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Avoiding Episiotomy (really long)From: Judith Kurokawa (jkuro@mcn.net)Wed Mar 13 20:39:20 1996
You make the point that you believe position to be a deciding factor in the prevention of perineal trauma. What birthing positions do you favor and which are the positions that are utilized most often? Douglas Krell MD djkrell@aol.com @@@@@@@@@@@@@ Hello Doug, This is a favorite topic of mine. IMHO, the best way to reduce one's epis rate is to DON'T CUT. If you make up your mind to only cut when there is a definate fetal indication, your epis rate drops and your intact rate goes up. This means PATIENCE. Perineums take time to stretch. The next thing is to avoid coached pushing. That means make all the woman's support people (fathers are notorious for this 'cause they want to hurry up and see that baby), nurses and yourself to stop yelling at her to PUSH! PUSH! PUSH! She needs to push according to her body's urges. No counting to ten and all that. At the end, when she is C/O burning, she should avoid pushing hard, and most women do this naturally if uncoached. If she is anesthasized, obviously she will need some coaching, but pushing per se should be avoided until the head is visable at the introitus when you pull down on the perineum. This may mean a 3 hr 2nd stage, but what's the big deal if baby is ok. Again, patience. Positioning - I use a birthing bed (Adele - and I like it fine) but birthing beds can also be misused - I've heard them called Fooled-ya beds - you thought it was a birthing bed but it can be made into a regular delivery table and end up with the mom immobilized . So my advice there is to avoid breaking the bed. Encourage side lying or hands and knees positioning. IMO, these positions are the absolute best for preserving perineums. Both positions require some rethinking of your hand positions, but after 2 or 3 births in these, you will probably like it. An added benifit of H & K is that if there is meconium, it is much easier to suction the infant prior to delivering body, and if you have a shoulder dystocia, the posterior shoulder is more easily
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