Avoiding an episiotomy

Is there anything I can do to prevent tearing or having an episiotomy? (January 2019).

Anonim

What is an episiotomy?

An episiotomy or episiotomy is a small incision in which the perineum (dam) is stretched by the child's head. This happens during the second birth phase when about 2 to 4 cm of your baby's head is visible.

The perineal incision may serve to speed up childbirth, facilitate a forceps or vacuum birth or breech birth. Even if your baby is in mortal danger and must be brought to the world quickly, an episiotomy can be made. In premature births, an episiotomy can be done to minimize birth trauma to the baby's head. Sometimes the incision is made to prevent a rupture of the perineum. In the middle of the 18th century the first episiotomy was documented. However, it was not until women gave birth to their babies more often in clinics that the episiotomy rate increased (Schlömer et al 2003) and reached its peak in the 1950s to 1970s. In the 70s, the episiotomy was made in up to 90 percent of women giving birth (Halder 2005). Since then, the benefits and harms of the perineal incision have been discussed, and now midwives are careful to only have a perineal incision if it is really necessary.

As a result, the perineal cut rate is now declining. In 2007, it was carried out 126. 188 times (Federal Statistical Office 2007, which corresponds to a rate of 18.4 percent of births), but the concrete episiotomy rate varies from clinic to clinic and fluctuates between five and 76 percent (Ökotest 2002).

How to avoid a pelvic incision

If you do not want a pelvic incision, talk to your midwife about what methods are used at the maternity clinic of your choice. ""Are there any specific criteria for when an episiotomy is done? Wishes regarding an episiotomy in your birth plan, or discuss it with the responsible midwife and the doctor when you register at the hospital.

Here are some things you can do during pregnancy or during childbirth, to prevent a pelvic incision.

In Pregnancy

Improve the elasticity of your musculature at the perineum by means of a perineal massage to start in week 33 of pregnancy. For the massage, sprinkle a little oil (with vitamin E or pure vegetable) on the entrance of your vagina. Now insert your (also oiled) thumb about 3 inches deep into the vagina and gently press it outwards and downwards until you feel a slight tingling sensation.Hold the tension for about two minutes. Then start to massage the lower part of your vagina and the labia through forward and backward movements. Do it for three minutes. You can relax your muscles with a hay flower or lime blossom steam bath before the massage.

  • Pelvic floor exercises will familiarize you with your pelvic floor muscles and will help you to consciously relax your muscles. Many women automatically contract when contractions begin, especially when they are afraid of the impending birth. Through pelvic floor training you can learn to relax your muscles in the second birth phase.
  • The more you do for yourself and your child during pregnancy, the fitter, stronger and healthier you are for childbirth - and the faster your body will recover. Therefore, a healthy and balanced diet as well as exercise and rest are equally important. If you take this to heart and seek the advice of your midwife, chances are good that you can give birth to your child calmly and in a controlled manner.
  • During Childbirth

If you've done your dam massage in pregnancy, it can give you more peace of mind: If the baby's head shows, then you'll experience the pain of stretching that comes from it recognize increased stretching through the massage. Some women describe it as a stinging or burning pain. Some pregnant women are afraid of it and stop squeezing when the pain comes. Recognition can help you not panic, but exhale slowly and slowly.

The moment the baby's head dilates the perineum, it's important that you listen well to the midwife's instructions for squeezing or suppressing the urge to press through ""panting."" The slower and more controlled the child's head stretches the causeway and is born over the dam, the greater the chance that no or only a small perineal rupture arises.

Some women are unsure when or how to squeeze. It can help to sit on the toilet during the first labor and to practice light weighting a few times. It feels like a heavy digestion - this may not be a very charming comparison, but it does provide a helpful idea.

If you are not giving birth, gravity at birth can help you. An altered birth position, for example, kneeling on all fours, can prevent a perineal incision or tear.

There is some evidence that aquatic births make it easier to prevent severe perineal tears (perineal trauma) and episiotomy (Burns 2001).

During labor, your midwife may relax your musculature through massage or warm compresses. There is no scientific evidence that this reduces the likelihood of episiotomy, but you may feel more relaxed as a result (Beckmann2006).

Reviewed by Dr. med. Antje Hofele

Sources

Beckmann M, Garrett A. 2006. Antenatal perineal massage for reducing perineal trauma.

Cochrane Database of Systematic Reviews , Issue 1. www. mrv. inter science. wiley. com Burns E. 2001. Waterbirth.

MIDIRS Midwifery Digest September 2001. Vol 11. Halder 2005. Mechthild Katharina Halder (2005): ""Influence of training with the birth trainer EPI-NO® on the episiotomy rate and incidence on intact embankment as well as on the Rate of infections in patients at the gynecological clinic on the right bank of the Isar ""; Complete imprint of the dissertation approved by the Faculty of Medicine of the Technical University of Munich to obtain the academic degree of Doctor of Medicine. 2005.

Ökotest 2002. ""Kliniken, Geburtskliniken"" Published: 27. 05. 2002

Schlömer et al 2003. Gabriele Schlömer, Mechthild Gross, Gabriele Meyer: ""Effectiveness of the liberal vs. of the restrictive episiotomy in vaginal delivery with regard to the prevention of urinary and fecal incontinence: A systematic review ""2003

Federal Statistical Office 2007, Fachserie 12, Reihe 6. 4.:"" Case-related hospital statistics (DRG statistics), diagnoses and procedures of full-time inpatients Patients in Hospitals "", Health Statistics, Federal Statistical Office

// www-ec. destatis. de [pdf file 711kb, as of May 2009]

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