• Squatting throughout pregnancy
• Kegel throughout pregnancy
• Good nutrition, including healthy fats & oils

• No soap on the perineum - it is drying
• Lotion and massage - if desired and ok'd by care provider
• Talk to care provider in advance about having an episiotomy versus tearing
• Be patient during pushing phase of birth
• Push with self-control
• Ease or "breathe" the baby out
• Remind doctor or midwife of your wishes at birth
• Listen for the words "local" or "local anesthetic" - those are red flags for a jab and a cut!!

• Kegels (pelvic floor contraction and relaxation) – during pregnancy it tones the muscle; a toned perineum encourages the baby’s chin to their chest making presenting part of the head smaller; control of the muscle helps slow down pushing if necessary to prevent tear
• Squatting - during pregnancy it stretches and tones the muscle making it supple; during labor it opens outlet of pelvis making birth easier for you and the baby

• flax seeds or chia seeds in smoothies or sprinkled on top of salads
• flax oil, walnut oil, or avocado oil as part of a salad dressing
• heat-tolerant oils as ingredients in a marinade for cooking
• lots of raw healthy fats: nuts and avocados

Anatomy of the perineum From WikiCommons

Types of Episiotomy From WikiCommons

Definitions from WikiParents:

From social to surgical: historical perspectives on perineal care during labour and birth

“A review of key historical texts that mentioned perineal care was undertaken from the time of Soranus (98-138 A.D.) to modern times as part of a PhD into perineal care. Historically, perineal protection and comfort were key priorities for midwives, most of whom traditionally practised under a social model of care. With the advent of the Man-Midwife in the seventeenth and eighteenth century, the perineum became pathologised and eventually a site for routine surgical intervention--most notably seen in the widespread use of episiotomy. There were several key factors that led to the development of a surgical rather than a social model in perineal care. These factors included a move from upright to supine birth positions, the preparation of the perineum as a surgical site through perineal shaving and elaborate aseptic procedures; and the distancing of the woman from her support people, and most notably from her own perineum. In the last 30 years, in much of the developed world, there has been a re-emergence of care aimed at preserving and protecting the perineum. A dichotomy now exists with a dominant surgical model competing with the re-emerging social model of perineal care. Historical perspectives on perineal care can help us gain useful insights into past practices that could be beneficial for childbearing women today. These perspectives also inform future practice and research into perineal care, whilst making us cautious about political influences that could lead to harmful trends in clinical practice.”

Copyright © 2010 Australian College of Midwives.

http://www.ncbi.nlm.nih.gov/pubmed/21035413

• Baby is in an abnormal position and might need manipulation or forceps to aid in vaginal delivery
• Baby needs to be delivered quickly due to fetal distress
• Extensive vaginal tearing appears likely: easier to repair a single cut than multiple jagged edges

• Higher incidence of a third or fourth degree tear that extends into the external anal sphincter and the rectum
• More blood loss
• More pain and discomfort in the postpartum period
• Painful intercourse
• Incontinence
• Additional surgeries to repair or reduce discomfort from initial episiotomy

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