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Giving Birth Without an Episiotomy: Talking to Your Care Provider About Your Preference on Episiotomies

Times are changing with regard to how mothers are giving birth. The use of more natural methods of birthing include the use of birthing centers, waterbirths, birthing balls and doulas. With all of the latest in natural childbirth techniques, an emphasis on not cutting an episiotomy is often one of the things that many expectant mothers are talking to their care providers about in their birth plans prior to giving birth.

Episiotomies Do Not Prevent Tearing

Contrary to popular opinion, episiotomies do not prevent tears, even larger ones, from happening. In some cases, care providers have used this reasoning to justify cutting an episiotomy in labor. Actually, there is more likely to be a third or fourth degree tear after an episiotomy has been done.

A French study showed that when doctors were asked to restrict their use of episiotomies, the rate of episiotomies fell from 18% to 3% over a four-year period. Not surprising that the study showed that even though the episiotomy rate was only 3%, the amount of large third and fourth degree tears did not increase. Thus the argument that doing an episiotomy will prevent tearing (or not doing one will cause the mother to tear more) does not hold up to evidence. Be sure you include this in your birth plan discussion when you talk to your care provider about the issue of episiotomies.

Talk to Your Care Provider about the Use of Warm Compresses, Not Pushing while Giving Birth

Research is now showing that warm compresses can also decrease tearing at the time of giving birth and ultimately make an episiotomy unnecessary. In addition, you may find that if your care provider slows the birth of your baby’s head by instructing you not to push while giving birth can also decrease tearing. In fact, research shows that when care providers instruct a mother to not push as the baby’s head was crowning, then deep third and fourth degree tears were reduced from 4% to 1%.

EPI-NO Can Be Used to Increase the Mother’s Chance of Intact Perineum

Though use of the device, known as “EPI-NO” is more common in Europe and Canada than in other regions, it has been shown to significantly decrease the amount of tearing and as a result, decreases the chance of episiotomy. Even better it has been shown to increase the mother’s chance of having no tears at all, called an intact perineum.

The EPI-NO is a device that contains a balloon and hand-operated pump that can be used by the mother at home. It is recommended for use three weeks prior to the mother’s due date with daily exercises that take about 20 minutes. The EPI-NO is designed to gradually stretch the mother’s perineal tissues, much like perineal massage, so that your body will be more flexible to stretch around your baby’s head while giving birth.

Talking to Your Care Provider Using a Birth Plan

If you are interested in giving birth without an episiotomy, be sure to talk to your care provider well before you go into labor. In some cases, the question of the care provider’s philosophy about performing episiotomies can and should be thought of as a make or break interview question. This might require working on your birth plan as early as possible your first trimester of pregnancy.

Since the research is very clear that episiotomies are not typically needed and do not help mother or baby, talking to your care provider early in your pregnancy about this issue will help you select the right care provider for you.

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