Episiotomy-Is It Necessary?
© Krista Beck-Gallagher
An episiotomy is an incision made into the perineum (the area between the vagina and rectum), usually in the late stages of second stage labor.
Some health care providers insist that episiotomy can help a woman avoid perineal tears, something that has been proven over and over again to be absolutely untrue, in fact, the opposite has been shown to be the case — a woman is more likely to tear from an episiotomy than from the birth itself. This is a topic you will have to bring up with your own healthcare provider to find out her or his views on the subject. You can find references to the research studies at the end of this article.
So, what can you do to avoid an episiotomy or tear? There are actually many things that have been shown to help:
- Positioning
Choosing an upright or side-lying position for birth has been shown to decrease the risk of tears and the "need" for episiotomy by putting less pressure on the perineum than the traditional lithotomy (woman lying on her back with legs in the air) position. - Kegel Exercises
Doing simple Kegel exercises throughout your pregnancy can help tone your perineum and reduce your chances of tearing and the need for episiotomy. - Perineal Massage
Performing perineal massage, a technique used to stretch the vaginal opening and soften the perineal tissue, has been shown in some studies to significantly reduce a woman's risk of tearing during labor. - Warm Compresses During Crowning
Having your midwife, doctor or labor assistant provide hot compresses to your perineum during the pushing stage has also been shown to reduce the chances of tearing. - Pushing
Avoiding directed, or purple, pushing during the second stage of labor, only pushing when the urge is felt, not straining with each push, and/or using spontaneous exhale techniques (not holding your breath) can all also help you avoid a tear and episiotomy.
Tears that occur naturally during labor almost always heal better than episiotomies. There are instances where episiotomy may be necessary, such as with a very large baby, a shoulder dystocia (the shoulders being stuck after the birth of the head), or a very small, premature baby where trauma should be avoided if possible. Ask your healthcare provider for her thoughts on episiotomy and remember your rights as a patient and client.
For more information, including study references, please see the following web sites:
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