how can we avoid episeotomy?

Birth is a normal bodily function and women are designed for it.  Most women can give birth without an episiotomy or tear if they are:               

·       allowed to assume proper position for pushing

·       receive adequate training to help them prepare the muscles for giving birth

·       encouraged to tune-into their body’s instincts to stop pushing as the head delivers

My own faith in the normality and simplicity of birth is reaffirmed each time I accompany a mother who gives birth naturally with no episiotomy or tear. Our body design is very efficient and it makes sense that Allah (SWT) made the opening big enough, as a general rule. With proper ante-natal preparation, and good coaching while pushing, most women do not need this procedure.

American College of Obstetrician and Gynecologists (ACOG) has publicly withdrawn support of routine episiotomy.  Random, controlled clinical trials indicate no data to support widespread use of episiotomy.

Reasons doctors may give for episiotomy include:

·        personal clinical experience as an adequate basis for good practice

o   I’d question if they deliver women flat on their backs and in stirrups

·        to shorten the second stage

o   it only shortens second stage by a few contractions

o   this equates to less than fifteen minutes

o   a cruel joke from the woman’s point of view as she has experienced perhaps a couple of hundred contractions over several hours

·        to prevent baby”s head from pouncing on the perineum

o   this is really reaching to support the routine episiotomy

o   the perineum is hardly a brick wall

o   baby has just come through the cervix

o   it took 10-14 hours of “pounding” to dilate the cervix with much more work

o   baby is not going to have difficulty passing through the vagina or perineum.

·        to prevent “over stretching” of the Kegel muscle which supports the internal organs

o   Dr Kegel said the scar tissue from episiotomy does not make strong muscle

·        to make a repair easier as a “clean” cut is said to be easier than a jagged tear to stitch

o   there would be far fewer and less serious tears if we gave up episiotomy

(REMEMEBER AN EPISIOTOMY IS A MEDICAL PROCEDURE THAT MAY BE NEEDED OCCASIONALLY, BUT IS NOT PART OF THE NATURAL PROCESS.)

Good nutrition. A well-nourished mother has healthier skin that can stretch in labor.

Squatting. Squatting on a daily basis with the feet flat on the floor is the only exercise we have that helps to give elasticity to the perineum. Women who squat have a perineum that is thinner and more elastic. Those who do not squat are more likely to tear because the perineum is thicker and less likely to stretch easily.

Air.  Perhaps one of the worst things a mother can do is wear tight-fitting clothes. Wear instead breathable cotton underwear.

Kegel. Daily Kegel practice throughout pregnancy helps the baby to put its chin on its chest in labor, and encourages the smallest part of the baby’s head to come first. The smaller part coming first helps the perineum to stretch normally.

No soap. Soap can be drying and takes away the natural oils, causing irritation to the skin, especially the perineum. A warm bath works well without soap.

Lotion and massage. Putting lotion on the perineum can be soothing. Be sure you are using a lotion that you are not allergic to. Aggressive perineal massage is not necessary; gently massaging as you apply the lotion is fine.

Talk to your doctor in advance. Talk to him ahead of time so he knows what you want. Make sure he is in agreement so there are no surprises.

Be patient. Some babies pop right out in second stage, some take their sweet time. Push to the point of comfort.

Keep your elbows up and out and knees back. Doing so during second-stage contractions helps prevent tearing. Putting your knees apart (widening) as far as possible overstretches the perineum and makes it more likely that a tear will occur. If the doctor or midwife does need to do a small midline episiotomy it is not as likely to extend if your elbows are up and out and knees back.

Push with self-control. When the urge to push starts, take a minute and think about how hard your body is telling you to push. Push to the point of comfort. That might be with all your might, especially in the beginning, or you may feel like a gentle push as the perineum is stretching. Tune in to your body and follow those clues. Author:

Dr Hanaa Kassem OB/GYN , provisional lecturer at AAHC(American Academy of husband coached childbirth)

 reference books husband coached childbirth and Bradley method of natural birth .