How to avoid Episiotomy [Surgical Vaginal Tear]

Following are the informations I gathered from different places. Hope this helps all the mommies-to-be. Please do add if you know any informations.

Perineum Massage

Starting around 34 weeks, you could try massaging your perineum (the area around your vagina). Daily perineal massage may increase the area's stretching ability, leading to less need for an episiotomy and fewer natural tears.

Try this technique yourself, with clean hands and trimmed nails, or have your partner do it for you. If you're going solo, have a large mirror handy so you can see what you're doing and to help familiarize yourself with your perineal area.

• Sit in a semi-reclined position in a warm, comfortable area, spreading your legs apart. Lubricate your fingers, thumbs, and perineal area with vitamin E oil (from punctured vitamin E capsules), pure vegetable oil, or personal lubricant. Don't use baby oil, mineral oil, or petroleum jelly.

• Place your thumbs about 1 to 1 1/2 inches (to or just past your first knuckle) inside your vagina and spread your legs. Press down toward the rectum and toward the sides at the same time. Gently and firmly continue stretching until you feel a slight burn or tingling.

• Hold this stretch for about two minutes — until the tingling starts to subside.

• Now slowly and gently massage the lower part of the vagina back and forth, hooking your thumbs onto the sides of your vagina and gently pulling the tissue forward, as your baby's head will do during delivery. Keep this up for three to four minutes.

• Finally, massage the tissue between the thumb and forefinger back and forth for about a minute.

• Be gentle because a vigorous touch could cause bruising or swelling. During the massage, avoid pressure on the urethra (urinary opening) as this can lead to irritation or infection.

Of course, perineal massage isn't for everyone and it may not help in every case. The most important thing you can do is to choose a midwife or doctor who's experienced and comfortable delivering babies without doing episiotomies. In general, midwives tend to perform this surgery less often than physicians. Regardless of the type of practitioner you choose, discuss your wishes and expectations with that person before the birth.

Relaxation and Lubrication

The number one way to prevent an episiotomy is relaxation. Pick up a book on focused breathing or relaxation during delivery (hypnobirthing is great for this!). Also, check with your OB to see which oils are allowed during labor - extra lubrication can also reduce the likelihood of a tear.

Practice Positions

Preparing for birth by squatting is a time honored and common sense practice that helps stretch all the areas that will be affected during childbirth. It is a natural and helpful posture to use in addition to walking during labor and delivery.

BirthBall

Sitting on a birthing ball while you are in early to mid labor help stretch out the area. Making it easier for baby to come through.

Kegel Exercises

My OB for my first child did not believe in doing episiotoies. She recommended doing kegel exercises to strenghten the muscles and stretching exercises. She would give instructions every month on different exericises to help with delivery. I followed every one and when it came to the delivery, I didn't even tear a little bit, nothing. She helped guide the baby out with ease. My son was a big baby and his head was huge for a newborn of his size, I barely just got him out, but still no ripes. Afterwards I was walking and back to normal within a few hours. I couldn't even tell that i just popped a child out. With this child I'm carrying now, I have a new OB but I clearly stated that i refused to have one done because I still do my exercisies regularly...oh and the bonus of these exercisies is they also help with increasing your organisms and make sex feel much more intense.

More to Continue..

 

Steps to follow when you are pregnant:

1. The first thing you should do is discuss your preference to avoid an episiotomy with your care provider. A good place to start is the Questions to Ask form. It does no good to research alternatives for pushing and positioning as well as do perineal massage if your provider routinely cuts episiotomies. Some mothers may decide to switch providers if the provider's answers to questions are not in agreement with their plan to avoid an episiotomy.

2. Next write a birth plan. Include ideas for a variety of pushing positions. Request to not give birth lying on your back with your legs in stirrups. Birthing on your back with your legs in stirrups will increase your chances of tearing as well as make it easier for an episiotomy to be performed.

3. Include in your plan a desire to have a slow, controlled birthing of the baby's head. Request that your provider encourage you to push, if possible, in between contractions during the crowning stage. This will enable your body to slowly stretch over the baby's head versus coming out too quickly.

4. Ask if one of the members of your birth team (partner/husband, doula, nurse, midwife or obstetrician) use warm compresses during crowning to ease discomfort and assist in stretching. If you have a lot of swelling in your pelvic floor and labia, cool compresses work well to reduce swollen tissue.

5. Starting at 34 weeks of pregnancy, begin doing prenatal perineal massage. This massage has been shown to increase a first time mother's chance of having an intact perineum.

6. Eat a varied and healthy diet. If you have good prenatal nutrition, your skin will be healthier and stretch better. These include foods rich in Vitamins A, E, K and B complex.

Remember that this is an important decision, not only regarding your birth, but in your long-term health. The research in the last 20 years has been consistently clear. Episiotomies have either caused equivalent outcomes to when no episiotomies were cut, or they have caused more complications such as more postpartum pain, greater blood loss, infection, deeper tears, and playing a role in long-term problems such as bladder control.


For the research-minded parents, here is only a small list of recent research on episiotomies:

1. Study (Jan 2007, Obstet Gyn) showing that anal sphincter tears (deep 4th degree tears) are more likely to occur if mother had an episiotomy.
2. This research study (Euro J Obstet Gyn Rep Gio, 2006) indicates that the rate of episiotomies were reduced in waterbirths.
3. Researchers (J Repro Med, 2006) found that the episiotomy rate was decreased when physicians were taught about the latest evidence and also had to document a reason for performing an episiotomy.
4. This study (Green Journal, 2006) showed that a significant increase in anal sphincter tears occured when mothers had both an instrumental birth (vacuum or forceps) and an episiotomy.
5. Interesting study (Jnl Repro Med, 2006) that indicated episiotomy rates were higher in private practice physicians versus staff residents.

More to Continue.

 

Choice of Birth Attendant and Birth Place

• Doulas: Hiring a doula can help you to avoid an episiotomy, especially if you plan on a hospital birth. Research has found that having a doula cuts requests for epidural by 60 percent and has a 40 percent reduction in forceps deliveries; both procedures are major contributors to high episiotomy rates.
• Midwife-assisted Birth: Births assisted by midwives rather than by obstetricians have lower rates of most interventions, including episiotomies.
• Birth at home or in a birthing center: Here you and your chosen assistants/partners have more control over the progression of birth. Also, if you are giving birth in a place where you can be most relaxed.

Nutrition

Good nutrition and hydration are very important for tissue health and elasticity. "Good nutrition is vital to your body's work in preparing the perineum for stretching during birth. Hormonal changes during pregnancy cause the tissues of your cervix and perineum to become extremely thick and elastic. Crucial to this process is an adequate intake of protein, vitamin E, and short-chain fatty acids, which consist of two types of 'good' fat, Omega-3 and Omega-6. Short-chain fatty acids are found in nuts and seeds, cold-pressed oils, all types of beans, and fish such as salmon and tuna" [SIZE=-1]"Avoiding an Episiotomy", Nancy Griffin, Mothering Magazine, # 75, summer 1995, (p 60).[/SIZE]
Vitamin E can be especially helpful (at least 1,000 mg per day). Food sources include: Wheat germ oil, wheat germ, sunflower seeds, almonds, pecans, safflower oil, peanuts, corn oil, soybean oil, and lobster.
Vitamin C is also very beneficial for tissue health, cellular integrity, elasticity and regeneration.
Bioflavanoids. These are the compounds that make oranges orange, blueberries blue, and cherries red. These crystalline compounds give foods their bright colors and great taste. More than 4,000 flavonoids are known. While sometimes-called vitamin P, they are not truly vitamins. The medicinal effects of many foods and herbs are due to their flavonoid content. The most well known flavonoids are PCOs (proanthocyanidins), quercetin, citrus bioflavanoids, and green tea polyphenols. Some foods rich in flavonoids are blueberries, cherries, citrus fruits, pears, grapes, cabbage, legumes, plums, and onions.



During Birth -- Positioning

Recommended positions:

• Water birth encourages "good mechanics" A mom can float into a very natural relaxed position. She can push as she feels a need to. She may be more relaxed -- no one is flexing the head or has their fingers in her vagina. The warm water soothes and takes away the sting of crowning, so she is more able to slowly birth the head (some women push like gangbusters just to get the crowning over with!). There are very few tears in water births.
• Squatting (can be done with a birthing bar or directly on the bed with support from labor partners) helps reduce tearing. It shortens the length of the vaginal canal and increases the diameter.
• Lying on left side Most women do better if they lie on their left side to avoid tearing.

The following positions and techniques can actually CAUSE tears:

• Any back lying position, including semi-sitting
• Widely flexed legs -- lithotomy position or any back lying.
• Coached pushing -- Standard American births, we coach to PUSH HARD until full crowning -- then tell the mom to slow down. This is TOO LATE!
• Rushing the shoulders -- standard in the US.

During Birth -- Understanding Pushing

Avoid unnecessary pushing. This is commonly encouraged by impatient care providers and involves pushing before the mom feels an urge to push or before the head is reasonably low and is mostly rotated into the optimal orientation for birth. This is best avoided altogether.
True pushing occurs when the mom feels an uncontrollable urge to push because the baby's head is putting pressure on the nerves of the pelvic floor. This almost certainly means the head is low and rotated into birth position. This takes however long it takes for the mom to get the hang of it and to push the baby out. If the mom's instinctive pushing efforts are moving the baby, it doesn't make sense to mess with it.
Be wary of olympic-style "purple pushing" (the Valsalva maneuver), where the mom is encouraged to hold her breath and use all the muscles in her body, may occasionally be helpful; but it also can impede venous return and cause the swelling mentioned above.
Stop pushing when the head has been pushed through the pelvis and is beginning to stretch the perineum. Once the head is through the pelvis, it's just the delicate perineal tissues that are holding the baby in, and this is where a woman's perineum is either protected through careful coaching and hand maneuvers or allowed to tear through ignorance or a rush to get the baby out.
Ideally, the care provider is maintaining a good connection with the birthing woman. By letting her know through words, tone and manner that this is the time to stop pushing and simply to breathe the baby out, i.e. avoid putting any voluntary efforts behind the uterus, which is "pushing" all on its own. "There is a time to push, and a time simply to breathe". Prolonging the unnecessary phase of pushing may contribute to tearing, but prolonging the very end of pushing is likely to reduce tears, rather than cause them.
"When your baby's head no longer disappears back inside you after a contraction, it is about to slip out. At this point, not pushing can allow you to stretch without tearing. You may feel pressure, heat or burning. This too shall pass!"
To help women in second stage stop pushing when we are attempting intrauterine resuscitation (or waiting for the MD). Instead of telling her to "Stop pushing!" over and over, rock her hips side to side and tell her to "Rock your baby." The motion of the hips keeps the abdominal muscles from coming fully into play for a push effort and prevents an all out bearing down. Besides it is much nicer to say gently "Rock your baby." than commanding "Don't push, don't push." We want to have S L O W crowning and head birthing, supporting the tissues as the baby is born. It is important to ease shoulders through slowly, arms close to the chest.

Preventative: Exercises and Tissue Health

A good foundation in prenatal exercise is helpful. It is beneficial for circulation, which keeps tissues supple.
Kegel exercises for tissue health and elasticity. A Kegel is the name of a pelvic floor exercise, named after Dr. Kegel who discovered the exercise. These muscles are attached to the pelvic bone and act like a hammock, supporting your pelvic organs. To try and isolate these muscles, try stopping and starting the flow of urine. Once you have located the muscles simply tighten and relax the muscle over and over, about 200 times a day. These are basic Kegels. There are many variations on Kegels: elevator Kegels (Where you tighten slowly, in increments going in and out, like an elevator stopping on several floors.), you can hold the muscle tightened for five seconds, you can bulge the muscles out at the end, and many other variations.
Sexual activity, especially orgasms, help increase blood flow to the area thereby enriching the health and stretching ability of the tissues.
Perineal Massage

In a study, researchers asked women to massage themselves every day and found 24% of first time mothers did not tear, while only 15% of those who did not do the perineal massage did not. Perineal stretching seems to help both psychologically as well as physically. Most women (85%) who preformed the massage would recommend it to other pregnant women!
To perform a perineal massage, a woman or her partner places one or two fingers about an inch to an inch and a half into the vagina. Use almond oil, K-Y jelly, pure vitamin E oil, wheat germ oil or other lubrication. Gently stretch the lower part of your vagina, gently stretching the perineum, until you feel a slight burning or stinging sensation for several minutes. Concentrate on relaxing the tissues through the stretch. Then, gently, massage your lower vagina with your thumbs for several more minutes, avoiding the urinary opening.
In addition, oils can also be massaged into the perineum daily to help avoid episiotomy.
During Birth - Breathing

Focus on your throat while giving birth. The throat has a connection to the vagina. As you breathe deeply, try to open and relax the throat. As you relax, imagine all the oxygen getting to the cells of the vaginal walls… nourishing them with rich oxygen and making them more resilient and stretchy.
During Birth - Perineal support, compresses and oils

Olive oil or mineral oil gives a slippery quality to the perineum. It feels like hands move more easily over the skin without dragging or causing irritation. Use verbal imagery when applying the oil. "I'm going to put some oil down here now to help the baby slide out." Women find it a relaxing and reassuring image and it seems to help them believe in their ability to deliver intact.
Warm compresses at the perineum feel great and encourage relaxation of tissues. Do not use hot compresses, as temperatures that are too warm can bring excess blood flow and cause swelling.
Castor oil packs for the perineum can help relieve prenatal pain around the perineal region as well as make your tissues supple and help prevent tearing when you give birth. Castor oil has healing and restorative properties so the relief builds up over time and the heat increases blood flow to the area, relieves pain, improves circulation and relieves venous congestion. You have to use cold pressed castor oil. Soak an old washcloth or a flannel in the oil, wring it out and put it right on your perineum. Then cover that with something waterproof and put a heating pad of some sort on (electric, microwave, hot water bottle, it won't matter.) Cover the compress because the castor oil will stain and also to avoid shock if you use an electric heating pad. Leave it as long as you can but at least 30 minutes. You can't do it too much, and it can only help not hurt.
Additional practices to avoid:

• Multiple vaginal exams -- irritating the tissues.
• IODINE SOLUTIONS ARE IRRITATING AND MAY BE DAMAGING. Toss out your betadine!

 

Hope you get all the information from here and do the needful..

Happy delivery !!!

 

Punitha..

I agree.. its an unique situation for every woman when shes in the labor room... and whatever happens in there ... we got to take it as "all for the good"

I just want to have a place with lots of information.. so that ladies could try that out.. nothing mentioned is out of the way but indeed good in a sort right..

relaxing, massaging, exercises... may be it will help her to gain confidence I guess !!