How to Avoid an Episiotomy
Consider giving birth with a midwife., Look into the possibility of delivering your baby at a birth center., Find a supportive obstetrician., Get additional support., Ask about water birth., Get regular prenatal care., Eat well., Do Kegel...
Step-by-Step Guide
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Step 1: Consider giving birth with a midwife.
Although most American women give birth under the care of obstetricians, there is information suggesting that midwives tend to perform episiotomies less often than obstetricians.Midwives can and do perform episiotomies in certain cases, for example, if there is an emergency that requires a rapid delivery, but do not usually perform them unnecessarily.
If you have a high-risk pregnancy or wind up with complications, you’ll have to be transferred to a specialist; therefore, if you choose a midwife as your provider, be sure to discuss how this process will work.
Most midwives are affiliated with hospitals and obstetrical associations and can transfer you easily to the care of an obstetrician.
High-risk pregnancies should be managed and cared for by a trained obstetrician.
A midwife does not have the training necessary to take care of high-risk pregnancies.
Consider a Certified Nurse Midwife (CNM), who is a midwife with graduate-level education and training. -
Step 2: Look into the possibility of delivering your baby at a birth center.
Birth centers are non-hospital facilities, which are usually staffed by midwives.They typically do not perform episiotomies.
This is probably due partly to the providers at birth centers – midwives as opposed to obstetricians – and partly to the fact that birth centers tend to promote natural childbirth with as few interventions as possible.
Midwives will typically use other methods to help relax the area, such as using warm compresses., If you decide to use an obstetrician and give birth in a hospital (whether out of medical necessity or personal preference), find one that supports your desire to avoid an episiotomy.
Ask lots of questions about how many episiotomies a particular obstetrician performs, which circumstances he or she performs them under, and what his or her attitudes are toward other interventions.
In general, an episiotomy rate of 15% or less is a good sign; this suggests that a practitioner does not tend to perform the procedure routinely or unnecessarily.Be are that they are sometimes necessary, however, to prevent an even more severe tear of the perineum. , Whether you choose a midwife or an obstetrician, and whether you have your baby at a birth center or a hospital, you can also enlist the support of a doula — a professional who specializes in helping women through labor and delivery.Although a doula does not provide medical care, they often help women get through childbirth with less pain and fewer interventions.
Make sure your doula knows that avoiding an episiotomy is important to you, so that she can be your advocate.
You can also enlist the support of a doula before and after labor to provide physical and emotional support.
These doulas are commonly referred to as antepartum and postpartum doulas.If you don’t want a doula or cannot afford one, this supportive role can be played by your partner or another trusted person.
Make sure this person is as educated as possible in ways to help you deal with the pain and stress of labor — including breathing and massage techniques – and understands your desire to avoid an episiotomy. , Some birth centers and hospitals offer the option of giving birth in water, usually in a warm tub or pool.
If you have this option, consider it! Water birth lowers episiotomy rates considerably, and it also tends to minimize your pain and make labor shorter., Healthy pregnancies are more likely to lead to uncomplicated deliveries.
See your midwife or obstetrician regularly, and follow his or her advice about keeping you and your baby safe and healthy.
Your doctor should perform tests throughout your pregnancy to make sure things are going well.
Early tests include blood type (Rh Type) with antibody screen, hemoglobin and hematocrit, cervical examination for cervical cancer, rubella and varicella immunity, urine culture and protein, test for STDs, and thyroid function tests.
In the coming months your doctor should should evaluate your blood pressure and urine protein, weight, document fetal cardiac activity, assess fetal activity and presentation, measure of uterine size, and check for gestational diabetes with a glucose tolerance test. , A balanced diet is crucial for a healthy pregnancy, and it may also help you avoid an episiotomy.This is because good nutrition contributes to healthy skin and tissue – including the skin and tissue of your perineum, which will need to stretch significantly during birth.
Stay hydrated! This will also contribute to the elasticity of your perineum.
Foods high in Vitamin E and C such as sunflower seeds, pecans, and lobster, as well as acidic fruits are especially important for your skin’s health and elasticity., Kegel exercises strengthen your perineal muscles and your pelvic floor.
They can also increase circulation and decrease swelling.
If you can, perform these exercises every day until delivery.To do a Kegel exercise, simply tighten the muscles you would use to stop the flow of urine.
Hold for ten seconds, then release.
Aim for 10–20 at a time, whenever you think about it.
Kegels are also great for pregnant women because they may also reduce the likelihood of urinary incontinence after childbirth., Some studies suggest that massaging your perineum will help you avoid tearing or needing an episiotomy; other studies suggest that this isn’t so.Talk to your midwife or obstetrician.
If you decide to try perineal massage, begin by finding a warm, comfortable place.
Sit in a reclined position, with your legs apart and your knees bent.
Apply a lubricant like vitamin E oil or cocoa butter to your perineum, avoid lubricants such as petroleum jelly, baby oil, or mineral oil as these can cause vaginal infections.
Insert your thumbs into your vagina and pull toward the sides and press downward, stretching your perineum very gently.
Massage your lower vagina and perineum for several minutes, but do not put pressure on the urethra (top part of the vagina), as this can cause swelling or infection.
You can repeat this daily from the 34th week of pregnancy until you deliver.Alternatively, you can have your partner massage you, using the same technique.
Make sure he or she proceeds with care, though – it’s important to be gentle.
Massaging too vigorously can lead to infection. , If you have had an episiotomy or a tear with a previous delivery, consider applying hypericum ointment to the scar tissue regularly during the weeks before your due date.
This may help you avoid tearing along the same line or needing another episiotomy.Hypericum ointment is homeopathic ointment made from the leafy herb known as St.
John's wort.
One of its many uses includes increasing collagen production, which is what makes skin elastic., Once you are in labor, things can happen quickly, and — especially in busy hospitals — the wishes of the laboring mother can be overlooked.
Make sure to remind your care providers that avoiding an episiotomy is important to you.
If you can, have your partner, doula, or trusted friend there to advocate for your wishes.
It can be difficult to be firm about your wishes when you are in pain. , Studies show that women who received pain medication during labor and delivery have the highest rates of tears and episiotomies, and epidurals seem to lead to the most episiotomies.
This may be because epidurals make many of the best birthing positions impossible, and it may also be related to the fact that epidurals eliminate your natural sensations, so that you will have to push when someone tells you to, not when your body feels ready.To help you deal with the pain of childbirth, you can also consider medical alternatives for pain management such as local anesthesia, which may be injected to numb a specific area (such as the vagina), or pain medications which can be injected intravenously into the arm, for example.
These options will not completely get rid of the pain, but they can lessen it., Whether or not you plan to deliver your baby in the water, soaking can be beneficial during labor.
Warm water is relaxing; it may minimize your pain and make you feel more comfortable.
In addition, it can help your perineum relax and stretch. , Kneeling, crouching on your hands and knees, or lying on your side are thought to be the best positions to help avoid an episiotomy.
Do not spread your knees wider than your shoulders, and point them forward (not to the sides).
These positions will help your perineum relax and stretch while easing your baby’s descent., Warm compresses can help your perineum stretch naturally and remain intact during delivery, as can gentle massage with olive oil or another lubricant.The compress should be placed gently against the perineum, and should be warm but not hot as this could increase blood flow to the area, which may cause more swelling., Some women feel the urge to push as hard as they can as soon as they are fully dilated, but it’s better to take delivery slowly in order to protect the perineum.
Slow, controlled, careful pushing will give your perineum time to stretch.
As the baby crowns, you can even stop pushing for a few contractions.
Let your midwife or obstetrician know that you want to go slowly, and then, when you feel ready, push again.
You will be much more likely to deliver with your perineum intact., Episiotomies are sometimes necessary, just as other interventions are.
No obstetrician or midwife can guarantee that you will deliver intact.
Understand that the most important thing is that you and your baby get through labor and delivery safely. -
Step 3: Find a supportive obstetrician.
-
Step 4: Get additional support.
-
Step 5: Ask about water birth.
-
Step 6: Get regular prenatal care.
-
Step 7: Eat well.
-
Step 8: Do Kegel exercises.
-
Step 9: Consider perineal massage.
-
Step 10: Rub hypericum ointment on scar tissue.
-
Step 11: Remind your care providers that you want to avoid an episiotomy.
-
Step 12: Avoid getting an epidural.
-
Step 13: Soak in warm water during labor.
-
Step 14: Choose an ideal delivery position.
-
Step 15: Ask for additional support for your perineum.
-
Step 16: Control your pushing.
-
Step 17: Manage your expectations.
Detailed Guide
Although most American women give birth under the care of obstetricians, there is information suggesting that midwives tend to perform episiotomies less often than obstetricians.Midwives can and do perform episiotomies in certain cases, for example, if there is an emergency that requires a rapid delivery, but do not usually perform them unnecessarily.
If you have a high-risk pregnancy or wind up with complications, you’ll have to be transferred to a specialist; therefore, if you choose a midwife as your provider, be sure to discuss how this process will work.
Most midwives are affiliated with hospitals and obstetrical associations and can transfer you easily to the care of an obstetrician.
High-risk pregnancies should be managed and cared for by a trained obstetrician.
A midwife does not have the training necessary to take care of high-risk pregnancies.
Consider a Certified Nurse Midwife (CNM), who is a midwife with graduate-level education and training.
Birth centers are non-hospital facilities, which are usually staffed by midwives.They typically do not perform episiotomies.
This is probably due partly to the providers at birth centers – midwives as opposed to obstetricians – and partly to the fact that birth centers tend to promote natural childbirth with as few interventions as possible.
Midwives will typically use other methods to help relax the area, such as using warm compresses., If you decide to use an obstetrician and give birth in a hospital (whether out of medical necessity or personal preference), find one that supports your desire to avoid an episiotomy.
Ask lots of questions about how many episiotomies a particular obstetrician performs, which circumstances he or she performs them under, and what his or her attitudes are toward other interventions.
In general, an episiotomy rate of 15% or less is a good sign; this suggests that a practitioner does not tend to perform the procedure routinely or unnecessarily.Be are that they are sometimes necessary, however, to prevent an even more severe tear of the perineum. , Whether you choose a midwife or an obstetrician, and whether you have your baby at a birth center or a hospital, you can also enlist the support of a doula — a professional who specializes in helping women through labor and delivery.Although a doula does not provide medical care, they often help women get through childbirth with less pain and fewer interventions.
Make sure your doula knows that avoiding an episiotomy is important to you, so that she can be your advocate.
You can also enlist the support of a doula before and after labor to provide physical and emotional support.
These doulas are commonly referred to as antepartum and postpartum doulas.If you don’t want a doula or cannot afford one, this supportive role can be played by your partner or another trusted person.
Make sure this person is as educated as possible in ways to help you deal with the pain and stress of labor — including breathing and massage techniques – and understands your desire to avoid an episiotomy. , Some birth centers and hospitals offer the option of giving birth in water, usually in a warm tub or pool.
If you have this option, consider it! Water birth lowers episiotomy rates considerably, and it also tends to minimize your pain and make labor shorter., Healthy pregnancies are more likely to lead to uncomplicated deliveries.
See your midwife or obstetrician regularly, and follow his or her advice about keeping you and your baby safe and healthy.
Your doctor should perform tests throughout your pregnancy to make sure things are going well.
Early tests include blood type (Rh Type) with antibody screen, hemoglobin and hematocrit, cervical examination for cervical cancer, rubella and varicella immunity, urine culture and protein, test for STDs, and thyroid function tests.
In the coming months your doctor should should evaluate your blood pressure and urine protein, weight, document fetal cardiac activity, assess fetal activity and presentation, measure of uterine size, and check for gestational diabetes with a glucose tolerance test. , A balanced diet is crucial for a healthy pregnancy, and it may also help you avoid an episiotomy.This is because good nutrition contributes to healthy skin and tissue – including the skin and tissue of your perineum, which will need to stretch significantly during birth.
Stay hydrated! This will also contribute to the elasticity of your perineum.
Foods high in Vitamin E and C such as sunflower seeds, pecans, and lobster, as well as acidic fruits are especially important for your skin’s health and elasticity., Kegel exercises strengthen your perineal muscles and your pelvic floor.
They can also increase circulation and decrease swelling.
If you can, perform these exercises every day until delivery.To do a Kegel exercise, simply tighten the muscles you would use to stop the flow of urine.
Hold for ten seconds, then release.
Aim for 10–20 at a time, whenever you think about it.
Kegels are also great for pregnant women because they may also reduce the likelihood of urinary incontinence after childbirth., Some studies suggest that massaging your perineum will help you avoid tearing or needing an episiotomy; other studies suggest that this isn’t so.Talk to your midwife or obstetrician.
If you decide to try perineal massage, begin by finding a warm, comfortable place.
Sit in a reclined position, with your legs apart and your knees bent.
Apply a lubricant like vitamin E oil or cocoa butter to your perineum, avoid lubricants such as petroleum jelly, baby oil, or mineral oil as these can cause vaginal infections.
Insert your thumbs into your vagina and pull toward the sides and press downward, stretching your perineum very gently.
Massage your lower vagina and perineum for several minutes, but do not put pressure on the urethra (top part of the vagina), as this can cause swelling or infection.
You can repeat this daily from the 34th week of pregnancy until you deliver.Alternatively, you can have your partner massage you, using the same technique.
Make sure he or she proceeds with care, though – it’s important to be gentle.
Massaging too vigorously can lead to infection. , If you have had an episiotomy or a tear with a previous delivery, consider applying hypericum ointment to the scar tissue regularly during the weeks before your due date.
This may help you avoid tearing along the same line or needing another episiotomy.Hypericum ointment is homeopathic ointment made from the leafy herb known as St.
John's wort.
One of its many uses includes increasing collagen production, which is what makes skin elastic., Once you are in labor, things can happen quickly, and — especially in busy hospitals — the wishes of the laboring mother can be overlooked.
Make sure to remind your care providers that avoiding an episiotomy is important to you.
If you can, have your partner, doula, or trusted friend there to advocate for your wishes.
It can be difficult to be firm about your wishes when you are in pain. , Studies show that women who received pain medication during labor and delivery have the highest rates of tears and episiotomies, and epidurals seem to lead to the most episiotomies.
This may be because epidurals make many of the best birthing positions impossible, and it may also be related to the fact that epidurals eliminate your natural sensations, so that you will have to push when someone tells you to, not when your body feels ready.To help you deal with the pain of childbirth, you can also consider medical alternatives for pain management such as local anesthesia, which may be injected to numb a specific area (such as the vagina), or pain medications which can be injected intravenously into the arm, for example.
These options will not completely get rid of the pain, but they can lessen it., Whether or not you plan to deliver your baby in the water, soaking can be beneficial during labor.
Warm water is relaxing; it may minimize your pain and make you feel more comfortable.
In addition, it can help your perineum relax and stretch. , Kneeling, crouching on your hands and knees, or lying on your side are thought to be the best positions to help avoid an episiotomy.
Do not spread your knees wider than your shoulders, and point them forward (not to the sides).
These positions will help your perineum relax and stretch while easing your baby’s descent., Warm compresses can help your perineum stretch naturally and remain intact during delivery, as can gentle massage with olive oil or another lubricant.The compress should be placed gently against the perineum, and should be warm but not hot as this could increase blood flow to the area, which may cause more swelling., Some women feel the urge to push as hard as they can as soon as they are fully dilated, but it’s better to take delivery slowly in order to protect the perineum.
Slow, controlled, careful pushing will give your perineum time to stretch.
As the baby crowns, you can even stop pushing for a few contractions.
Let your midwife or obstetrician know that you want to go slowly, and then, when you feel ready, push again.
You will be much more likely to deliver with your perineum intact., Episiotomies are sometimes necessary, just as other interventions are.
No obstetrician or midwife can guarantee that you will deliver intact.
Understand that the most important thing is that you and your baby get through labor and delivery safely.
About the Author
Douglas Morgan
Creates helpful guides on creative arts to inspire and educate readers.
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