Last updated: Feb 25, 2008
The second of 5 operations you don't want to get—and what to do instead.


It can sound so simple and efficient when an OB-GYN lays out all the reasons why she performs episiotomy before delivery. After all, its logical that cutting or extending the vaginal opening along the perineum (between the vagina and anus) would reduce the risk of pelvic-tissue tears and ease childbirth. But studies show that severing muscles in and around the lower vaginal wall (its more than just skin) causes as many or more problems than it prevents. Pain, irritation, muscle tears, and incontinence are all common aftereffects of episiotomy.

Last year the American College of Obstetricians and Gynecologists (ACOG) released new guidelines, which said that episiotomy should no longer be performed routinely—and the numbers have dropped. Many doctors now reserve episiotomy for cases when the baby is in distress. But the rates (about 25 percent in the United States) are still much too high, experts say, and some worry that its because women arent aware that they can decline the surgery.

“We asked women whod delivered vaginally with episiotomy in 2005 whether they had a choice,” says Eugene Declercq, PhD, main author of the leading national survey of childbirth in America, “Listening to Mothers II,” and professor of maternal and child health at the Boston University School of Public Health. “We found that only 18 percent said they had a choice, while 73 percent said they didnt.” In other words, about three of four women in childbirth were not asked about the surgery they would soon face in an urgent situation. “Women often were told, ‘I can get the baby out quicker,” Declercq says, as opposed to doctors actually asking them, ‘Would you like an episiotomy?”

What to do instead
Communicate. The time to prevent an unnecessary episiotomy is well before labor, experts agree. When choosing an OB-GYN practice, ask for its rate of episiotomy. And when you get pregnant, have your preference to avoid the surgery written on your chart.

Get ready with Kegels. Working with a nurse or mid-wife may reduce the chance of such surgery, experts say; she can teach Kegel exercises for stronger vaginal muscles, or perform perineal and pelvic-floor massage before and during labor.