I'm worried about tearing, or needing an episiotomy. Is there anything I can do to help my perineum stretch rather than tear?
Our midwife Melissa says:
"This is a very common question I am asked! Many women are concerned about tearing and would prefer to minimise tearing. An episiotomy is different to tearing: this is a deliberate cut in the perineum and vagina to widen the opening for the baby to be born. An episiotomy is done instead of allowing the perineum to gradually stretch on its own.
"The only real need to do an episiotomy occurs when the baby is very distressed such that waiting for the perineum to stretch on its own may not be safe for the baby. These situations are very rare. Different midwives and obstetricians have different rates of episiotomy. If this is something you wish to avoid, you might like to ask your midwife or obstetrician what their rate of episiotomy is."
To avoid an episiotomy or a tear:
- Birth in a position where you are off your back and off the bed: stand, kneel, birth on your hands and knees or on your side. These positions all make tearing and episiotomy less likely by evening out pressure on your perineum and pelvic floor. It also allows your pelvis to open up to its maximum, making for a smoother second stage.
- Use the Epi-No from 34 weeks onwards
- Focus on breathing your baby out, rather than actively pushing
- Vitamins C and E and Zinc can help to prevent tearing.
- Exercise your pelvic floor.
- Aim for a second stage that progresses according to your body’s signals. Directed pushing contributes to perineal tears.
- When you are birthing your baby, if you feel stinging or burning, breathe and wait for the feeling to pass.
- Focus on relaxing your pelvic floor and think open and soft.
- Avoid an epidural as this can contribute to tearing / episiotomy.
This answer was written for Birth by midwife Melissa Maimann from Essential Birth Consulting.
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Last revised: Thursday, 3 January 2013
This article contains general information only and is not intended to replace advice from a qualified health professional.