An episiotomy is a small surgical incision made into the tissues of the perineal floor at the time of birth. Its purpose is to enlarge the vaginal opening and facilitate the delivery of the baby. The physician or nurse-midwife makes the incision just before the baby's head emerges. Although the procedure is used infrequently in many countries, it has become the "standard of practice" in the United States, being performed on 80 to 90 percent of women having first babies. The reasons given for doing an episiotomy are that it will prevent tearing of the woman's vaginal and perineal tissues, will decrease pressure on the baby's head during the birth process, and will shorten the second stage of labor. As with every medical intervention, however, there are also detriments. Increased blood loss, infection, and pain may result for some women. Discomfort during sexual intercourse during the months after birth is another commonly reported result of an episiotomy.
There are several things you can do to decrease the need for an episiotomy.
During your pregnancy do Kegel exercises (contractions and releases of the pelvic floor muscles) regularly.
A month or so before your due date, begin doing massage of the perineal tissue with natural oil to make the tissues more elastic.
At the time of birth, use upright positions (such as sitting, standing or squatting) when you are pushing your baby out.
During labor, use gentle "exhale pushing" techniques rather than prolonged breath-holding when pushing.
Warm compresses and oil massage applied to the perineum by your physician or midwife as the baby's head is crowning will also help stretching and decrease the need for an episiotomy.