Pregnant women often stress about how labor and delivery is going to affect their body. One of a new moms’ biggest fear is whether they will tear during birth or have an episiotomy.
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Fortunately, there are lots of ways to avoid an episiotomy. And if you do end up with one, there are also great ways to take care of yourself so you can start feeling back to normal. So let’s talk about how to avoid an episiotomy during childbirth!
What is an episiotomy?
Simply put, an episiotomy is a cut to your perineum made by your OB or midwife during delivery. If it is done, an episiotomy is made during crowning or if your baby is stuck in a malposition.
It may also be done if the baby’s heart rate drops and he needs to be delivered quickly. An episiotomy can be first degree, or just a slight cut through the skin, or can cut much further into muscle (2nd-3rd degree).
Related: Natural ways to induce labor
Episiotomies used to be fairly routine, especially for first-time vaginal deliveries. The thought process was that a clean cut would be easier to heal from than if the perineum tore during crowning.
However, studies have shown that natural tears generally heal easier (and less painfully) than episiotomies, so recommendations have been updated to save the procedure for true emergencies.
What it’s like to heal from an episiotomy
Frankly, healing from episiotomy is not pleasant. The cut will have to be stitched up immediately after childbirth.
The area will likely be rather painful at first and continue to be sore for weeks or months after. The condition can make going to the bathroom painful (or at least a little nerve-wracking).
Unfortunately, an episiotomy can also cause painful intercourse. This problem may just happen several weeks after delivery (even after the go-ahead from your doctor at 6 weeks), or it could continue for months after.
In fact, 20% of women who were given stitches post-delivery have pain with sex at 6 months later, and some have problems for years (if this is you, find a doctor who will listen to your concerns and actually help).
Healing from an episiotomy will take time and being gentle with yourself post-partum, but it can be done!
How to avoid an episiotomy
Fortunately, there are several things you can do to make an episiotomy less likely. Here are some recommendations.
Choose a provider who has a low episiotomy rate
Perhaps the most important thing to do is to be selective about who you choose as your healthcare provider for your pregnancy and delivery.
Some providers (often older ones or ones from rural areas) are behind the times on current recommendations and do episiotomies from force of habit.
Important note: Often, we assume that midwives take a more natural approach to labor, but this may not be the case! I have a friend whose midwife gave her a quick, unnecessary episiotomy without consent, while the father wasn’t looking.
Especially if your midwife is part of a more traditional OB/gyn practice, make sure you have this conversation with him or her.
Talk to your provider about your wishes
Well before you arrive in L&D, discuss your care with your provider. Ask what his/her episiotomy rates are (get an actual number) and what situations they believe make one necessary.
If you don’t have this conversation with your midwife or OB beforehand, you may find out their practice the hard way when you end up with an unnecessary procedure.
Opt for a natural birth
If you have chosen to forego pain medication for your birth, you will need local anesthesia before an episiotomy is performed. That one extra step may be what makes the difference with whether a scalpel-happy doctor chooses to cut you or not.
These meditations are designed by a prenatal yoga teacher and are perfect to use during birth.
In addition, a natural birth allows you to be aware of what’s going on in your body. You can feel the stretching of your perineum during the pushing and crowning stage, you can choose to slow down your pushing (here’s a good article on how to do that).
Want to know more about the advantages of natural birth? Check out this post!
Find the right position to avoid an episiotomy
Having a natural birth also allows you to easily move your body in the right position for you. Having an epidural doesn’t allow for this and creates dependence on staff for repositioning.
However, if you’re having a natural birth, you have an increased advantage. Your ability to feel your body and try alternative positions to help reduce your chances of being talked into an episiotomy. Doing this can also help the baby ease down the birth canal.
How to care for an episiotomy or tear
Let’s face it episiotomy recovery ain’t going to happen overnight. Yet, whether you have an episiotomy or natural tear during delivery, there are several ways to take care of yourself. Both to help your episiotomy recovery along and to get you some much-needed pain relief.
Take a stool softener
The first time you poop after having a baby is… unnerving. Areas that have been way overstretched are having pressure put on them, and if you’ve had a tear or episiotomy, you definitely feel the strain of using that same area.
When you’re at the hospital, you’ll likely be offered a stool softener like Colace. Definitely take it. It’s not a laxative, so it won’t mess with your digestive system, it just makes things easier when the time comes.
Whatever you do, do NOT just refuse to go to the bathroom. The longer you wait, the more things get compacted, and the harder it will be (no pun intended) when you finally do go. Constipation is not your friend postpartum.
Use counter pressure when going poop during episiotomy recovery
Your perineum (the area that is cut during an episiotomy) is the skin and muscle between your vagina and anus. When you go to the bathroom, you put pressure on that area as you use those muscles to poop.
This sounds weird, but you will feel better if you use your hand to press on your perineum as you go to the bathroom. The counter-pressure will keep you from feeling like you’re going to blow your stitches out as you poop (and remember, use that stool softener to make things easier too!).
When you’re at the hospital, they’ll give you some numbing spray. The plan is when you go pee, do what you have to do while spraying down the area with a Peri-bottle (basically, you’re just rinsing with warm water, then pat (don’t wipe like normal) dry.
Afterward, use the numbing spray. It’s really helpful for making you comfortable as you await your episiotomy recovery..
Postpartum sitz bath
A sitz bath is basically sitting in a few inches of water with Epsom salt in it (here’s more detail about how wonderful a sitz bath can feel and how to do it).
The Epsom salt will soothe and help you heal, and the bath will help your stitches dissolve. If you have time, you can do a sitz bath a few times a day for 15-20 minutes each until to aid in your episiotomy recovery.
Use Tucks pads
Tucks make pads with witch-hazel on them. They can feel really nice to wear. Pro tip: put them in the fridge and get one out right before use. It will make the pad even more soothing.
If you’ve followed all this advice and are still having pain from your episiotomy months or years later, get help! If your doctor won’t listen, find one who will. It’s not normal or okay to live with pain years after birth.
Conclusions on avoiding an episiotomy during childbirth
Nowadays, we as women get to have a lot of say in how we want our births to go. So yes, you have a say in your care! If your provider is keen on an episiotomy and gives it out like candy then find another one fast!
Always do your research before committing to a provider. I hope these tips help you avoid an episiotomy and to take care of your body postpartum. Any tips or tricks I missed? Let me know in the comments!