How to Avoid an Episiotomy
Author: Carla Snuggs
An episiotomy is a procedure where doctors cut the perineum, which is the area between the vagina and anus, in order to smooth the progress of the baby's emerging (or crowning) head.
Episiotomies are sometimes unnecessary and may not be as harmless as previously believed. Recent research presented in the American Journal of Obstetrics and Gynecology and the Journal of Nurse-Midwifery reveal that episiotomies may not prevent deep tears, may not heal better than other tears, and may not prevent fetal brain damage. There are several measures you can take to avoid an episiotomy if it is not absolutely necessary.
Birth plan
The purpose of your birth plan is to assist you in informing your midwife or doctor of your wishes during labor and delivery. Ask your doctor how often they perform episiotomies and how they make that decision. Explain your position to your doctor and add simple statements in your birth plan, such as "I prefer not to have an episiotomy unless it is medically indicated" and/or "I would rather tear than have an episiotomy". There is no guarantee that your doctor will remember your preferences, so be sure to keep in communication about this with your doctor or midwife throughout the process.
Perineal Massage and Dilators
Perineal massage conditions the tissues around the vaginal opening with massage to help prepare the perineum for labor and delivery. You should do this massage once or twice per day, beginning around the 34th week of pregnancy.
You may also want to discuss the use of a perineal dilator with your doctor. A perineal dilator is a device inserted into the vagina which allows the perineum to practice gradually stretching. This helps prevent trauma to the perineum during childbirth. Using a perineal dilator has shown to reduce episiotomy rates in first time births by 50 percent.
Warm Compresses
Your midwife, or anyone on your birthing team, may also place warm compresses on the perineum. This will relax the tissue and make it more flexible, as well as reduce swollen tissues. In addition, ask your doctor or midwife for instructions for applying castor oil packs, which may be helpful in relaxing and soothing the perineum.
Practice Good Nutrition
To help avoid an unnecessary episiotomy, practice good nutrition, and stay hydrated to promote tissue health and elasticity. Make sure you are taking in sufficient amounts of protein, vitamin E, and foods rich in omega 3, omega 6, and bioflavanoids.
Keep in mind that having an episiotomy is a choice, but sometimes it is absolutely necessary. Some situations where an episiotomy may be necessary include breech births, unusual fetal positions, and premature births, since the baby's skull is so delicate.
