Episiotomy | Fit Pregnancy

Episiotomy

What a Difference a Few Letters Make

•  One patient insisted she wanted her episiotomy before her epidural. We assured her, she’d really like it better if we did it the other way around.

•  Another said she had a good epidermal with her first baby and wanted another one this time. Her nurse told her she had a lovely complexion and we’d try to get her a great epidural too. 

•  My patient was adamant. She didn’t want to have anything to do with an epididymis. Unfortunately, it was too late.

Perineal Massage and Episiotomy

Maite emailed and asked: Will perineal massage help me avoid a tear during delivery? Will the doctor do an episiotomy even if I don’t want one? Let me start with reassurance: While episiotomies are still performed, they’re not done routinely anymore.

What’s better: a tear or an episiotomy? The best choice is neither. Back in the olden days routine episiotomies were considered safer, cleaner and easier to repair. Nowadays, we know better.

The Bottom Line

What's worse? An episiotomy or a tear? Tough choice, huh? The answer—none of your business. OK, not really. It is, of course, your very personal business but not your decision to make at delivery, most of the time. One of the most popular items on a birth plan is the ever-popular demand—no episiotomy under any circumstances. Really? There's no situation where an episiotomy would be OK? How about if you've been pushing for 4 hours and the only thing separating your baby from your perineum (the skin, tissue and muscle between your vagina and rectum) is a small episiotomy?

The Real Deal

As birth stories go, mine was about as unnatural as they get: I was given Pitocin to speed my labor, then an epidural for the pain and, much later, had an emergency C-section. Fortunately, both baby Robby and I were fine. But because of my experience, I cannot quell other women's labor fears or advise them about the best way to heal a perineal tear.

Escaping Episiotomy

As many as 35 percent of vaginal births involve an episiotomy. But women may be able to avoid this incision by massaging the perineum during the last month of pregnancy. Australian researchers reviewed studies in which women were taught to massage the perineal area beginning around the 34th week of pregnancy. The women had a 15 percent lower episiotomy rate, and some reported less perineal pain in the months following birth.

Inside Information

The job description: Registered nurse specializing in inpatient obstetrics. Provides expert care of mother and baby through labor, birth and recovery; monitors fetal heart and contractions; cleans up mess. Adjusts for quirks, temperaments and family drama. Coaches dad, pampers siblings. Translates medical-speak. Serves as cheerleader, drill sergeant and best friend du jour. Your labor nurse might spend more time with you in one shift than your obstetrician does in nine months. Here's what she wants you to know.

Fatigue May Predict Depression

Feeling exhausted on the 14th day after giving birth makes it 50 percent more likely a new mom will suffer from postpartum depression by day 28, according to a new study. To prevent fatigue, study author Elizabeth Corwin, Ph.D., advises that all new mothers, not just nursing moms, continue taking prenatal vitamins for at least three months and that they ask their doctors to check their iron level. "In some studies, women with increased fatigue were anemic," she says, "and if they weren't anemic, they had low iron." Pain control also helps combat fatigue.