Tips To Avoiding An Episiotomy.

Ann Douglas, author of The Mother of All Pregnancy Books: The Ultimate Guide to Conception, Birth and Everything in Between and The Mother of All Baby Books: The Ultimate Guide to Your Baby's First Year, is here at Pregnancy & Baby! Read Ann's advice on everything from keeping romance alive amidst the structure and stress of baby-making to weathering the storms of morning sickness to preparing for the birth of your dreams.
Ann Douglas

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Episiotomy and pain
It's not difficult to figure out why pregnant women start squirming when the subject of episiotomy is raised. After all, the mere thought of having an incision made to one of the most tender parts of your body -- the area between the vagina and the rectum -- can have you rethinking this whole pregnancy thing. And given that studies have shown that women who require episiotomies are more likely to experience such post-delivery complications as blood loss, infection, postpartum pain, pain during intercourse and the involuntary passage of gas or fecal material, you can see why most women are eager to do whatever they can to sidestep this particular surgical procedure.

The good news department
Fortunately, there is some good news on the episiotomy front. A study reported in the March 2000 issue of Obstetrics and Gynecology demonstrated quite conclusively that first-time mothers who practice perineal massage (the stretching of the tissues surrounding the opening to the vagina) for 10 minutes daily during the final weeks of pregnancy are less likely to require an episiotomy or to experience perineal tearing than other first-time mothers. (Unfortunately, perineal massage doesn't appear to offer the same benefits to women giving birth for the second or subsequent time -- bad news for the veteran moms in the crowd.)

The art of perineal massage
For best results, you'll want to start practicing perineal massage about six weeks before your baby is due, and you'll want to set aside about 10 minutes for each daily stretching session. Here's what you'll need to know to get started.

Get comfortable. Some women find that soaking in a warm bath or applying warm compresses to the perineum for at least 10 minutes prior to the massage helps them to relax.

You can either do the massage in the bathtub or on a towel on your bed. (If you decide to do the massage on dry land, you'll need to use a water-soluble lubricant such as KY jelly, olive oil or vegetable oil.) Place your thumbs 1 to 1 1/2 inches inside your vagina and press downward towards the rectum as well as out to the sides. You will feel a slight burning, stinging or tingling sensation. Hold the pressure for about two minutes, until the area becomes numb, and then breathe slowly and deeply while you try to relax the muscles in this area. Then gently massage back and forth along the sides of your vagina, moving your hands in a u-shaped motion for three minutes. Relax and repeat.

One last bit of advice: Don't wait too long to get started. Practicing perineal massage during labor itself (as opposed to during the weeks leading up the delivery) does not appear to reduce the chances that a woman will require an episiotomy or experience a significant tear. This is definitely one of those situations where the early bird gets the worm (or, in this case, the intact perineum!)

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