A guide to understanding episiotomies

Part of the experience of childbirth includes the "other stuff" that they don't always tell you about before you head into the hospital to deliver your bundle of joy. One of those things is that you might end up getting an episiotomy. Here's what you need to know about episiotomies.

During childbirth, doctors sometimes perform an incision called an episiotomy to enlarge the vagina and make delivery easier for mom and baby. Episiotomies, however, do not prevent tears, and they may cause problems that could have been avoided without the procedure.

• Worldwide, it is one of the most common procedures performed on women, used in about one-third of vaginal births. But are doctors making the right move? Maybe not. As it turns out, there's an extensive body of research showing that episiotomies may cause the same problems physicians are trying to avoid.
• A review of more than 40 scientific studies shows that routine use of episiotomies doesn't prevent tearing of tissue between the vagina and the anus and that natural tears as a result of childbirth are typically smaller than episiotomy incisions.
• In 2006, the American College of Obstetricians and Gynecologists posted recommendations that called for restricted, not routine, use of episiotomies, claiming the procedure does not benefit moms or newborns and may actually increase the risk of further tears and painful sex.
• There are instances when an episiotomy is required, such as when the baby's head is too large for the opening, its shoulders are stuck or a delivery happens too quickly for the vagina to stretch naturally. Doctors may also resort to episiotomy for vacuum and forceps deliveries. But new research is calling even that practice into question. One study found an increased risk of tears with the use of episiotomies during "special deliveries."

Pain during sex is more common among mothers who've had episiotomies. Some women even find that intercourse is less pleasurable because sexually charged nerve endings may be replaced with scar tissue after the procedure.

• Sometimes, such hardened scar tissue can later be surgically removed if it is causing pain.

Episiotomies can make childbirth easier, but they can also cause problems down the road. Make sure you know the risks of having an episiotomy and contact your doctor for more information.