it-as-it-comes approach to labor. Women shouldn't feel the need to rush off to the hospital the moment contractions become regular. You don't want to wait until crowning to hit the highway, but getting to the hospital too soon seems only begging for interventions to move labor along. Having a midwife, again, is an advantage here, as she will be patient and ready to work with however her patient's body is going in childbirth. She won't have a stopwatch, and she won't rush nature. By relaxing at home or in a birth suite that is comfortable, having light refreshments and passing time with family, the woman should feel more at ease and less likely to become stressed and tense. Letting nature take its course will make episiotomies or tears far less likely to occur or be needed.
2 Deliver In Upright Position
When a woman transitions from the first stage of labor to the second, when her cervix has opened completely, she should get ready for the pushing stage of childbirth. This is a time to avoid stirrups or laying on her back. She should find a supported, upright position to deliver her baby. She could be sitting back against her partner, or up against the bed, or on a birthing stool or ball. While preparing to push, warm compresses can easily be placed against the perineum. In this position, she should be able to rest between contractions while the warm compresses are administered. Then when it's time to push with these final contractions, she is using every bit of gravity to help her along. A woman should speak to her caregiver prior to labor about all the different positions for pushing that may work for her, so she can "try them out" and will be familiar with them on D-day.
1 Don't Push Until The Urge Strikes
Finally, she's gotten through the first stage of labor and has gotten into position for the second stage. Compresses have warmed her bottom to make it relaxed and is set to bring this baby into the world. Here's where births can go offtrack and episiotomies may happen unnecessarily. Women who are coached heavily to push, against what their own body tells them can end up prolonging labor. It's important to wait until she feels the immense pressure to bear down and push. It's like being in love; people can describe it to you, but when it really happens, you'll know! The urge to push feels not a little like having to go #2, and of course, a bit of that may happen, too, but a woman should work with those deep, pressure contractions and push in time with those. By doing this, a woman should help avoid needing the incision and stitches involved in getting an episiotomy. It will also lessen or eliminate superficial tearing of the perineum in many cases.