How to Avoid an Episiotomy and Perineum Tears

An episiotomy is a surgical cut in the perineum (the skin between the vagina and the anus) intended to avoid a tear in that area during childbirth. Episiotomies are becoming less common, since the practice is now seen as having minimal benefit, but here are some tips on avoiding them.

	Talk to your OB/GYN or midwife about the issue. Many doctors perform the procedure rarely. Let the care provider know about your concerns before labor and birth. Waiting until you're in the hospital to let your care provider know will probably result in less satisfactory results.
	Attend a childbirth class, particularly one dealing with natural childbirth (such as Lamaze). The teacher will have plenty of techniques for avoiding many kinds of medical intervention by making the intervention unnecessary.
	Retain the services of a doula. A doula is a non-medical childbirth assistant whose job it is to coach you and support you during childbirth.
	Discuss birth technique with your childbirth class teacher and your doula. Often episiotomies and tearing can be avoided by pushing the baby out in a slower, more controlled manner, as sudden movements can cause tearing, but slow movements are more likely to stretch than tear.
	Practice perineal massage in the weeks leading up to birth. Perineal massage gently stretches the perineum before birth, so that it is already flexible when it's time for birth.
	Consider using a Perineal Dilator, such as the Epi-No Childbirth Trainer. This stretches the perineum mechanically in a manner similar to that of perineal massage.

• This is not medical advice. Talk with your own care provider!