STEPS TO AVOID EPISIOTOMY

• Some women have tissues that naturally stretch more easily and are more likely to give birth without tearing or an episiotomy.

• During a birth in which the mother is encouraged to ease the baby’s head out slowly, using a position which is aided by gravity, and the perineum is supported, it is possible to minimise tearing or the need for episiotomy.

• Avoid sustained pushing and avoid giving birth on your back. Try a more upright position (being raised on pillows into a semi-reclining position is much better than lying almost flat) and let gravity help you to stretch the vagina open more evenly and slowly.

• Massaging the perineum with natural oil for six weeks before your due date can improve the pliability of the skin and underlying tissues. This massage also helps women become familiar with their anatomy and accustomed to stretching sensations, which are common during the birth.

• A warm, moist pad placed against the perineum during pushing increases the circulation to this area and provides support and comfort while the tissues stretch during birth.

• Try to avoid pushing using sustained breath holding. Rather use gentler, spontaneous pushing, without excessive straining, to ease the baby down through the birth canal. By preventing excessive straining during pushing you can reduce the over-stretching of the pelvic floor and push your baby out more effectively.

• Epidurals often increase the need for episiotomy. In a full epidural the pelvic floor may be very relaxed and the baby’s head may not completely turn into the birthing position. Sometimes the mother is unable to push effectively. When this happens, the doctor needs to use forceps to help the baby out. An episiotomy is done to make enough room to put the forceps in position. The likelihood of this happening is reduced in women who have a partial epidural during labour.