What Can I Do to Avoid an Episiotomy?

This information comes from the American Academy of Husband-Coached Childbirth (Bradley)

Twelve things mothers do to help avoid an episiotomy:
An episiotomy is a medical procedure that may be needed occasionally but is not part of the natural process. It has become traditionally part of the birth process.

1. Good nutrition – A well nourished mother has healthier skin that is more likely to stretch with the process of labor.

2. Squatting – Squatting on a daily basis with the feet flat on the floor is the only exercise we have that helps to give elasticity to the perineum, the skin that stretches during birth. Women who squat have a perineum that is thinner and more elastic. Those who do not squat are more likely to tear because the perineum is thicker and less likely to stretch easily.

3. Air – For the health of the perineum light and air are important. Perhaps one of the worst things a mother can do is wear tight fitting clothes like panty hose. Around the house wear a long flowing skirt with no underwear or at least breathable cotton underwear.

4. Kegel – Daily Kegel practice throughout pregnancy helps the baby to put its chin on its chest in labor, and encourages the smallest part of the baby's head to come first. The smaller part coming first helps the perineum to stretch normally.

5. No soap – soap can be drying and takes away the natural oils causing irritation to the skin, especially the perineum. A warm bath works well without soap.

6. Lotion and Massage – Putting lotion on the perineum can be soothing. Be sure you are using a lotion that you are not allergic to. Perineal massage is not necessary, especially the exaggerated perineal massages you see on the internet. There does not seem to be any difference in the episiotomy rate. Gentle massage as you apply the lotion is fine.

7. Talk to your doctor or midwife in advance-Chances are you have a doctor or midwife who is supportive of natural childbirth and probably has lots of patients. Do not assume that they can remember what everyone wants. Talk to them ahead of time so they know what you want. Make sure they are in agreement so there are no surprises.

8. Be patient – some babies pop right out in second stage, some take their sweet time. Push to the point of comfort.

9. Keep your elbows up and out and knees back - during second-stage contractions, to help prevent tearing. Putting your knees apart (widening) as far as possible over-stretches the perineum and makes it more likely that a tear will occur. If the doctor or midwife does need to do a small midline episiotomy it is not as likely to extend if knees are back and toward
your shoulders and your elbows are up and out because this shortens the birth canal and relaxes the surrounding tissues. It also reduces the amount of pain women feel while pushing.
10. Push with self-control – When the urge to push starts. Take a minute and think about how hard your body is telling you to push. Push to the point of comfort. That might be with all your might, especially in the beginning, or you may feel like a gentle push as the perineum is stretching. Tune into your body and follow those clues.

11. Remind the doctor or midwife about your wishes. -You may have talked to your doctor or midwife weeks ago about avoiding an episiotomy, but how do know they remember? Bring extra copies of your birth plan to the birth to remind them about your wishes. Tell them again when you see them for the first time at the birth. They are human you know.

12. Some babies come out fast on their own, others ease out, - if the mother uses self-control. If possible, ease the baby out. Some women, especially first time mothers feel the baby come down into the vagina and over-react by screaming 'get it out'. They push with all their might forcing the baby to fly out and often tear in the process. Stay calm and let the baby do its thing.
©2007 AAHCC