All this to avoid the birth canal spontaneous tears do is make an episiotomy. when benefits and risks of episiotomy is not proportional. When compared together, this study supports that routine episiotomy should be discarded. And serve as the practice of the past are no longer necessary in the present. And many studies have not supported the existence of this practice. 

RATIONALE episiotomy Actions:
To extend the perineal opening for the baby's head and prevent tearing.

REALITY:
Episiotomy cut muscle tissue and skin that lies in between the vagina and anus, which often leads to incontinence of urine. It is also associated with creating more trauma to the perineum and in fact this is the cause of the torn perineum. Local anesthesia is given to the episiotomy action would only cause swollen perineum tissue, decreased flexibility and increased opportunities for ripped / torn. Naturally occurring tear is actually better and faster healing than with episiotomy tear due to the action. With the support of the right perineal, both spontaneous and action rip episiotomy can be avoided.
BENEFIT = Able to allow the baby to be born more quickly when in kesulitab
RISK:
a. Damage to muscle tissue
b. Can cause a tear in addition to an episiotomy which can lead to incontinence
d. Local anesthesia can cause more tear with tissue swelling
e. Usually done for convenience
f. Usually completely unnecessary
g. Take a long time to heal
h. Require stitches
i. Improve healing time
j. Very uncomfortable
k. episiotomy scar tissue can be flexible and affect the future labor

Despite evidence that the benefits and risks of episiotomy is not justified, some obstetricians persist in using it regularly to comfort them, to the detriment of their patients.
Avoiding episiotomy
There is a simple solution to avoid an episiotomy. This must be one of your top priorities if you want to remain intact perineum during childbirth.
1. If your service provider is used episiotomy as a routine procedure, you can discuss your desire to avoid and remind them gently that the American Academy of Obstetrics and Gynecology (ACOG) and the WHO-did not support the routine use of episiotomy. support from your service provider is important to help you avoid an episiotomy.
2. After securing the support of your service providers', the best option to avoid an episiotomy use measures that better support the perineum before and during birth. These include:
· Perineal MASSAGE
It helps you learn to relax during labor and allows the network to become more flexible and to prevent tearing at all.
Dr. Robert Bradley, a DSOG in his book "Husband Coached Childbirth" explaining that perineal massage is one of the most effective way to avoid the occurrence of tears in the perineum.
Before performing the massage he teaches her to take hot water in the drop in the bucket and given salt. Then take a clean cloth that has been ironed (for sterile) and then water is inserted into the bucket of hot water there was salt in the bucket while the steam is used to her mother's cunt-I steam. So the mother can sit on the bucket for hot water vapor is about the mother's vagina.
Then, the fabric that had soaked in hot water is taken and then squeezed kompreskan the vaginal area and perineum. The function of these actions is to stimulate the effects of stretching on the perineal area so it is more elastic and stretched. But this can not be applied to the mother who has an infection or inflammation of the genitals. After that just started in the massage perineumnya. The order of administration can do as below:
How:

a. Wash hands with soap
b. Cut nails when long
c. Identify the perineal area (with mirror)
d. Prepare position
e. Maternal half-lying position. Prop back, neck, head and both feet on the pillow. Renggangkan foot, then put a pillow under each leg. Use the middle finger and index finger or both index fingers to massage partner (if by partner)
f. Stand with one foot stepped on the floor and put one foot lifted chair
g. *** Find the position of the most safe and comfortable for the mother
h. Apply a warm massage oil, for example wheat oil are rich in vitamin E, Olium cossar or VCO or water-based lubricant like KY jelly.
i. *** Do not use baby oil, mineral oil, petroleum jelly or hand lotion
j. *** Before the massage take a deep breath in and relax, with caution and remain confident start massaging the area.

k. Insert your thumb into your perineum around 3-4 cm (max 7cm) with bent position, and the other fingers outside the perineum.
l. By maintaining a steady pressure (about 2 minutes), press for a while until you feel a little soreness, tingling or warm sensation (slight burning)
m. Continue to press with your thumb. Then slowly and gently massage back and forth to the bottom of the vagina, do it for 3-4 minutes.
n. *** Remember to avoid the urinary tract / urethra as it will cause irritation.
o. By maintaining a steady pressure, move your thumb or index finger in the vagina in a rhythmic form of the letter U and the bottom (rectum), for 1-2 minutes (20-30 times)
p. *** Each time you rub, always imagine and intend perineum becomes more flexible
q. Massage should not be too hard, because it will cause swelling of the perineal tissues, initially you will feel muscle fast muscle but with time and with training of this network will be flexible
r. Once completed bagu in compress using warm water / warm cloth again, for blood circulation

The better you prepare your perineal tissues to stretch during the birth process, the less they will tear, and the better they will heal. The study reported that women who did perineal massage every day in the last six weeks of pregnancy has the experience uncomfortable sensations during head crowning.
3. Kegels
It is also effective to help the pelvic floor muscles more toned and elastic. This method was originally developed by Dr. Arnold Kegel in 1948 to cope with incontinence in women after childbirth by strengthening muscles pubococcygeus or "PC".
These exercises are recommended to avoid an episiotomy. Another benefit of pregnancy is that train these muscles makes you more aware so you can keep them relaxed during birth.
Special attention should be given to contracting the PC muscles just not the stomach or thigh muscles.
Doing Kegel exercises:
Ø Empty your bladder.
Ø While exhaling, tighten the pelvic muscles.
Ø Hold for 10 counts. Relax for a count of 10.
Ø Perform 10 repetitions three times a day.
Kegel exercises can be done anytime and anywhere. Many women will do this exercise as part of their routine perineal massage.
4. Setting the correct position when the pushing
Pushing their backs using it will emphasize the perineum and the pelvic outlet narrowed as much as 30%. Usually that happens on the field is the mother in point (likely dipaksas) to sleep on your back with your knees on Hold by the tool or dipenga midwife, then the midwife necessarily lead to pushing without looking at the mother's wish or not wish to push. It all really does not make sense at all. Especially when pushing the mother was asked to hold his breath ... it does not make sense.
The best way is to follow the impulse to mengajan yourself and be in positions other than supine. Remember contraction is doing work to push your baby out. You really do not need to add much extra effort to encourage.
Remember that you should take advantage of gravity during labor, moving, and utilize some maternity position (whatever position makes you feel comfortable for you to do at the moment) Being in an upright position - squatting, on hands and knees, sitting, kneeling - all reduce the likelihood of tearing
Gravity does not help when a woman is supine or lying down during the second stage. There is more unnatural pressure on the perineum when in terlentang.Jongkok position, sitting, kneeling, crawling, standing, turns on a birth ball, this will help to utilize the force of gravity.
5. Perineal episiotomy SUPPORT TO AVOID DURING BIRTH (hot compress / COLD)
Using hot compresses on the perineum during the opening even as the head crowning can help stretch the network and help you stay relaxed.
Cold compresses can reduce swelling and give effect to numb the perineum.
Manual support can be provided by your service provider directly to the perineum when the baby's head was crowning. perineal support can be applied with oil to promote or intended to slow the network stretching.
Baby's head should be allowed to slowly go down until you feel the uncontrollable urge to push. Full dilation does not necessarily mean that you should start mengajan you know! Follow your body to decide when it's time for you to push and push. In your birth plan, you can specifically state that you insist on avoiding episiotomy. If someone menjadnamun if there are medical indications that require performed episiotomy at delivery, you can request an episiotomy with pressure. This is done when the head is already cr Owning and slowly stretch the perineal tissue. Usually allows for a smaller incision with fewer stitches. In addition, the pressure exerted by the baby's head has the effect of numbness, so you may not feel anything even without local anesthesia.
6. Prenatal Yoga     Do yoga during pregnancy and pelvic floor exercises in teratur.ini will be very useful to avoid a tear in your
    perineum.
7. Maternity in the room dark / dimly lit or other location where you feel safe and full privacy.     Maternity indoor dark / dimly lit, quiet location where you feel that you have the privacy and security,
     reduce the time and duration persalunan, reduce fear, reduce discomfort, and reduce the possibility of
     tearing (Odent 2003). Make your birth team of people who you know and trust and who believe in
     natural birth so that you do not feel like you're 'watching' or 'monitored' and not feel foreign. Your body
    will 'open' more easily if you do not feel that you have support (Gaskin 2003). Birth is not about to set
    goals or to meet expectations - it is about to change into for yourself, your baby, your body's instincts
    sound.
8. WATERBIRTH     Birth in water. Warm water works is a miracle in the birth process, but also allows the muscles and tissues
    to relax and stretch soft (Napierala 1994). Possible action on waterbirth episiotomy dangat small -
    especially when combined with birth attendants who know how to provide support for the perineum when
    the baby's head started crowning (Balaskas, 2004). If you can not give birth in the water, just sitting in
     warm water will help to gently stretch the perineum (Harper 2005).
9. Push / Mengajan only when you feel like pushing (not when someone tells you to 'push' or 'push') and    
    pushed slowly, gently head crowning. DO NOT hold your breath WHILE pushing!
10. Do not rush.       Listen to your own instincts and let your uterus that lead you. Balaskas reminds us that, "If you're not in a
      hurry during the birth process, your perineum will have time to stretch properly" (Balaskas 1992).
11. Let the peak of the baby's head naturally stretch the vaginal entrance.       Usually the midwife will guide you to draw breath (dog breathing) to avoid straining and to allow for
      stretching gently on the perineum.
12. Feel your baby's head with your own hands.       This practice is still very rare in Indonesia, usually when the mother's instinct to hold the baby's head on
      the lips of the vagina, the doctor / midwife yangsung angry and forbade the mother to do so by reason
     dirty and not sterile when you need to remember is that NO LABOR NET, however sterile. If you feel
     comfortable and feel like it, yes do!. Dr. Michael Rosenthal reported that mothers who use their hands to
     feel the peak of the baby's head became very rarely suffered tears to the perineum.