1. Select your family doctor, Ob/Gyn or midwife wisely.
   Choosing a person or team that you trust will make all the difference in the world. Find someone that you know will respect your wishes. Base your choice of health care practitioner on a few key factors: What is their rate of episiotomy use? Yes, you can ask this question and expect a truthful answer. It is public record, so it is your right to know. Choose a practitioner that has a low rate (you want less than 10%) and doesn’t practice routine use (emergency use only). Make it clear that you do not consent to an episiotomy.
   Other questions to ask: Does she promote childbirth as a natural process that a woman’s body is capable and built to do? Will she suggest techniques to prepare you for the physical event in the months and weeks before birth? During how much of the labor will she be present? Will she be a positive supportive influence during birth and advise you when pushing the baby to allow your skin to adjust and stretch?
   Knowing the answers to these questions, you will be more confident in your practitioner’s decision-making process. The comfort of trust will help to buoy your confidence and stave off tension.
2. Kegels and Perineal massage are invaluable.
   These two exercises can make a huge difference in how your perineum prepares for birth. And, both are really easy to incorporate into your daily routine. Many women do kegels while performing everyday tasks like driving, sitting at a desk or cooking.

   To do Kegels:

   • Remember to breathe normally.
   • To find the correct muscles, practice stopping the flow of urine when urinating. This is called contracting the pelvic floor muscles.
   • Hold for 10 seconds, then relax. Try not to contract legs, buttocks, or abdominal muscles.
   • You can do a series of “short holds” (5-10 seconds) then a series of “long holds” (10-20 seconds),repeating 10-20 times for a full session of Kegels.
   • It’s recommended to do a session two-to-three times a day.

   Perineal massage can be added to your bedtime ritual and is a wonderful way to get your partner involved. Go to childbirth.org’s step-by-step guide to get started.

3. Remain active during your pregnancy and labor.
   Your perineum is a collection of intricately woven muscles. So, according to what your doctor, midwife or practitioner recommends, be active and exercise. It will strengthen the perineal area just as it would any other muscle group. Walking and squatting do well to keep the area flexible. As squatting is an ideal position for birth, practicing the position will help you to find a comfort zone and be ready for when you want to use it during labor. When in labor, stay as active as possible. This help to keep labor progressing and the laws of gravity will help baby descend.
4. Use visualization. Stay calm. Be relaxed.
   It sounds new-agey, yes, but many women have utilized this technique while in labor. The idea of imagining or visualizing yourself opening up for baby can actually cause your body to physically do it. Some women imagine a melon, basketball or even a hula hoop while focusing on their round, open qualities. Try this as you exhale through a contraction; imagine the sphere widening. You’ll be amazed at the results and distraction from contractions is a bonus.
5. Breathe slowly and deeply.
   Many childbirth preparation classes teach us how to breathe effectively during labor. The key here is to continue through the birth. It’s especially important to breathe during the crowning, stop pushing and let your skin adjust to the stretching. Try to stay calm and wait until your doctor/midwife says it’s OK to breathe and push. By allowing for adjustment, you prevent a tear or drastically reduce the severity of a natural tear. Natural tears heal quicker, easier and with much less pain than episiotomies.

All of the above steps can help to avoid having an episiotomy during birth. More importantly, they can make an impact on your overall experience by keeping you confident, positive and calm. As always, we recommend that you never start a new activity without consulting with your doctor. Discuss the suggestions listed above with your practitioner, and follow her direction as per your individual medical health and history.

See Episiotomy Part One: The real story your doctor isn’t telling you

See Episiotomy Part Two: A Call for Awareness and Change

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