How to avoid episiotomy?

Question

As I'm getting close to my due date more likely I would like to avoid it as much as necessary. Does somebody have any tips how and did it work for you?? (I heard massages, different positions for pushing, etc.....??)

Answer 1

SAY NO. If they pull out the instrument to cut you, have your husband or partner say no.

You are more likely to tear to the rectum if you have an episiotomy. A tear heals better than a cut. A cut can lead to incontinence, numbness, pain during sex. I have had three babies, one with episiotomy, one small tear, one nothing at all. I have taken care of hundreds of postpartum women, and believe me some of them will have lifelong problems due to these things.

Do what I'm about to tell you to save your perineum. Do not get induced. That involved you coming in the night before for cervidil and/or being hooked up to bags of fluids. Labor at home as long as possible, walk around. Avoid getting the epidural as long as possible, the longer you lie there, the more fluids pumped into you, the longer you push, the more you will swell and the more likely they will want to cut you.

When it's time to push, perineal stretching is good, have a partner or nurse familiar with this and open to the idea (not all nurses are, or want to take the time). Shoulder dystocia (which is a big baby stuck at the shoulders or other emergency situation such as cord around the neck, heart rate dropping rapidly) is the the only reason you should get one (in my professional and personal opinion) and that is a last resort.

After birth, use real icepacks or the blue icepack pads they have at the hospital. Injuries heal best if iced for 24 hrs so that is what you can do. As mentioned above you can use Tucks pads (we also use a hydrocortisone foam called Epifoam to reduce swelling) they feel great. After the 1st 24 hrs, use a sitz bath which you can get at the hospital or at a drugstore. Keep the pressure off your perineum as much as possible (try to breastfeed lying down and lie on your side) if your labia is very swollen and/or you have hemorrhoids, this will reduce the throbbing, swelling and pressure.

Now, regarding other things mentioned. If you have a midwife, homebirth or birthing center, great. In general, if you are delivering at a hospital with nurses and OB/GYNs, they hate them. Also different positions for pushing - most OB/GYNs are not open to this idea, they like the lithotomy position and will be irritated if you suggest otherwise, best to get this out in the open during your prenatal appts. If you want the safety, benefits and options provided by a hospital birth, discuss your preferences with your partner ahead of time, don't have a birthplan. In my experience, at the hospital, things are always completely opposite of what you wanted. Just discuss your preferences with your partner and make sure he sticks to them but keep an open mind and see how things go.

Answer 2

The last few weeks of my pregnancy, I'd sit up at a 45 degree angle, and using lotion or oil, firmly but gently stretch the lower edge of the perineum. Put both thumbs into your vagina and push down and to each side, til your thumbs are not quite halfway up toward the top of the vagina, as if you're trying to widen and round out a clay pot. Try it three times a day. Just enough so it barely hurts.

Also, I've heard that lying on your side is a position in which you're less likely to tear. Your doc and you can control the rate of expulsion easier, so you don't go too fast and hard. I gave birth to my son over 9 lbs this way, no tear, no episiotomy, although I had previously had two births, one with an epis., one without. Best of luck!

Answer 3

Talk to your caregiver and find out how often he ends up cutting episiotomies. If he says that "all first time moms need one" then I would *RUN* to find another caregiver because that is NOT true. An episiotomy should be reserved for an emergency situation when the baby needs to come out NOW.

Waterbirthing can help to stretch your perineum.

Doing perineal massage now and having your caregiver do it while you are pushing can help.

Talk to your caregiver about using warm compresses and supporting your perineum during pushing.

DO NOT PUSH FLAT ON YOUR BACK. This is the WORST position for birthing a baby! Sure, the doc can see easy but it is NOT a good position to get the baby out! Squatting is GREAT and will widen your pelvic outlet something like 25-35%! Talk to your caregiver about being allowed to choose your own positions for pushing and to remain active during labor. Most hospitals will have a squat bar that can be installed on the bed to help you or your partner/doula/nurse can help to hold you up.

Actually, tearing is BETTER than being cut. Think of it this way.....

If you have a piece of fabric and you try to rip it in half with your hands, it's difficult! If you make a small cut in it and then try to rip it, it tears right in half easily. Your perineum is the same way. If you allow the doc to weaken it by cutting an episiotomy, it is almost certain that the cut will extend into a tear. The worst tears usually actually started out as an episiotomy! A cut will certainly involved BOTH skin and muscle, which makes it harder to heal. A tear may very well only involve skin.

A cut IS faster for the doc to sew up than a tear. That's because he doesn't have to work to put things back together. Think of putting a jigsaw puzzle together. Pieces with two straight sides you can just lay against each other. They are hard to line up exactly though sometimes. If the pieces are unique (like a tear in your perineum would be) then it is easier to match them up to exactly where they belong. SO.....it takes longer to sew up BUT you are back closer to your original state.

A cut is a certaintly. A tear is a maybe. It's better to risk the tear because it will almost certainly be less severe, your perineum will be easier to put back like it was before and it will heal better.

Good nutrition in pregnancy also helps your skin to be more elastic and stretch better in labor. I've had three births and only one tear (first baby), no cuts. My second two were waterbirthed and I'm sure that helped a lot.

If you are cut or do tear, have some thick maxi-pads or some Poise pads at home. Squirt witch hazel into them to soak them and then freeze them. Wear these in your panties to help with healing. The frozen pad will feel really good on your sore bottom.

It is NOT out of your hands. Talk to your doc about this beforehand! This is VERY important. Put it in your birth plan that you DO NOT WANT CUT unless there is an emergency. This is YOUR body and the doc CANNOT do a surgical procedure on you without your consent!

BABYRN mentioned shoulder dystocia. In SOME cases an episiotmy would be appropriate here. If you don't have an epidural and you can move around and change positions, try doing the "Gaskin maneuver" which means getting on hands and knees to push the rest of the baby out. Many times this will help if there is shoulder dystocia. If that doesn't work, THEN consent to the episiotomy. (My 2nd got stuck and they called it positional dystocia because when I did the Gaskin Maneuver she came right out with no problems. I didn't even tear!)

I did tear with my first baby and had stitches. (2nd degree tear) I spent a lot of time sitting on my Boppy pillow while I healed.

Answer 4

Let your doctor know how you feel about it. He or she can give you advice on perineal massage. And if your doctor knows you don't want an episiotomy, he or she will help you prevent it during labor.
I ended up getting an episiotomy, very small and much less dreadful than the tear it prevented, but my doctor also helped me slow down a bit when I was pushing so I had a little time to stretch as the baby was coming out. (It was a fast, fast labor -- 2.5 hours.)

Answer 5

From personal experience, a nice clean surgical incision heals more quickly and is less painful than a rip. That just even sounds horrible. I don't know what the medical concensus is now, but for my 1st and 2nd babies, the episiotomy was used. For the 3rd, my doctor said the OB/GYN board had decided just allowing the tissue to tear naturally was better. Undoubtedly they were all men.
If your baby is large it is hard to avoid.

Answer 6

kinda common for 1st time moms to get them. A 1st time mom is more easy to tear a jagged tear is harder to fix& more painful. The doc will not cut you if there is no need to. If there becomes a need it will be done without asking you in a emergency situation to get the baby out. IT is outta your hands 4 the most part! I had one with my son i was never ask. It was not too bad either. With my daughter i did not have one, i did get two tears they were so much WORSE! they burned when i peed. Massages can help losen the mussles but, really if the baby is large it's not going to help a whole ton you can only streatch so much before you tear. YOU ARE BETTER OFF with a nice clean stitched cut then a sore tear.

Answer 7

Sadly there is really nothing you can do.Remember it's better to have an episiotomy then to tear.A tear takes a long time to heal,while the other heals fairly quickly.♥

Answer 8

Change positions ever 30 mins in labor

Answer 9

My kids averaged 10 pounds. For some, it's simply cut or tear. I wouldn't stress too much about it. Believe me, once it's over, it won't matter. Whatever it takes to get that baby out, healthy and safe, is all that will matter.

Answer 10

Tell your doctor don't do it. Or get a csection. there is different views on wether or not this is safe or needed. remember your vagina will stretch on its own and in my opinion unless the child has a bigger than usual head it shouldnt' be necesary. Just tell your doctor you dont' want one. and the nurses when you go in just incase you end up having a different doctor delivering.