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Nancy SullivanPreventing an Episiotomy
by Nancy Sullivan, CNM, MS, FACNM

Q. I am 33 weeks pregnant with my second child. With my first, my labour was fairly quick (5 hours), and I had a substantial episiotomy. I would like to know if there is anything I can do to prepare the perineum for stretching rather than face another episiotomy.

A. There isn't much that you can do to "prepare" to avoid an episiotomy this time. Studies have shown that massaging and stretching the perineum ahead of time actually increase the likelihood that you will tear. I would talk to your midwife or doctor and tell her/him that you want to avoid this procedure. Tell her/him that it is no longer recommended by the American College of Obstetricians and Gynecologists as a routine procedure.

At the time the baby's head is crowning, it helps a lot if you don't push too much; when you feel that "ring of fire" start to really burn, stop pushing and pant through the rest of that contraction. That will allow the perineum to stretch a little more, and then you can repeat the push-burn-pant thing with the next contraction. As long as the baby's heart beat is good, there is no rush to get the head out; the baby's head can crown out slowly and stretch everything on its own. Also, it is less likely that you will tear or need an episiotomy with the second labor.

More on episiotomies:
  • Get Through Childbirth in One Piece! by Elizabeth Bruce, MA, CCE
  • Are Episiotomies Necessary? ~ a message board archive
  • Episiotomy vs Tearing by Nancy Sullivan, CNM, MS, FACNM
  • Third Degree Tearing by Barbara Parker, RN, ARNP, CNM
  • Episiotomy Scar Problems by Barbara Parker, RN, ARNP, CNM

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