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15th Jun 2015

Expert Tips To Help Avoid An Episiotomy during Labour

Sylda Dwyer

An episiotomy is the name used to describe a surgical cut with scissors to the perineum during birth.

The original theory behind performing an episiotomy was to help prevent a serious tear during childbirth but evidence now shows that routine episiotomies could cause more harm to mothers than a natural tear and should only be used in limited circumstances.

Episiotomy is hard to pronounce and hard to think about without crossing your legs! The good news is there are a number of things that you can do to minimise your chances of having one.

1. Perineal Massage

Not the lovely relaxing kind of massage that you’d like to think it is, perineal massage is definitely still worth your time, particularly if you’re a first-time mum. Studies have shown that massaging your perineum a minimum of twice a week from your 35th week of pregnancy will decrease your chances of having an episiotomy and ongoing perineal pain. The research doesn’t support the same effects for mothers who have already had a baby – but if it ain’t broke… Perineal massage is best performed with a lubricating and softening oil such as sweet almond oil or an organic olive oil, for example. Buy a big bottle and use generously! This YouTube video shows you what to do.

2. Choose a caregiver with a low episiotomy rate

Whether you are attending a midwife or a consultant, it is definitely worth your while having a conversation with your caregiver early on in your antenatal care to find out their individual practice with episiotomies. Don’t be afraid to ask them how often they perform them. You might find out that they rarely do them or your caregiver might have a policy to perform them routinely on every woman they attend. This important information will help you decide if you’re happy to stay in their care or if you’d prefer to look for a caregiver with a lower episiotomy rate.

3. Put it in your birth preferences

Birth preferences are an important communication tool between you and the midwife or doctor who will be supporting you on the day your baby is born. If you would like to avoid an episiotomy, then make sure you include it in your written preferences. Then you or your birth partner can discuss it with your caregiver on the day so that they are aware of your wishes and can support you with that knowledge.

4. Labour in water

Many studies have shown that labouring or giving birth in water can significantly decrease or eliminate your chances of having an episiotomy. There are a couple of reasons why this might be, such as the effect of the water itself on your perineum and that it’s difficult for a caregiver to perform an episiotomy if you are submerged in water.

5. Give birth in an upright position

Giving birth on your back has been shown to increase your chances of both an instrumental delivery – that’s where a forceps or vacuum is used – and having an episiotomy. Think about delivering your baby in an upright position, such as standing, kneeling or perhaps on all fours. Not only will gravity be on your side for your labour but you’ll also reduce your chances of having an episiotomy.

6. Warm Compress

Treat yourself to a nice face cloth – sure you’ll pick up two for a euro – and use it to create a warm compress to support your perineal area while your baby’s head is emerging. This is a great technique for birth partners to use. Simply wet the face cloth with warm water, squeeze it out and fold it into a long strip. Test the temperature of the compress on your arm first before applying it to the perineal area. The warmth and moistness of the compress will help support and soften the stretching skin as your baby’s head is born.

So that’s six very simple but effective ways to help reduce your chances of having an episiotomy. You could use all six or just one, whatever works best for you. Happy birthing!

Sylda Dwyer is a GentleBirth birth preparation instructor and Doula. She teaches workshops in Dublin and provides support and advice to women and their partners in pregnancy, birth and early parenting. For more, find her at AlphaBirth or catch up with her at @birth_rocks.