Many recent studies have shown that routine episiotomies shouldn’t be performed, because they are not helpful to the majority of women, although there are certain circumstances when they are needed. Having an episiotomy can increase pain during the postpartum period, leading to a longer recovery time. In addition, women who have episiotomies may have weaker pelvic floor muscles as well as more pain when resuming intercourse postpartum.
Episiotomy rates have declined over the years, but the number still remains high. Despite all the evidence against routine episiotomy use, close to 50- 80% of first time moms end up with an episiotomy in the U.S. The majority of women having them done are young white women, who have private insurance, according to a recent study.
There are a few situations when an episiotomy may be medically necessary. If there is a sign that your baby is in distress while in the birth canal, such as slowing of your baby’s heart rate, an episiotomy may be unavoidable for the sake of your baby’s well-being. If your baby’s shoulders get stuck, if your baby has a very large head that cannot fit through the vaginal opening or if delivery happens too quickly for the skin of your perineum to stretch naturally, you may need an episiotomy.
Perineal message helps reduce the chance of tearing during birth and the need for an episiotomy. It can make the perineum more flexible and increase elasticity, in preparation for birth. It’s a good idea to start doing perineal massage around the 34th week of pregnancy or before. To perform perineal massage, wash your hands thoroughly (or your partner). Place K-Y jelly, vitamin E oil or another mild lubricant on one or two fingers and gently stretch the lower part of the vagina until you feel a slight burning sensation. Hold the pressure steady for about 2 minutes or so. Repeat this daily for about 8-10 minutes.
Warm compresses during labor (especially during the pushing stage) encourage the stretching and relaxing of the perineum. Make sure they are only warm, but not hot, which can cause some swelling. Positioning during labor and birth may contribute to whether you need an episiotomy or not. Squatting can help reduce tearing. Avoid laying directly on your back, if possible and keep changing positions if you can. Talk to your doctor or midwife early about your feelings regarding episiotomies, especially if you wish to avoid one.