On Monday I discussed why you want to avoid an episiotomy and promised I would provide some techniques for avoiding an episiotomy and hopefully tearing all together.
Here they are:
Do lots of squatting. This helps to stretch out the perineum and will also increase flexibility and leg strength which will help during labor. Squat down with your butt as low as you can get it without touching the ground and while keeping you heels flat, stay down for 5-10 seconds, then slowly and smoothly stand back up with out bending over or going down on your knees or butt first. You may need help getting up and down at first, but the more you do it the better you will get at it. If you make a conscious effort to squat instead of bending every time you have to pick something up or go down to the ground you will become a pro in no time.
Perineal Massage. This helps to make the perineum more stretchy and pliant. To do this sit in a semi-reclined position and spread your legs apart. With lubricated thumbs and fingers (you can use vitamin E oil, vegetable oil, or a personal lubricant- DO NOT use petroleum jelly, mineral oil, or baby oil) place thumbs about knuckle deep into vagina and put pressure down toward rectum and out toward sides. Hold this for one to two minutes. Then, GENTLY massage the lower part of your vagina back and forth and then rub the tissue between your fingers. It is important to remember to use a very gentle touch to avoid bruising, irritation and infection. If you are comfortable it may be easier to have your partner to do this for you.
Do Kegel Exercises. This helps to strengthen the pelvic floor and can help prevent tearing, but another benefit of Kegels is that if you do tear it can help shorten recovery time.
Beginner Kegels- Flex the PC muscles. If you are clenching you butt your aren't doing it right. It may help you to understand what it should feel like by stopping and starting the flow of urine. It is recommended that you do this 300 times a day. I know that sounds like a lot, but it is the equivalent of 5 to 10 minutes a day. Once you have mastered this, move on the next level.
Intermediate Kegels- Now, instead of flexing 300 times per day, you will be flexing just 36 times. However, now each time you flex try holding it for ten seconds. Once you have mastered this, move on to the next level.
Advanced Kegels- Now you will only be doing about a dozen flexes a day. Flex just the lower portion of the vaginal barrel, then the middle, then the upper portion. Now, release the upper portion, then release the middle, last release the lower portion.
(From Natural Birth the Bradley Way by Susan McCutcheon)
What you do before labor is very important, but how you deliver your baby can also affect your chances of tearing.
Keep these things in mind when you are making your birth plan:
Do NOT push laying on your back. Laying on your back puts added pressure on your perineum. Better positions to push in would be squating, on all fours, or on your side.
Avoid forceps and vacuum assistance. These techniques both forcefully pull the baby through the vagina which obviously can lead to tearing.
Avoid anesthetics. Drugs can affect the way your body and muscles work and limit your ability to control pushing which leads to tearing.
Have a waterbirth. The warmth and lubrication of the water helps to make the perineum more pliant during delivery.
Use a warm compress. Most midwives use this technique of applying pressure to the perineum with a warm, damp cloth during pushing.