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An episiotomy is a surgical incision or cut to the tissue between the vagina and anus, the perineum. No one puts an episiotomy down on their birth plan wish list. I felt a sense of dread just considering the topic. It is not uncommon to be fearful of the possibility of an episiotomy.
The purpose of an episiotomy is to prevent tearing and speed up delivery. In the past, episiotomies were a routine procedure. If you were born vaginally, your mother may have had one. Thankfully for birthing mothers in Canada, The Society of Obstetricians and Gynaecologists of Canada (SOGC) updated the guidelines for assisted birth in 2004 and now states that routine episiotomy is not necessary for an assisted vaginal birth.The number of episiotomies performed in Calgary has significantly declined since recent years. As of 2013, less than 3% of Calgary hospital births involved an episiotomy.  SOGC recommends non-operative interventions such as one-to-one support, oxytocin use, and delayed pushing in women using epidurals to decrease need for operative birth.
The least invasive ways to prevent an episiotomy include:

  • having someone apply warm compresses to your perineum in the late stages of labor.
  • using a warm bath during labor.
  • choosing a waterbirth.
  • having one-to-one support, like a doula.
  • delaying pushing, if you have an epidural, until the urge to push is felt.
If you just can’t shake your fear of episiotomy it’s a good idea to speak with your primary care provider. Your doctor or midwife can help to ease your fears and help you to prepare for an episiotomy free vaginal birth. You can discuss episiotomy with your doctor by asking questions like:

  1. How can I best avoid an episiotomy?
  2. Do you perform episiotomies routinely?
  3.  May I labor and/or birth in water?
  4. Do you perform perineal massage during delivery?
  5. Will you support my perineum while I am pushing?
  6. What can I expect in the event that a repair is needed? Dissolving stitches, numbing, etc.
  7. Do you have any specific suggestions to encourage perineal healing?

Sometimes facing your fears head on by asking the right people the right questions can really ease your mind and help you prepare for a positive experience!

Happy birthing!
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