Ask the Midwife: How can I avoid an episiotomy during birth?
“How can I avoid an episiotomy during birth?”
Today an episiotomy is no longer a routine procedure – thank goodness – but is performed for cause. Some reasons include a tight perineum which prevents the baby’s head from distending the perineum, prior scarring of the perineum, female circumcision, and/or the baby’s heart beat is low and delivery needs to be expedited. We can decrease the problems with the perineum but not some of the other causes.
The other question is how to prevent natural tears of the vagina and the perineum. It is important for women to know that there is a group of muscles in the vagina that support the vagina, bladder and rectum. These muscles need to be strengthened and toned prenatally to increase their elasticity to allow for relaxation of the vagina and perineum during birth. These same muscles need continued exercise for the remainder of our lives. Thank Dr. Kegel for giving us the Kegel exercise!!
Proper overall fitness is important so consider walking and squats for toning. Proper nutrition is also key. Make sure that you get adequate protein and other nutrients for your tissues to respond well to the stretching of birth.
Keeping the vagina healthy and reporting any signs of an infection to your provider promptly to maintain good vaginal tissue integrity is hugely important. Perineal massage is advocated by many to be helpful in preparing the vagina and the vaginal muscles for birth. This needs to be initiated at 34 weeks and done for approximately 5 minutes 3-4 times per week.
When it comes time to push, your position is important, as is the use of warm compresses on the perineum. The lateral position or squatting for birth is protective of the perineum.
Finally, a slow, controlled delivery of your baby’s head will definitely help to decrease tears. This is difficult when you have a very strong urge to push. I recommend practicing techniques learned in childbirth classes such as focused relaxation.
Susan Papera, CNM,MSN received her undergraduate degree from Cornell University and her Master’s degree and Midwifery from Columbia University. She joined the staff at NYC Health + Hospitals/North Central Bronx as a staff midwife shortly after the Obstetrical services were open in 1978 and she has been helping to care for the women and families in the Norwood section of the Bronx ever since. Presently, she is Director of Midwifery Services. Working with such a richly diverse group of women is extremely rewarding and also an on going learning process as she says. Ms Papera is particularly proud of the fact that she is an NCB “Grandmother”- babies she has helped into the world are returning and she has had the privilege of helping their babies into the world.
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