All About Episiotomies

Avoiding an Unnecessary Episiotomy

Ask when and how often the individual doctors or midwives in your provider's group find it necessary to perform this procedure. Make sure that you're on the same page with them about when and if an episiotomy is necessary.

A caregiver who does few episiotomies will probably recommend several strategies to help you avoid an unnecessary cut:

• Practice Kegels. Kegels are exercises that tone the vaginal muscles so they can stretch more easily for birth. To do a Kegel, tighten and relax the muscles around your urethra, vagina, and anus, as if you're trying to hold back urine. Keep the muscles contracted for about 10 seconds. Repeat 10 to 20 times in a row, two to three times a day.
• Perform prenatal perineal massage. With your doctor's okay, start about six weeks before your due date. Here's how: Sit up, leaning back, in bed, or stand with a foot resting on a chair. Lubricate your fingers with vegetable oil or a water-soluble gel like K-Y Jelly. With your thumbs on the inside and other fingers on the outside, make a U-shaped movement around the bottom portion of your vagina (the part toward your back). For about five minutes, apply just enough pressure to create a stinging sensation while you focus on relaxing. Your partner could also do this massage for you, with index fingers inside and thumbs outside.
• Control your pushing. During the birth, you can help by controlling your pushing according to your birth attendant's directions, by letting your knees fall far apart, and by completely relaxing your pelvic floor muscles (the opposite of a Kegel). Your doctor or midwife may apply warm compresses to help you relax, topical lubricants to ease out the baby's head, and firm hand pressure to keep the baby's chin flexed to present a smaller diameter at birth.