an excerpt from The Birth Center Client Manual
Episiotomies are performed at the TBC on an as-needed basis, not routinely.
Our hope is that throughout the prenatal period, a relationship of trust will be established between you and us. Then, in the rare situation an episiotomy is needed, you as a couple will not only feel comfortable that we will do all we can to avoid an episiotomy, but that we will perform one properly if necessary. Having a properly performed episiotomy does not mean the recovery period will be slowed down. On the contrary, if an episiotomy is needed, it is understood that without one, the woman could have lacerations far more extensive than the cut, requiring suturing at a number of areas in and around the vulva.
To prevent the need for an episiotomy and decrease the chances of laceration, the CNMs do the following:
- Encourage perineal massage prenatally to help ready the perineum for stretching.
- Use warm compresses as the baby’s head arrives at the perineum to provide comfort, decrease physical tension, and increases blood flow to the region of the perineum.
- Use a lubricant (e.g. olive oil or K-Y Jelly) on the labia and inside the perineum as crowning begins to decrease scraping of the fetal head against any dry tissue.
- Encourage a slow delivery of the head. It is healthy for the baby’s head and for the perineal tissues to encourage the head to crown extensively, be held there with a steady push (but not advanced further) and then allowed to recede back between contractions.
- Encourage the woman to push during the crowning and delivery stage on her side with her legs together, knees bent toward her abdomen (unless she is physically uncomfortable in this position). This position affords less stretching of the perineal tissues and allows the CNM to have a much better view of how the perineum is holding up.
- Have the woman, as the baby is imminently ready to be birthed, do the following:
- Push between contractions
- Blow out and not push at all
- Give grunts to provide small pushes as the head slides out
- We will perform an episiotomy only if necessary. We do have Lidocaine that provides local anesthesia. We will inject it before we cut if we do an episiotomy and before we repair. Episiotomies are performed about 1-2 times a year, sometimes none are performed in a year.
- If you incur a small laceration requiring only a few stitches, we will stitch without anesthesia, as the number of needle punctures would be greater with anesthesia than without. Local anesthesia provides good pain relief but is not completely effective on the skin, so some sensation will be felt after injection.