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How can I avoid having an episiotomy?
Q: Other than having a c-section, are there any alternatives to having an episiotomy? I’ve read something about perineal massage and how this can circumvent the need for an episiotomy. Please tell me more about both, what to expect, and what you advise.
Craig L. Bissinger, M.D.
A: Episiotomies receive way too much attention in my estimation. The vagina was not constructed to deliver 9- and 10-pound babies. It was designed for a cavewoman, who was delivering a 4-pound baby while running away from T. Rex. Seriously, avoiding an episiotomy by choosing a cesarean section is not the standard of care in the United States. In fact, most obstetricians would recoil at the thought. And perineal massage has not been shown to help reduce episiotomies, either.

The best solution is to eat well, take care of yourself, stay in good shape and have an epidural during labor. I find healthy women who watch their weight tend to push better and have an easier labor. Why do I recommend having an epidural? Because I can attest to the tremendous pressure and discomfort experienced by women who deliver without anesthesia—they want that baby out NOW, and won’t tolerate waiting for the tissue to naturally stretch before delivery. An epidural allows you to tolerate the baby stretching the vaginal opening near the end of labor, which may help reduce your need for or the extent of an episiotomy.