How to: Avoid an Episiotomy

es, this is a good idea; I would certainly avoid one if I could. On the other hand, if the OB/midwife is anticipating a nasty tear, then they are likely to cut an episiotomy. The good news is that episiotomies are no longer a standard of care or a protocol in labor and delivery. It is pretty well agreed upon that a small tear is preferable to an incision. This is because a tear tends to heal more efficiently than an artificial incision.

Here are some very doable tips to help prevent the need for an episiotomy:

Talk with your OB/midwife prenatally, underscoring that you would love to avoid this if at all possible. Again, they are looking for reasonable expectations and need the room to maneuver depending on what needs to be done in the moment. (If they can deliver your baby over an intact perineum, they will be congratulating you and out the door a lot sooner than if they need to stay to suture up an episiotomy. So not only do they have your best interests in mind, they are saving themselves time and energy too!)

Discuss this with your labor and delivery nurse. When they know that you are highly motivated to avoid an episiotomy, they can take extra steps.

Warm compresses. During pushing, once there is a small patch of head visible (about the size of two quarters), warm compresses (washcloths dipped in warm water and wrung out) can be placed on the perineum. The combined warmth and the moisture will increase the blood flow, which increases elasticity and helps avoid the need for an incision.

Perineal massage during labor is also effective in increasing blood flow, hence increasing elasticity. This can be done by the L&D nurse as well as by the OB/midwife as they are preparing for the head to emerge.

Partners, you can give one more reminder to the doctor or midwife that she would really like to avoid an episiotomy! This can prompt them to allow the head to “sit” for a few extra moments on the perineum, which causes more stretching of the tissues.

Note: Unbeknownst to most expectant parents, prenatal perineal massage does not affect whether she will need an episiotomy the day of delivery. This is very old-school thinking and has been disproven long ago. Only when there is that much pressure and the perineal tissues are under that much stretch can the massage actually assist in avoiding an episiotomy. This is not to say that there is anything wrong with doing perineal massage prenatally – have a good time! Just be clear that it does not affect the outcome on the day of delivery.