To cut or not to cut:

An
episiotomy is when the caregiver takes scissors and cuts through the perineum tissue. This cut goes through several layers of tissue and therefore takes longer to heal than a tear. It may sound awful to tear, but it is actually much more gentle then a cut that goes through tissues including muscle. Allowing a woman to tear naturally creates a more natural healing process. Also if the woman is allowed push at a natural pace without being rushed and allowed to slow her pushing as the baby’s head is crowning, she is likely to stretch and possibly not tear at all or have a very minor tear. Durning the pushing stage of labor, if the caregiver stretches and uses warm compresses, this helps the tissue to relax and stretch naturally as well. So this makes the healing after your baby is born faster and easier.
Episiotomy

Side effects of an episiotomy include:
- Infection
- Increased 3rd or 4th degree tear
- Increased pain
- Longer healing time
- Increased discomfort with intercourse even after the first 6 weeks postpartum

How to avoid an episiotomy:
The first way to avoid an episiotomy is to find a caregiver who does not routinely give them. This will be your best chance of not having one. If a doctor is telling you that’s is what he/she does or he recommends one, it is a warning saying, “I will give you an episiotomy.” Remember and gently remind your caregiver that the American Academy of Obstetrics and Gynecology (ACOG) doesn’t support the routine use of episiotomy. Second, ask your care provider if they will stretch the perineum in-between pushes and use oil and warm compresses. Also, self directed pushing helps with allowing the muscles to stretch more naturally and easily.

What you can do: Kegal exercises. These help you to be aware of your muscles so you are better able to relax them during the birth.


How to avoid a postpartum hemorrhage

Some of the risk factors of a postpartum hemorrhage are:
Multiple gestation
Large baby
Polyhydramnios (excess of fluid)
More then 5 term pregnancies
Prolonged labor
Labor augmented with pitocin
General anesthesia
Placenta previa
Abruptio placentae
Magnesium sulfate infusion.

By looking at the list and knowing what you want for your birth you will be able to put yourself into a low, medium or high risk category and you will start to be able to decide what you want for yourself after your birth.

After the birth if hemorrhage does occur, there are several steps the doctor takes to control that bleeding. These steps depend on the reason for the bleeding which is most commonly uterine atony (the uterus is not contracting enough).
1. Uterine massage
2. Have the mother with her feet above her heart
3. Give oxygen
4. Ensure 2 large IV sites are available
5. Give medications - pitocin, methergine, hemabate
6. Consider surgery including ligation of Uterine and Hypogastric arteries and/or hysterectomy

Now lets talk about prevention. During labor there are a few things you can do, first be proactive on keeping your labor going by moving and changing positions at least every hour. This keeps your labor going so you don’t have a prolonged labor, which is one cause of postpartum hemorrhage. Also, drink plenty of fluids and empty your bladder at least every hour. A full bladder can inhibit contractions or at least make them weaker. After the birth, a neutral approach would be to wait and see if bleeding is a problem and let the placenta come on its own. The mom’s first step in prevention after the birth is to have the baby immediately placed on her tummy or chest and the baby should be kept there so that she can begin breastfeeding. This sends more natural oxytocin through your body which causes the uterus to contract and expel the placenta.

The doctor should NEVER pull on the cord to help the placenta out, the mom should push it out. Once the placenta is separated it is ok to assist it going through the cervix. The doctor SHOULD aggressively massage the uterus to help expel clots of blood and check the tone of the uterus while making sure it is clamping down to prevent excessive bleeding. Poor uterine tone causes 70% of postpartum hemorrhages. This can be painful but the benefit outweighs the risk. The mom should continue with all the relaxation techniques she used during the birth. If these methods are not working then it might be appropriate to administer pitocin.



Conscious Birth is serving Placentia, Yorba Linda, Fullerton, Brea, Anaheim, Irvine, Newport Beach, Alicia Viejo, Mission Viejo and other Orange County, CA cities. I am also very near, some Riverside and San Bernardino County cities. If you are interested in meeting with me, please e-mail kristen@bestocdoula.com or call 714/269-0172.