Can Episiotomy be Avoided During Childbirth?

Reasons doctors do Episiotomy

Most doctors initially resort to this procedure when there is a medical need, such as:

• Issues with the vagina during active labor: If this stage becomes prolonged and starts affecting the baby, leading to a slight decrease in the baby's heart rate, the healthcare provider may opt for an episiotomy to expedite the delivery.
• The inability of the mother to push correctly: This could be due to pain relief options during labor or a lack of awareness about the appropriate moments for pushing.
• Fetal position in the womb: The baby's position may hold back its exit without an incision.
• Positioning for delivery: Certain delivery positions  (e.g., Supine position or lying on your back)are less favorable, and those that utilize gravity, such as sitting or standing, are generally better.
• Lack of psychological and physical readiness: Insufficient education about pregnancy and childbirth or inadequate attendance at childbirth classes can contribute to the need for episiotomy.
• Need for more readiness of the pelvic floor muscles: These muscles, crucial for pushing the baby, may not be ready.
• Necessity to use forceps and vacuum for delivery: When forceps are required to assist in delivering the baby, an episiotomy may be necessary.

It's important to note that this medical procedure has become a routine aspect of childbirth in many countries,  even without a medical necessity.

Impact

• Physical effects: Pain from the incision and stitches after childbirth.
• Psychological effects: Pain during and after childbirth can affect a mother's desire for following pregnancies, potentially delaying a second pregnancy.
• Emotional and social effects: Postpartum intimacy may be painful, leading many women to avoid intercourse, negatively impacting her marriage.

Can an Episiotomy be Avoided?

This is an incision done in the perineum, which is s a small area between the vagina and anus, and it can be avoided in several cases by:

• Mental and educational preparation: Adequate mental and educational preparation for pregnancy and childbirth.
• Physical readiness: Engaging in exercises, such as Kegel exercises and squats, a daily practice that used to be done by our grandmothers several times a day when using the bathroom, “Turkish toilets.” In addition to deep breathing, walking and climbing the stairs strengthen pelvic muscles and enhance flexibility in the perineal area. Doing all these practices throughout the pregnancy is essential to gain the best effect; doing them in the last few weeks won’t be as effective.
• Choosing a mother-friendly hospital.
• Selecting a doctor who prefers avoiding episiotomy who prefers surgical interference only when medically necessary.
• Develop and review a clear birth plan with the healthcare provider.
• Seeking support from a childbirth educator, a “Doula.”

Perineal Massage

Although perineal massage with oils during pregnancy is encouraged to reduce the likelihood of episiotomy, there is insufficient evidence of its effectiveness compared to the methods mentioned earlier in this article.

It's important to note that even with the above steps, spontaneous tearing of the perineum may occur during vaginal childbirth, which is a natural and normal occurrence. The severity of these tears varies based on perineal elasticity and the preparation of the pelvic floor.

Postpartum Care Steps

• Use pain relievers as needed.
• Apply cold compresses.
• Use postpartum pads.
• Care for the perineal area to ensure proper healing and prevent infections.
• Follow up with a gynecologist until the incision is completely healed.

In conclusion, while episiotomy may sometimes be necessary, taking proactive steps in education, physical preparation, and healthcare choices can contribute to minimizing the need for this procedure during childbirth.