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Preparing the perineum – how to reduce the chances of an episiotomy or perineal tear

pregnant woman researching on laptopWomen are often well aware and concerned about the physical challenge of birthing a baby, particularly the crowning of the baby’s head. The crowning refers to the widest diameter of the baby’s head as it journeys through the birth canal.

A pregnant woman may well become anxious about her ability to push her baby out when her time comes. Even family and friends can trigger anxiety with their birthing stories.

Perineal tears and episiotomy often occur with first time deliveries, but the risk of these injuries can be reduced by preparing the perineum.

Informative books on childbirth will also explain the meaning for the medical term “Episiotomy”, which is the use of surgical scissors to cut the perineum to enlarge the opening for the delivery of the baby.

Sheila Kitzinger, well known author, refers to the episiotomy as the “Unkindest cut of all” in her book “Childbirth and Parenting”. There was a school of thought many years ago in the medical profession that it was better to cut routinely than to tear. This has now been challenged as there is no evidence to support the claim.

Whenever anxiety and fears surface it is best to take a look at the reality of the situation (and the truth is that most women are very capable of birthing their baby), and the next step is to identify for herself what IS within her power to do to reduce her feelings of anxiety and fear; to feel more ready and prepared to birth her baby.

Strategies that women can use to minimise risk of tears or the need for an episiotomy

  • Gather information from a variety of sources with regard to preparing the perineum for normal birth and reducing the risk of tears and episiotomy
  • Choose a caregiver; midwife or doctor who encourages perineal preparation and is motivated to avoid the use of episiotomy unless clearly medically indicated such as fetal distress, very rigid perineum or to facilitate a forceps delivery
  • Use a “childbirth trainer” or practise “perineal massage” (ask your caregiver for more information)
  • Ask questions at your childbirth and parenting education classes
  • Research the internet with key words such as “childbirth trainer”, “perineal preparation” and “perineal massage for childbirth”
  • Choose a birth place (hospital delivery suite, birth centre or home birth) where the woman is encouraged and supported in her decision to choose an active upright birth
  • Choose a birth place which has an epidural rate of about 25% or less – some hospitals have a rate of 50 – 80%. If possible, avoid the use of an epidural – because the woman will be confined to bed, restricted in her choices of position for birth. An epidural may well reduce her ability to feel sufficiently to push – with pushing hampered this may lead onto the need for forceps, and with the majority of forceps births, the use of episiotomy to allow space for the forceps blades to be used.
  • Choose a birth place (hospital delivery suite, birth centre or home birth) where the woman has free access to a bath deep enough to facilitate her relaxation in the warm water
  • Avoid the supine or laying down on back position as it increases pressure on the perineum, preference is given instead to any other position such as standing, kneeling, all fours, squatting and any other upright positions the woman selects for herself
  • get baby in the best position for labour

The modern woman needs to research her options, taking a good look at the full range of choices she has to avoid the risk of requiring an episiotomy or perineal tears.

Perineal injury during childbirth can lead to a longer recovery period in the post natal period, and long-term conditions such as incontinence and sexual dysfunction. Reduced anxiety is linked to a lower requirement for pain management medication during labour, and therefore reduced risk of episiotomy and successfully increasing her chances of an intact perineum.

Reduction of anxiety during delivery plays an important role in preparing for normal childbirth. It is recognized that perineal preparation provides the woman with the confidence she needs to birth her baby normally. She can then concentrate on her choices of other aspects of the birth such as positioning, relaxation breathing and pushing.


Childbirth is a marathon physical event and preparation is essential.


For more articles and more visit our…

:: pregnancy & birth info hub

:: birth and labour knowledge vault


– this article kindly supplied by Julie Clarke from Transition into Parenthood

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