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Here's what you can do to avoid having an episiotomy

For those who don’t know, an episiotomy is basically an incision that is made on the perineum – the tissue between the vagina and anus – during childbirth. It is during the pushing stage of labor that this procedure is performed in order to make the vaginal opening wider for birth.

Back in the days, performing routine episiotomy used to be a standard obstetric procedure for several decades, but there has been a steady decline. This is because research has not been able to bring forward any evidence whatsoever to support routine episiotomy. Even the World Health Organization suggests that episiotomies should only be used in restricted cases. What this means is that an episiotomy should only be performed when it is medically necessary.

Although most birth facilities and healthcare providers have made it an intentional policy and avoid routine episiotomies as best as possible, there are some that still perform them on a routine basis. Their act is typically justified by them as an intervention that is necessary for the well-being of the mother/baby and a ‘medical decision’. Well, to save yourself from an episiotomy, here are a few tips that you should follow:

7 Tip # : Choose a provider that doesn’t perform routine episiotomies

If you truly want to avoid an episiotomy, then you need to be very careful about the midwife or doctor that you choose for your delivery. When choosing one, it is highly recommended for you to ask them how they typically attend to birth. The best health care provider will be one that you are most comfortable with. Apart from that, to ensure a positive birthing experience, your chosen provider should have a similar birth philosophy as well.

A major benefit of choosing the right health care provider can go a long way in terms of lowering your risk of interventions like an episiotomy or unnecessary C-section. For this, when you interview different providers, it is best for you to ask them about the circumstances under which they recommended an episiotomy. While you are at it, you should also ask if they seek verbal consent from the patients who they believe should necessarily have an episiotomy performed. Remember, you may have already given written consent in your admission papers, but as a mother, you have the right to make an informed choice instead of just letting your provider perform a procedure just because they think it is needed.

What does research have to say?

Although some researchers believe that the only time an episiotomy is really required is never, let’s just say that it is a bit extreme in most cases. For this reason, the World Health Organization suggests that an episiotomy needs to be performed in just about 5-20% cases. However, a rate of about 30% or more simply cannot be justified and does not, in any way at all, lies in the best interest of the patient. 

6 Tip # : Hire a doula – forget about getting an epidural

Yes, having a doula around during childbirth has the potential to help you decrease your chances of having an episiotomy. From extensive research that has been performed over the benefits of having a doula around during childbirth, it is evident that the support a doula offers leads to a significant reduction in forceps deliveries, epidural requests and C-sections. Getting an epidural and the utilization of forceps both go a long way in terms of increasing your chances of having an episiotomy.

Doulas are basically trained labor support professionals. Through research, it has become rather evident that the presence of a doula when a woman is in labor has the potential to reduce her risk of requiring pain medications by a full 36%. Her presence also plays a vital role in reducing a laboring woman’s risk of having a forceps delivery by about 57%. The simple fact of the matter is that both epidurals and forceps have long been associated with increased incidences of excessive tearing and episiotomies. Hence, if you truly want to stay intact down there, it is highly recommended for you to take on the services of a doula so that she can stay around to keep you calm all through labor and delivery. If you still aren’t convinced, then make sure that you go through our article Top 7 reasons why you should have a doula around during and after labor!

Hospital’s one person only policy

At times hospitals have a ‘one person only’ policy that you need to put up with. If you want your partner along with you in the labor room when delivering you baby at such a hospital, this will mean having to give up on the doula. But from what I know, it is better for you to choose to have your doula around so that you don’t have to worry about interventions.

5 Tip # : A water birth may help

Several research studies have shown that having a water birth has the potential to decrease your chances of needing an episiotomy. Even if facilities for laboring and giving birth in water aren’t as widespread as of yet, but hopefully as more and more awareness is raised about the benefits offered by water births, more hospitals will come about to provide the said facilities and the staff required by it.

A study was carried out over 5953 births that took place in a birth clinic in which a comparison was carried out over three different birthing methods. The birthing methods that were compared by researchers in this study included bed births, water birth, and birth with the help of a Maia-birthing stool. Amidst all three, the lowest episiotomy rates were noted in water births at 12.8%. As for the other two, the highest rate of episiotomies was in bed births at a full 35.4%, while births using the Maia-birthing stool had an episiotomy rate of 27.7%. In another study, researchers found out that women who give birth out of the water have a 5 times higher ate of having an episiotomy than those giving birth in water. Apart from that, although women who give birth in water are known to have a higher rate of minor tears, the number of severe tears (3rd and 4th grade tears) is believed to be fairly higher in women who give birth out of water.

Water births offer pain relief too

Another major reason why you should prefer having a water birth is because along with reducing your chances of having an episiotomy, it also goes a long way in offering excellent pain relief during labor.

4 Tip # : Stay patient while pushing

To tell you the truth, when you and your baby go through labor, the clock really doesn’t have to matter. In order to save mama from interventions like C-sections, episiotomies and forceps deliveries, it is necessary for her to be given all the time in the world. For this reason, when you are going through labor, it is necessary for you to listen to your body and push with the urge – trust me, this is honestly going to help you have the finest birthing experience.

When listening to your body, it is also necessary for you to know when you need to pause. Yes, you have a severe urge to push and have that ‘ring of fire’ type of feeling during crowning, but you need to pause for a bit. The ring of fire feeling is triggered when your tissue stretches and instead of pushing harder, it is highly recommended for you to pause and let the tissue stretch by itself. If you keep pushing through, you will increase your risk of tearing and your doctor may start feeling that an episiotomy is desperately required to save you from excessive tearing. There is no need at all for things to be rushed as long mama and her baby are doing well close to birth.

Let it stretch

Allowing a laboring mother’s tissue to stretch naturally is far better than performing an episiotomy. For this reason, ask your doctor if they feel pushing could take a certain amount of time. While you are at it, just listen to your body and stay patient.

3 Tip # : Choose an upright position for birth

Most women believe that giving birth on your back is the ‘normal’ birthing position. Although this is the norm these days, there remains the fact that it isn’t the most effective position for pushing or labor in general. This is because when you are on your back, you actually lose gravity and put a whole lot of pressure on you pelvic floor. This position actually makes you work extremely hard in terms of helping your baby navigate through the birth canal. The worst part about this is that it tends to slow down pushing and make it seems as if the baby is struggling to fit. If your baby appears to be struggling, there is a good chance that your provider will want to assist him, which could call for an episiotomy. However, staying upright all through labor can easily prevent this.

The thing with remaining upright in a comfortable position is that it helps in pushing more effectively. As long as you are tolerating the pain well, and your baby is descending well too, there isn’t much chance that you will require an episiotomy or any other assistance in delivering your baby. Even the risk of natural tearing reduces greatly if you stay upright during labor.

Research

When compared with non-upright position, research shows that women who stay upright during labor have:

  • 21% lesser chance of having an episiotomy
  • 23% lesser chance of having a vacuum or forceps-assisted delivery
  • 54% less likely to have abnormal fetal heart rate problems

So for all the benefits that it has to offer, make sure that you stay upright during labor!

2 Tip # : Perineal massage

A perineal massage, which can be described as ‘working’ the skin of the perineum so that it becomes more elastic and supple, in late pregnancy has the potential to help decrease both tears and the need for you to have an episiotomy – and this claim is largely verified by experts in this field.

Research studies suggest that about 24 percent of women who performed prenatal perineal massage in their first pregnancy did not have any tears whatsoever during recovery, compared to just 15 percent of women who didn’t use this particular technique. However, for a perineal massage to be truly effective, it is extremely important for you to do it regularly in the last few months of your pregnancy. For this massage, apply a lubricant like cocoa butter or K-Y jelly around the perineum. Once doe, place your thumbs around 1-1 ½ inch inside your vagina and press down and to the sides simultaneously. Keep stretching for a few minutes till the time that you feel a burning sensation. Continue applying the pressure for a few minutes or till the time that the tissue starts feeling numb. Keep on massing the lower vagina with your thumbs for a few minutes, but make sure that you don’t do it over the urinary opening..

A bit of advice

For the best results, it is highly recommended for you to perform a perineal massage twice a day starting from the 34th week of your pregnancy. However, if you have a condition like active herpes lesions, then it is best for you to speak with your health care provider first.

1 Tip # : Eat healthy food

Hydration and proper nutrition are keys to tissue health and overall elasticity. Experts hold the opinion that proper nutrition is of utmost importance to your body’s work in preparing the perineum for stretching during deliver. What you need to know is that the hormonal changes that take place in your body can make the tissues of your perineum and cervix become extremely elastic and thick. What is most crucial to this process is that you take proper nutrition that provides you with adequate amounts of vitamin E, protein, and short-chain fatty acids that consist of two types of good fat Omega-3 and Omeg-6. For the acquisition of short-chain fatty acids, you should have seeds, nuts, all types of beans, fish like salmon and tuna and cold-pressed oils.

The difference sources of vitamin E that you should consume are inclusive of corn oil, wheat germ oil, almonds, sunflower seeds, safflower oil, pecans, lobster, peanuts and soybean oil. For the record, you should have about 1,000 mg of vitamin E on a daily basis all through your pregnancy. To ensure tissue health, you should also have adequate amounts of vitamin C as well. Apart from elasticity, it is also known to assist in tissue regeneration and integrity.

Stay educated

It is an absolute must for you know when performing an episiotomy is necessary. It is typically required when the fetus appears to be in trouble and a quick delivery is critical. It is also performed when instruments like a vacuum or forceps need to be used to deliver your baby. Your doctor may also perform an episiotomy if your baby is very premature.

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