It can also help to remind your practitioner of your desire when you get to the hospital. Increasingly, women's births are attended by M.D.s that they haven't met, says Dr. Signorello. Midwives are often more concerned with restricting the use of episiotomies during normal births. In fact, one of the hallmarks of good midwifery practice is keeping the perineum free from injury, Dr. Graham says. To accomplish this, many use techniques such as carefully orchestrating a woman's pushing in the second stage of labor or massaging the perineum during birth to avoid tears or the need for an incision.
Perineal massage is also something women can do themselves in the last months of pregnancy.
A recent study in the American Journal of Obstetrics and Gynecology found that 24 percent of first-time mothers who performed prenatal perineal massage did not tear, while only 15 percent of those who didn't massage kept their perineums intact. Our own informal poll of nurses indicated that few, if any, of their patients had tried the technique, let alone heard of it. Gently stretch until you feel a slight burning or stinging sensation for several minutes. Next, hold the pressure for about two more minutes or until the tissue begins to feel slightly numb. Massage the lower vagina with your thumbs for several more minutes, avoiding the urinary opening.