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Avoiding an Episiotomy

An episiotomy is best avoided, so here are some useful tips. But sometimes the snip is necessary, and you'll want to get comfortable and heal quickly afterwards.

An episiotomy is a cut made in your perineum - the skin between your vagina and your anus - in order to deliver your baby. Can you imagine being sliced with scissors down there, boys?

Your body is designed to give birth without surgical intervention. There are ways to avoid episiotomies. I have given birth four times without one.

There are situations when an episiotomy may be necessary. Perhaps your baby is in a breech position, and needs to be birthed quickly. Or some other unusual foetal position is putting pressure on your premature baby's delicate head, and a rapid delivery is called for.

Often, if a woman tears during delivery, it is as a result of her position as she pushes her baby out. Lying flat on your back is the worst possible position for delivery. Vary your positions in labour. Lying on your side is thought to be the best for avoiding episiotomy. Only push as your body tells you to. Unless you have had an epidural, you do not need someone ordering you to push. When you feel like you need to pass the largest bowel movement in the universe - push: your baby is on her way! As your baby's head stretches your perineum, you will feel a burning sensation. Raise your chin and blow quickly and lightly, allowing your baby's head to ooze out slowly. If you put your hand down and feel her head, it will help you feel in more control, because you will know what is happening. Midwives are well practised in helping women not to tear, and avoid episiotomy. Some will help you by 'guarding' your perineum with their hands as your baby crowns.

PERINEAL MASSAGE

The number one way to avoid an episistomy is ten minutes of perineal massage daily in your last trimester to make your perineum as elastic as possible.

Firstly, wash your hands and make sure your fingernails are short. Sit on your bed, or cushions on the floor. Bend your knees up, and let your legs flop apart. Prop them on cushions to make yourself comfortable. Lubricate your fingers with olive oil. I kept mine in a small squeezy bottle, like the type you buy empty at the chemists to decant products into for travelling. That means you don't have to dip your fingers in the oil, contaminating what is left.

Spread oil on your perineum. Be careful not to touch your rectum and then your vagina as you may transfer bacteria and cause a vaginal infection.

Insert your thumbs into your vagina, pressing them against the back wall. Then slowly and gently sweep them away from each other up the walls of your vagina. Repeat this movement for several minutes. This is a little like the pressure you will feel as your baby's head presses down before it starts to emerge.

Next, making sure you are well lubricated, rub your perineum between your thumb and forefinger. Your thumb should be inside your vagina, and your index finger on the outside, with your perineum between them. Consciously relax your muscles as you do this. Go gently, as vigorous stretching could cause bruising or swelling.

KEGEL EXERCISES

Kegel exercises will help to strengthen the muscles of your pelvic floor. Your pelvic floor acts like a hammock, supporting your bladder, uterus and intestines. Your heavy pregnant uterus can stretch out that floor, causing your intestines or bladder to drop.

Conditioned pelvic floor muscles will make pregnancy and birth easier, and you are more likely to avoid a tear or an episiotomy.

To find the correct muscles, pretend you're trying to stop peeing. Alternatively, put a finger - yours or your partner's! - inside your vagina and squeeze.

Don't tighten your stomach or thigh muscles at the same time. Make sure you do not hold your breath while you do them. Practising this will help you to coordinate your breathing with your efforts to birth your baby when the time comes.

Contract and relax

Get comfortable. You may like to lie on your side (don't lie on your back if you are pregnant). Slowly tighten your pelvic floor. Place one hand over your pubic bone and think about tightening your vagina all the way up to your hand. Hold for five seconds and then relax. Repeat.

The elevator

Get comfortable. This one makes me sound as mad as a hatter, but it works.

Imagine there is a really small elevator inside your vagina. Imagine it starts at the opening - complete with a tiny lift operator complete with epaulettes making announcements, if you like! I think mine sounds like the lady at the beginning of the old sitcom Are You Being Served?: 'Ground floor - vaginal opening'. Imagine the elevator rising through each storey. As it ascends, draw up your muscles a little more without losing any of the tension that you have been progressively accumulating from the 'ground floor'. Once you get to the top floor (and the voice announces: 'Cervix, uterus and internal organs') you slowly start the journey back down, until you are relaxed again.


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