By | May 8, 2025
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How To Avoid Episiotomy

An episiotomy is a surgical incision made in the perineum (the area between the vagina and the anus) to enlarge the vaginal opening during childbirth. While episiotomies used to be routine practice, current guidelines recommend them only when necessary for specific medical reasons, such as if the baby is in distress or if there is a risk of severe tearing.

Many women want to avoid an episiotomy if possible, so here are several ways to reduce the likelihood of needing one during childbirth:

✅ How to Avoid Episiotomy:

1. Prenatal Education and Birth Plan

  • Educate yourself about labor and delivery, including the benefits and risks of an episiotomy.
  • Create a birth plan and discuss your preferences with your healthcare provider, expressing your desire to avoid an episiotomy unless absolutely necessary.
    • Some providers may have different practices regarding the use of episiotomy, so it’s essential to align your preferences with theirs.

2. Choose a Supportive Birth Environment

  • If possible, consider giving birth in a birth center or having a midwife who may have a lower tendency to use episiotomies compared to some obstetricians.
  • Look for a provider who follows evidence-based practices, as studies show that routine episiotomies are no longer recommended, and they are used less frequently by providers who follow modern guidelines.

3. Perineal Massage

  • Perineal massage during pregnancy (starting at around 34 weeks) can help to increase the elasticity of the perineum and reduce the risk of tearing.
    • Gently massaging the perineum with oil (such as vitamin E oil or olive oil) can help make the tissue more supple and potentially prevent the need for an episiotomy or reduce the severity of tearing.
    • You can also try perineal stretching exercises to improve flexibility.

4. Optimal Birthing Positions

  • Certain birthing positions can help reduce pressure on the perineum and make it easier for the baby to be born, potentially decreasing the need for an episiotomy.
    • Squatting, hands and knees, or side-lying positions may be beneficial because they allow gravity to assist in the birth, which may reduce the need for an episiotomy.
    • Avoid the supine position (lying on your back with legs in stirrups), as it can increase the risk of perineal tearing.

5. Gentle Pushing Techniques

  • Instead of forcing strong pushes, work with your body and your healthcare provider to push gently during the second stage of labor.
    • Slow, controlled pushing can help prevent the perineum from tearing and give it time to stretch gradually.
    • Listen to your provider’s instructions to guide you through the pushing process, as they may use techniques like slow crowning (where the baby’s head emerges slowly) to help minimize trauma to the perineum.

6. Warm Compresses During Labor

  • Applying a warm compress to the perineum during the second stage of labor can help relax the tissues, increase blood flow, and reduce the likelihood of tearing or needing an episiotomy.
    • Warm compresses may be applied by your birth team to gently stretch the perineum during crowning, which can significantly reduce the need for surgical intervention.

7. Controlled Delivery

  • A controlled delivery involves slowly guiding the baby’s head out of the birth canal rather than allowing it to come out quickly, which can help reduce the chances of severe tearing.
    • Your healthcare provider may use a technique called “hands-on” delivery, where they support the perineum and assist with the baby’s head to prevent excessive stretching or tearing.

8. Stay Relaxed and Manage Pain Effectively

  • Tension in the perineum due to pain or fear can make the tissue more likely to tear.
    • Use relaxation techniques, breathing exercises, or labor pain management options like epidural anesthesia, hydrotherapy, or breathing techniques to stay calm and minimize stress.
    • The more relaxed and focused you are, the better the muscles of the pelvic floor will respond, which can help avoid injury to the perineum.

9. Consider Delayed Cord Clamping

  • Some studies suggest that delayed cord clamping (waiting 1-3 minutes after birth to cut the umbilical cord) may be associated with less need for an episiotomy.
    • Discuss this option with your provider, as it can give the perineum more time to stretch during birth.

10. Maintain a Healthy Weight and Exercise Routine

  • Maintaining a healthy weight during pregnancy can help reduce the risk of complications during labor, including the need for an episiotomy.
    • Pelvic floor exercises like Kegel exercises can help strengthen the muscles and improve their elasticity, reducing the risk of trauma during delivery.

11. Avoid Induction Unless Necessary

  • Induction of labor can sometimes increase the risk of an episiotomy because the body may not be fully prepared for labor.
    • Discuss your options with your provider and avoid unnecessary induction, opting for natural labor when possible.

12. Seek a Provider Who Practices Evidence-Based Care

  • Many hospitals and providers no longer recommend episiotomy unless there is a medical necessity. Look for a provider who follows evidence-based guidelines that emphasize perineal protection and natural birth when appropriate.

When Episiotomy May Be Necessary:

  • An episiotomy may be necessary in certain medical situations, such as if:
    • The baby is in distress and needs to be delivered quickly.
    • There is shoulder dystocia (where the baby’s shoulders get stuck during delivery).
    • The perineum is at risk of severe tearing that could cause significant damage to the pelvic muscles or organs.
    • The baby is in an abnormal position and requires assistance to be safely delivered.

When to Talk to Your Healthcare Provider:

If you are concerned about the possibility of an episiotomy, have a discussion with your healthcare provider well in advance of your due date. Having an open conversation about your concerns and preferences can help you understand your options and ensure that you receive the kind of birth experience you want.