Crotch incision during childbirth – 7 ways to avoid crotch incision

The perineal incision – episiotomy or perineotomy – is used to protect the woman in labor from chaotic vaginal ruptures and head injuries in the baby during his birth.

Episiotomy can be avoided if you study in advance a number of ways that help prevent incision in the perineum during childbirth.

1. Exercises to strengthen the pelvic floor muscles
   The main and most effective, but at the same time, requiring patience and perseverance, is to strengthen the muscles of the perineum through exercises that alternate tension and relaxation of the intimate muscles. These exercises will keep your pelvic floor muscles strong and elastic. Arnold Kegel, an American gynecologist, has developed a series of exercises that help improve blood flow to the genitals and prepare for childbirth in the perineum. In addition, exercising with this technique can help relieve vaginismus and dyspareunia and increase pleasure during sex.
   Here are a few of them:
   • For 10 sec. tighten the muscles of the vagina, then relax for 10 seconds. Do the exercise for 5 minutes.
   • Gradually contract the muscles of the vagina: first, contract a little, stay in this position for 5 seconds, then contract the muscles harder and linger again. At the end, contract the muscles as much as possible and return to the starting position in stages in the reverse order.
   • Tighten the muscles of the perineum as quickly as possible and relax them just as quickly (10 times).
   • Start contraction of the muscle with 5 seconds, and then, each time, increase the time and strain the muscle for as long as possible.
   • Try to contract a muscle by imagining that you want to push something out of the vagina. Hold the voltage for 3 seconds, perform 10 times.

   Exercises for this technique are recommended to do three times a day with 10 repetitions of the above complex, but before performing it, a personal consultation with a doctor about contraindications is necessary.
   These exercises are not recommended in the presence of a threat of miscarriage, discharge of bloody substance from the vagina, placenta previa.

2. Perineal massage in the last weeks of pregnancy
   Perineal massage will allow you to properly relax the muscles of the vagina during childbirth. To avoid episiotomy, it should be done daily for the last 6 weeks before delivery.
   The massage technology is as follows:
   • Training: wash your hands and lubricate them and the crotch with vegetable oil.
   • Massage: insert the fingers up to the second joint into the vagina and press on the muscles of the perineum so that their tension was felt. After that, you need to relax the muscles, and slide your finger along the vagina, either increasing or slowing down the pace, gradually moving to the perineum, which is next to the anus.
   • Duration of massage: about three minutes.
   • Contraindications: in the presence of herpes, vaginitis or other infectious disease, massage of the perineum is contraindicated, because it can provoke an exacerbation of the disease.
3. Give birth in a comfortable position
   Studies show that women who are given the opportunity to choose the type of birth very rarely choose the habitual “supine” position. In this position, it is difficult for a woman in labor to understand where she is directing the effort, as well as the forces of gravity are directed opposite to the birth effort. Women who give birth in a comfortable position for themselves (upright, on their side) feel their body much better, and can generate their efforts correctly, which significantly reduces the likelihood of rupture. It is forbidden to give birth in such positions in case of a disease of the internal organs of a pregnant woman, the threat of premature birth, during childbirth with complications (placental abruption, multiple pregnancies).
4. Correct breathing during contractions
   With proper breathing, labor is accelerated, and the pain sensations become less acute.
   Types of respiration in different periods of labor:
   • In the latent phasewhen contractions are short and not painful, you need to breathe calmly and deeply. Inhale through the nose, exhale through the mouth (lips with a tube). Take a gradual inhalation, counting to four, exhale, which should be longer than inhalation, counting to six.
   • Active phase the initial period of labor, when contractions last about 20 seconds, and pain becomes significant, “dog breath” will help alleviate the discomfort. The mouth is slightly open, breathing is shallow.
   • The stronger the contractions begin, the breathing should be faster.
5. Correct attempts
   At the second stage of childbirth, when contractions are replaced by attempts, the main thing is to listen and do what the midwife or doctor says. The duration of the active part of childbirth and childbirth in general depends on how she will correctly push, breathe and relax in the intervals between attempts. Breathing at this stage should be fast and frequent, pushing should not be on the face, but on the perineum.
6. Prevent fetal hypoxia!
   Because in case of oxygen starvation (hypoxia) of the fetus, the perineal incision is a mandatory procedure, then even before childbirth, one should deal with the prevention of oxygen deficiency: be carefully monitored by a doctor throughout pregnancy, eat right, and walk more in the air. If a pregnant woman has chronic intrauterine fetal hypoxia, then she needs rest and bed rest.
7. Relaxation during the appearance of the baby’s head
   When the baby’s head erupts, the woman feels a burning sensation, because the tissues of the perineum are stretched. At this moment, you need to relax, stop pushing and breathe like this: two small breaths, then a relaxed long exhalation through the mouth. The midwife will support the muscles of the perineum during this period. The described method, which serves to slowly exit the head, is called “breathing out the child.”

If in advance, before the time of delivery, start the execution of this complex, and continue it in the delivery room, i.e. follow all the recommendations of the doctor and midwife, then the episiotomy will not threaten you.