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| |    Preventing Episiotomy by Elisa Ross, MD and Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. There is a lot of debate over the necessity of episiotomy and the prevention of lacerations (tears) of the vaginal opening, or perineum at childbirth. Techniques to help prepare the perineum for childbirth There are exercises to do in the third trimester that may help prevent lacerations or the need for episiotomy at delivery. These involve stretching the vaginal opening with a technique called perineal massage. You or your partner can gently put two or more fingers about 2-3 inches into your vagina and press down and out on the vagina opening. Most pregnant women find, if doing perineal massage themselves, that they need to use the thumbs of each hand in order to reach. Stretch to the point of mild discomfort and hold it for a few minutes. Consciously relax the muscles as you massage. Using a lubricant like KY® jelly or mineral oil (available in your local drugstore) may make it more comfortable. Repeat this exercise as often as every day in the third trimester. The idea behind this exercise comes from the fact that a woman is much less likely to tear or need an episiotomy after she has given birth once. The theory is that perineal massage can imitate the stretching process of birth and get the vagina ready. It is unclear if perineal massage really does help prevent lacerations, since research in this area is scanty. Many well-intentioned couples find the exercises annoying or uncomfortable to do, and quit before it could be expected to be helpful. Some books recommend kegel exercises to prepare the vagina for birth. While these exercises may help in the preventing leakage of urine (urinary incontinence) and in recovery of vaginal tone after childbirth, they do not improve the stretchiness of the vaginal opening, and may actually make it tighter. What can be done during the birth to protect my perineum? So much is determined by your individual anatomy and labor course, that there is no guarantee that episiotomy or laceration will be preventable. While warm compresses on the perineum during the pushing stage can help with discomfort, this has not been shown to protect from laceration. Perineal massage during the pushing stage, with mineral oil or other lubricant, may be helpful. The best protection is a slow, controlled birth, with a practitioner experienced in avoiding laceration and episiotomy. When you see a baby come out of a vagina, it is not a mystery why an episiotomy or laceration is sometimes necessary. What's amazing is that many women deliver babies without tearing!
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