There are a few of things a woman can do to reduce her chances of receiving an episiotomy or avoiding one unnecessarily. Firstly, if you haven't already done so, read through some of the factors that can
reduce your chances of tearing as well as using methods such as
perineal massage or a
childbirth trainer. Other things can include:
Careful selection of your caregiver and birthplace
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Careful selection of your caregiver and birthplace
The best way to avoid an episiotomy is to choose a caregiver who is unlikely to perform one. There are some caregivers who perform episiotomies routinely on every first time mother and others who reserve it only for emergencies.
Discuss the use of episiotomy with your caregiver and under what circumstances they would perform one or when you would be happy to accept one. You may wish to ask them what their current episiotomy rate is. If you cannot come to a compromise, think about changing caregivers.
For women who do not know who their caregiver will be in labour, choosing a birthplace where the episiotomy rate is low could be the answer. Some hospitals or birthplaces have a culture that encourages the use of episiotomy more routinely than others.
In some delivery suites the rate can be as high as 40%, with 1/3 of these being associated with either a
forceps or
ventouse delivery. Smaller metropolitan and country hospitals would generally perform less episiotomies than large city and private hospitals.
In most birth centres and in homebirth practices the rate of episiotomy can be as little as 1% or less. In these places an episiotomy would generally only be done if the baby were distressed near the end of the pushing phase of labour. Be aware that individual caregiver practices can vary even within the one birth place setting.
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