Perineum under protection - how to avoid episiotomy - Canpol's Mums advise - Canpol

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Perineum under protection - how to avoid episiotomy

Until recently, perineal incision during labour was a routine procedure. According to obstetricians it was performed to enlarge the vaginal opening, to facilitate the child's passage through the birth canal and to protect child's head against injuries, to avoid perineal tear and descending of the maternal genital tract after childbirth. Studies conducted in recent years do not confirm these benefits. You can prepare your perineum for the delivery making it more flexible. It also heals better after a small incision, and the babies are doing well during the labour without episiotomy. Moreover, there is no evidence that refraining frorm the perineal incision leads to organs lowering. 

The incision causes more blood loss, frequent infections and perineal pain after delivery. But there are exceptional situations in which it must be performed: during instrumental delivery with forceps or vacuum or complications when the baby's shoulders are stuck in the birth canal or his/her heart rate decreases. Episiotomy is also performed during delivery under anaesthetic when the mother does not control pushing. The midwife may also make an incision when there is a risk of serious perineum injury due to tearing. To avoid this happen, start to take care of your perineum during pregnancy and prepare it for the delivery. Here are some proven methods:

Kegel exercise

These exercises will teach you how to stretch and relax the pelvic muscles. Stand slightly astride. Tense the perineum and anus muscles as if you wanted to stop peeing and keep them contracted for 8-10 seconds). Relax the muscles after that. Repeat the contracting and relaxing 10 times. Perform this exercise repeatedly during the day. 

Another exercise involves rapid regular muscle contraction and relaxation. Repeat it ten times. Perform this exercise during the day. This exercise differs from the previous one as there is quick contracting and relaxation of muscles, whereas in the first one you contract the muscles, count to 10 and only then relax.

Remember not to hold your breath during exercises. Avoid stretching the abdominal muscles as well. Perform systematic massages.

Perineal massage

Consult your doctor before using this method of preparing your perineum for the delivery. The doctor will check whether there is no vaginal inflammation or other contraindications. Massage cannot be performed during genital organs infection. It is also not indicated for women with allergies - after using various kinds of oils they suffer from discomfort of the intimate area, burning, stinging (which can lead to inflammation).

A massage relaxes the perineum and toughens it to pain. Start regular massages during the last two months of the pregnancy. Perform massage when your nails are short and clipped, otherwise you may damage the delicate perineal tissues.

Wash your hands thoroughly and then spread some olive oil or sweet almond oil. You can enrich the oil with a few drops of vitamin E. Stand on the floor next to a chair. Place one bent leg on the chair. This is a comfortable position for the perineal massage. 

Spread oil with your finger at the vaginal opening and apply circular movements. Then gently insert your finger into the vagina and press towards anus until you feel a tingling or burning sensation. Then stop the massage. Massage the perineum every day. First, do the massage for a few days with one finger, then with two and three, until your perineum becomes so flexible that you will be able to massage it with four fingers. The vaginal opening stretched this way will be prepared for the baby's head pushing during labour.

Learning proper breathing

If you learn to breathe properly during pregnancy and you practise breathing using your diaphragm, you will automatically inhale and exhale air this way durin labour. Sit comfortably on a chair or on a sofa, put your hand on your belly and take a deep breath so that the belly raises together with the hand (this way it is easier to see whether it raises or not) and slowly breath out through the mouth. Repeat inhaling and exhaling. After a few breaths you can feel intense kicking of the baby. Increased oxygen supply makes the baby more energetic. 

Most antenatal classes have breathing exercises on their curriculum. If this has not been mentioned yet during your classes, ask the tutors to show how you should practise breathing.

Protecting the perineum during childbirth

During labour the perineal tension is decreased through deep, rhythmic breathing using the diaphragm, and changing into standing or squatting position (due to the gravity, contraction force and the pressure of the baby's head no additional pushing is needed). Take advantage of the bathtub - the water not only reduces pain but also relaxes the perineum. In the second stage the perineal massage and pressure applied by a midwife can cause congestion and tearing of the delicate vaginal tissues, so it is better to avoid it, and let the baby's head slowly stretch and tension the perineum without mother's pushing. Even though you will be as tired as after running the marathon, try to avoid a reclining and lying position - then there is the greatest risk of perineal tearing (pushing the child upwards is a Sisyphean labour). The midwife should observe the perineum and control it, so that the baby's head does not cause tissue tearing. Both your and your midwife's patience is important so as to avoid pushing too hard. 

If you want to protect your perineum against incision, you cannot panic at the final stage, but you need to work closely with the midwife as otherwise the perineum will have to be cut or will tear itself. Before delivery or at the beginning you should necessarily tell the staff that you want to protect the perineum. Then the midwife will evaluate its structure (low, high, fleshy and less muscular, perineal tissues condition) and will try to protect the perineum if labor conditions permit. Favourable conditions include:

• Proper heart rate of the baby
• Translucent and not green amniotic fluid
• Cooperation of the mother
• Baby's weight below 4 kg
• Lack of contraindications due to reproductive organ structure 

Unfortunately, midwives often work under the pressure from the doctor and even our best intentions do not help. Episiotomy is still a routine procedure in some Polish hospitals. Before choosing the hospital, talk to its staff. Ask, whether the episiotomy is a routine procedure there. Indicate that you would like to avoid it and that you intend to prepare yourself for delivery without episiotomy. Do not consent to the incision without medical indications. 

Kasia

Mum of 9 year old Patrycja, 11 years of professional experience

Marta Piątkowska

Midwife
- consulting

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