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Tips to Avoid Episiotomy and Perineal Tears

Every woman giving birth would surely like to keep her perineum in tact. These tips to avoid episiotomy and perineal tearing can help achieve that goal.


Many caregivers believe that preparing the perineum for labor and taking preventive measures will help to avoid episiotomy or tearing, while others believe that understanding the details of the process of giving birth and confidence in the ability of a woman's body to do what it was designed to do at birth is the key to an intact perineum.

This page will focus on both approaches to avoid episiotomy and/or tearing of the perineum.

Preventative Measures

  • Good nutrition - a woman who has a healthy diet and thus healthy skin will be able to stretch more easily.
  • Kegel exercises - these exercises strengthen the muscles of the pelvic floor and enable a woman to push effectively while giving birth.
  • Perineal massage with various oils - this will help to soften and prepare the tissue for stretching during birth and help to avoid episiotomy.
  • Birthing in an upright position, standing or squatting - this will help to maximize the size of the pelvic outlet, enable the coccyx and sacrum to move back and facilitate the baby's descent and exit from the birth canal.
  • Warm compresses applied to the perineum will increase blood flow to the area and increase the flexibility of the tissues.
  • A gentle, slow second stage of labor where pushing is spontaneous and natural, rather than forced.
  • Plan a water birth - the episiotomy rate is reported to be zero!

Quote to Avoid Episiotomy

The best way to avoid an episiotomy or a dangerous tear is to give birth with nobody else around than an experienced, motherly, silent, and low profile midwife who does not guide you.

If you don't feel observed and guided, you can more easily ago to another planet, stop being rational, and just listen to your body. In such a context there is a high probability that you'll find yourself in the best possible posture, for example on hands and knees.

If the need for privacy was understood, 'episiotomy' would become a topic for historians.

~ Dr. Michel Odent

Tips for Pushing When Giving Birth - the Second Stage of Labor

To avoid episiotomy or tearing, you need to understand how your body functions and how to best use natural processes to keep your perineum intact.

Breathing in Labor During this stage, it is important to work with your body and yet stay relaxed.

Forced pushing will raise your blood pressure and result in less oxygen reaching your baby, so rather stay relaxed and breathe deeply and naturally. Rest between contractions.

  • When your baby's head is about to be born, you will feel great pressure in the bowels, as if you need to go to the toilet.
  • You may experience an overpowering feeling, known as a bearing down sensation. Don't rush to push the baby out, but rather relax, take some deep breaths or grunt and allow your perineum time to stretch sufficiently.
    Don't listen to the voice in your head or anyone else that says: "Push!"
  • You will most probably feel an intense stretching at the opening of the vagina. This feeling has been described as the 'ring of fire' as it is a burning, 'pins and needles' sensation. It usually only lasts momentarily.
    At this stage, you can place your hand on the bulge and help to control the birth and support the tissues as your baby's head emerges. Alternatively, you might enjoy the application of a warm compress.
  • Even now, you shouldn't rush any pushing efforts. You may feel an incredible urge to push hard and get this over with. Rather don't! Take some deep breaths or pant and rather breathe your baby out as gently as you can, along with any spontaneous contractions.
  • Once your baby's head is born, the most intense part of the birth will be over. In a few moments you will feel another contraction and will be able to push out the shoulders and the rest of the body will follow easily.
  • At this point, you should hold your baby skin-to-skin and say hello. Speak to your baby. You will soon feel a thrilling rush brought on by a cocktail of hormones that your body will release. Enjoy that natural 'high' feeling. You will have worked hard to earn it!

Third Stage of Labor

Some time after the baby's birth, you will feel another contraction which will bring down the placenta. This is usually not painful at all and it just slips out easily.

Immediately after the birth you can apply either a warm compress or a perineal cold pack to the vaginal area.

Your wishes for cutting the cord and disposing of the placenta should be expressed in your birth plan.

Fourth Stage of Labor - The Golden Hour and Beyond

Keep your baby skin-to-skin and allow her to breastfeed spontaneously if she wishes. This is an incredibly sensitive time for bonding and attachment between the two of you and significant hormonal responses are triggered in both of you during this special initial interaction.

Let your partner also hold your baby and participate in this special time of family bonding. Remember to take photos of him and his baby too!

Clean yourself up while he holds your baby and put on a stress pad or large maternity towel. Ask someone to bring you a refreshing drink and cuddle up with your newborn and enjoy the 'babymoon'.

You may feel sensitive in the perineal area but it will soon heal if no major damage was done. Treat any minor tears according to advice on Care of Episiotomy and Tears.

More Pages Related to Tips to Avoid Episiotomy

Perineal Massage

The Amazing Female Pelvis

Use of a Birth Ball in Labor

Back to Episiotomy


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