Natural Birth and Baby Care.com

Is There Any Way to Avoid an Episiotomy?

by Angela

I'm 7 months pregnant. I'd like to know if there anything I can do to reduce the chance for an episiotomy.

At what point during labour is an episiotomy done? Does every one require an episiotomy? Does it hurt even if local anesthesia is used?

Thank you,
Angela

Answer:

Hi Angela,

You've asked some really good questions. I'll start with your last couple.

First, no, not every woman needs an episiotomy. In fact, most women don't need an episiotomy. The female body is made to give birth - and that means the pelvic floor and those tissues are meant to stretch.

Episiotomies have been performed because doctors believed that they were better than tears, which some women do have. This hasn't really held up to research - in fact, an episiotomy can cause even more extensive damage because a woman will still tear past the episiotomy.

If you've ever tried to tear a piece of fabric in half, it can be challenging. But if you put a little snip in the fabric first, it becomes very easy. It's similar with the tissues in the pelvic floor. An episiotomy can cause more extensive damage.

An episiotomy is done during the pushing stage - generally just as the baby is crowning. They can give an anesthetic before doing the episiotomy but often it's not needed. When the baby's head is crowning and the skin is stretched very tightly it'll be numb and an episiotomy won't be felt.

It does hurt healing up, though. Tears often hurt healing, too.

You can reduce your chances of needing episiotomy or tearing.

Be careful with your nutrition during pregnancy. Also get out and walk or do some other gentle exercise often. Eating well will help keep your tissues healthy and soft. Getting up and getting moving will improve circulation all through your body, including down in your pelvic tissues.

During your baby's birthing it's best to let the second stage (pushing stage) go naturally. Don't push forcefully while someone counts and orders you to push. Push your baby out as your body gives you cues to do so - when you feel the urge to push. Stop and take a break when your body isn't telling you to push.

If your baby's head slips back a little, that's ok - this slight backwards and then forwards is ok and it gives your tissues time to stretch around your baby's head.

My Galen was born very, very, very fast - two pushing contractions and he was out. I had no tearing, no bruising - no problems at all.

I feel confident this is because of my good nutrition in pregnancy - but even more than that it's because my husband and I did the Internal Work from the Pink Kit. The Pink Kit is a childbirth class you do in your house. It has step-by-step directions for doing the Internal Work, which is sort of like perineal massage - just more.

It's basically massaging the tissues and working the muscles of the perineum to get ready for the birth. It takes just around 10 minutes daily and you start it in about the last 10 weeks of pregnancy. I feel like it made an amazing difference for me, and even though Galen was born really fast, I had an excellent birth experience and no tearing.

My midwife told me "Kristen, you could have 12 babies" ;)

So no, episiotomy is not required, and yes, you can do things to prepare yourself for birth without one.

One last thing - talk to your midwife or doctor and find out if they routinely do episiotomies on women. Some do, and you'll need to tell them you really don't want one.

The Pink Kit

Galen's Birth

Ina May's Guide to Childbirth - Ina May has an entire chapter devoted to preventing episiotomy (and the entire book is excellent, a "must read")