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RaMa Mama - Doula Share of the Month: To Tear Naturally or Get An Episiotomy, That Is The Question...

An episiotomy is a surgical cut made at the vaginal opening during childbirth in order to help support the delivery of the baby when there may be difficulty. The most important times to consider an episiotomy is when the baby's shoulder is stuck behind the pelvic bone, when forceps or the vacuum extraction method are being used, or if the baby is in trouble or has an unusual heart rate during delivery and needs to get out quickly. Past research was in favor of an episiotomy over natural tearing for many years, but this belief has shifted over time with research and countless experiences. Today, experts all agree that it is much better for a mother to tear naturally. They tend to heal better, preserve their tissues and muscles, and have better overall support in their pelvic floor after birth. Research now proves that an episiotomy can cause infection, blood loss, perineal pain, incontinence, may be deeper and more damaging than need be, and may possibly causing pain during sex for a long time after delivery.


There are two types of episiotomy incisions, the Midline Incision and the Mediolateral Incision. The Midline Incision is a vertical cut that has a higher risk of stretching all the way to the anal area. It is easier to repair than a Mediolateral Incision, however. The Mediolateral Incision is performed at an angle, which helps to prevent a further tear into the anal area, but is much more painful and takes longer to heal. Both cuts require anesthesia to numb the tissue and use absorbable stitches to repair. This procedure is invasive and the recovery is uncomfortable and could result in problems with sex and incontinence.


In order to prepare the vagina for birth and delivery, it is so important to practice Perineal Massage to stretch out the area a month to a few weeks before the due date. Also, by practicing kegel exercises throughout the entire pregnancy, we can help to tone the area, prevent urinary leaking, and strengthen the pelvic floor in preparation for birth. During labor, warm compresses can help to relax the tissues and muscles and support the natural opening of the vagina in birth. Also, working with gravity in an upright or squatting posture will help the process along.


Most importantly, mothers need to remember that it is their bodies and their birth experiences. Talk to the midwife, doctor, and doula about the preference and keep open communication through the birthing process in each phase in order to be clear on what is the best way to move forward for both baby and mother. Sometimes we want one thing, and the best thing manifests for a greater and higher purpose. There is always the element of surrender in the birthing process. May every mother be honored and cared for, and may each birth be blessed by higher guidance, protection, and professionalism.

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