avoid an episiotomy

Have a water birth

A number of studies have shown that having a water birth significantly decreases your chance of needing an episiotomy. Unfortunately for us in South Africa, facilities for labouring and birthing in water are few and far between, but hopefully as the benefits of water births become more apparent, more hospitals will provide the necessary staff and facilities.
In a study of 5953 births in one birth clinic, three birth methods were compared: water birth, birth with use of a Maia-birthing stool and bedbirths. Water births had the lowest episiotomy rates (12.8%), followed by Maia-birthing stool births (27.7%) with the highest rate of episiotomies amongst bedbirths (35.4%). (5) Another study found that women giving birth out of the water had an episiotomy rate 5 times greater than the group giving birth in water, and although the water birth group had a slightly higher rate of minor tears, the number of severe tears (3rd and 4th degree tears) was higher in the ‘land’ group. (6) Considering tall the other benefits, a waterbirth sounds like a good way to avoid an episiotomy to me!

Get a doula and don't get an epidural

Just as a having a doula around decreases your chances of tearing, she will also help you avoid an episiotomy. In one study, the support of the doula meant that there was a reduction in epidural requests, forceps deliveries and caesarean sections. Epidurals and the use of forceps both increase the rate of episiotomies. Again, having more than one person with you while in labour is not allowed in any South African hospitals that I know of, so in many cases you have to choose between the doula and the dad, although some couples have managed to get special permission to have a doula as well. Again, once hospitals start seeing how allowing that extra person in the labour room can help the patient, they may start relaxing their 'one person only' policy. Although it may work the opposite way for private hospitals who make more money if there are more interventions, so allowing doulas may not be in their best interests. Excuse my cynicism; I love to believe the best about people, but the more I know about this stuff, the more cynical I get...