How to Prevent an Episiotomy For Prenatal Mothers

By Shannon Strauch, PTA, STMT-1 on 9/25/2023

Episiotomy Image

Childbirth is a miraculous event, a powerful rite of passage for many women. However, it also comes with its fair share of challenges, and one of the more daunting prospects can be the risk of episiotomies or perineal tears. Thankfully, as the progress of medical science and holistic care continues, we have many methods to minimize this risk. Let’s dive deeper into understanding the ways you can prepare your body for a smoother childbirth experience.

The Anatomy and Dynamics of Childbirth

Before discussing preventive measures, it’s important to grasp the anatomy involved. The perineum is the area between the vaginal opening and the anus. During childbirth, this region undergoes significant strain. It's like a bridge that has to temporarily expand to let a large ship pass through. The smoother this process, the lower the chances of any injuries to the bridge.

Perineal Massage: A Deep Dive

One of the most proactive measures in preventing perineal tears and episiotomies is perineal massage. When done correctly and consistently, it can be an invaluable tool.

  • Technique Matters: Using a lubricant, insert one or two fingers into the vagina, applying downward pressure towards the anus, and side-to-side. This gentle stretching helps improve elasticity.

  • Consistency is Key: Practicing this massage regularly, especially from 28 weeks onward, can maximize its effectiveness. While the thought of massaging this delicate area may initially be daunting, it can help familiarize you with the sensations of stretching that occur during childbirth.

The Power of Pelvic Floor Exercises

Kegels are not just exercises relegated to post-childbirth; they're potent tools for preparation too. Regularly flexing and relaxing the pelvic floor muscles can enhance their strength and elasticity.

  • Finding Your Pelvic Floor: Imagine trying to stop the flow of urine; the muscles you use to do this are your pelvic floor muscles.

  • Balancing Act: While strengthening the pelvic floor is important, it’s equally vital to practice relaxing them. A muscle that is always tense will not have the flexibility needed during delivery.

Exploring Birthing Positions

Not all birthing positions are created equal, and the posture you adopt can significantly influence your birthing experience.

  • Upright Positions: Standing, squatting, or kneeling can harness gravity's pull and help in facilitating a smoother descent for the baby. They also allow the pelvis to open wider.

  • Horizontal Positions: While commonly depicted in media, lying down can sometimes reduce the effective diameter of the pelvic opening, making an episiotomy more likely. However, it’s essential to understand every body and birthing experience is unique, and what works for one may not work for another.

Additional Measures for a Seamless Birth

  • Warm Compresses: Warmth helps relax and soften tissues. Applying warm compresses to the perineum during labor can provide relief and reduce the risk of tears.

  • Breathing Techniques: Controlled breathing can help relax the body, reduce tension in the pelvic area, and provide a rhythmic guide during the pushing phase.

  • Water Births: Immersing in warm water during labor can be soothing. The buoyancy aids movement, and the water's warmth can relax the perineal tissues.

A Collaborative Approach

Preparing for childbirth, especially in preventing episiotomies and tears, requires a joint effort. Working with your healthcare provider, a pelvic floor therapist, and even a doula can offer personalized strategies tailored to your body and needs.

Childbirth, in all its intensity, is a profound experience. With the right knowledge and tools at your disposal, you can approach it feeling empowered and informed, ready to welcome your little one into the world. Knowledge, after all, is the first step to empowerment, and understanding the measures available to ensure a safer and smoother childbirth can make all the difference.

During a vaginal delivery, the pelvic floor muscles and skin of the perineum need to have enough elasticity and mobility in order to accommodate the infant passing through the birth canal. If there is not enough mobility, the possibility of a perineal tear or requiring an episiotomy increases. Good news! Research has shown that starting with a pelvic floor therapist around 28 weeks of pregnancy has been shown as an effective way to prevent tears or the need for an episiotomy. A pelvic floor therapist will be able to show you how to properly perform a perineal massage at home, as well as provide extra treatment during your session. Perineal massage has been shown to reduce pushing time, reduce the risk of perineal tears, and reduce the risk of needing an episiotomy. In the end, this will also reduce pain in and around the vagina after birth. Women assigned to the perineal/pelvic floor intervention showed a 31.63% reduction in episiotomy (Leon-Larios et al, 2017). Besides perineal massage, pelvic floor therapists can also give you pelvic floor exercises, such as Kegels, that have been shown to shorten the first and second stages of labor (Leon-Larios et al, 2017). Your therapist can also review different birthing positions and keep your mobility in order to reach those positions. Recent research suggests that upright positions in general are less likely to lead to tears (Rocha et al., 2020), while horizontal positions are more likely to lead to a birthing person having an episiotomy performed (Souza et al., 2020) Other ways to prevent episiotomies or perineal tears can include warm compresses on the area while pushing, proper breathing techniques, and possibly water births.

If you're anticipating childbirth and want to prepare your body for a smoother experience while minimizing the risk of episiotomies or perineal tears, it's time to act. Don't navigate this journey alone; let us be your guide.

Please email us at or call us at 908-443-9880. At Pelvic Health Physical Therapy in Madison, NJ, we're equipped with the knowledge and tools to support you through every step of your childbirth preparation. Your wellbeing and confidence during this transformative phase are our top priorities.

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