Once again Andrea Robertson offers me email advice in avoiding an episiotomy. I had no clue this word existed until I got pregnant. Yes I am opting for a natural birth, so there are chances of an episiotomy, something I'd like to avoid.



Regarding your question about episiotomy:

There are several things I can suggest to reduce your chances of
having this surgery.

* Choose your caregiver wisely. There is a lot of evidence that a
midwife supervising the birth will result in less perineal trauma. In the west, an intact perineum is the hallmark of agood midwife, and midwives are good at taking their time and not cutting.

* Stay upright for the birth. This will mean being off the bed, perhaps on a mat on the floor.
When upright, the tissues stretch more evenly around the baby's head as it is born,
reducing the strain on them and the chance of tearing. You will want to lean slightly forward,
and hold something or someone (kneeling is the easiest position).

* Only push when you really have to and not more than you need to. Often women are told to "push,push, push!" which is not only dangerous but unnecessary. The mportant thing is to take your time and push gently in short bursts as the urge comes on. That way there
will be time for the tissues to stretch as the baby comes through.

* Keep you eyes closed and your ears closed! Avoid making eye contact with anyone - it is
harder fro them to direct you if you are not looking at them. Keeping eyes closed will make it
easier for you to concentrate on pushing slowly and gently too. Keeping your ears closed is
to block out instructions that are not helpful. Only you can know
what is going on inside your body and you need to stay focused on that.

* If you are confused, put your fingers inside your vagina and feel
the baby's head - then what you are feeling will make sense.

* Take your time. There is no need to rush second stage. Attendants often get anxious and wantto rush through, but this can cause problems.

* Don't be coerced into pushing before you are ready. Sometimes there
is a lull between the first and second stage, when there are no contractions and everything stops for a while (this can last around 30 minutes). This is an important rest phase and gives you and
the baby time to rest before the pushing starts. Sometimes doctors want to speed things up at this point and put up a drip (saying that there is "uterine inertia") but they are wrong - trust
you body to know when the baby is ready to come.

* Doing some perineal massage in the last few weeks of the pregnancy
can help you prepare for the stretching sensations as the baby's head crowns and also helps to
soften the skin tissues. To do this massage, you need to have wet fingers (try this in the
shower) . Put your thumbs inside the vagina and gently move them apart, stretching the skin
until you feel a burning sensation. Massage the skin at this point for a few minutes. You can
do this with oil on your fingers as well, if you prefer. This won't prevent a tear (it will reduce
the chance of it happening), but will prepare you for the burning feeling that comes for about a minute when the baby's head is coming through.

These are some ideas you could think about. The upright position and taking your time will be the hard things to organise - you'll want to speak to your caregiver is advance about this. If you don't know who will be with you at the time, make it clear when you arrive at the hospital in labour that you will want to give birth upright on a mat on the floor. Also tell that you
DONT WANT and episiotomy and have them write this in the notes.

One point: some tearing may occur quite naturally, especially with a first baby. This is not usually extensive and will heal better than a cut. Stitching is only needed if the tearing
involves muscle layers (an episiotomy always involves the muscle layers ands much more extensive than a tear).

There is loads of information on the internet on all of these issues if you go a Google search.
The number of stitches is meaningless - in the West usually there is only one continuous stitch done to close the underneath layers and then a few small stitches to close the skin on top. A large tear might therefore only have "3" stitches. How many stitches are inserted is
dependent on the caregiver and their practices. Research shows that one continuous stitch is better than lots of smaller stitches.