During pregnancy, many women fill out a birth plan to outline their preferences for care and to communicate their wishes with the staff. Birth plans often include a statement such as "I prefer not to have an episiotomy."

An episiotomy is a surgical incision that widens the vaginal opening by cutting the tissue of the vaginal wall. If asked, most women would prefer to avoid this procedure. Maybe they have heard that a natural tear heals better, may not occur at all or may be smaller than an episiotomy.

Episiotomies tend to tear more as the baby is being born, becoming larger than the original incision. This can cause more discomfort, a longer recovery period for the mother and an increase chance of infection. Despite the side effects, approximately 25 out of 100 women having vaginal births experience episiotomies, according to the Listening to Mothers II survey by the Childbirth Connection, an organization for evidence-based health care. That translates to one million episiotomies performed each year in the United States alone.

As patients, we are led to believe that medical procedures take place following informed consent. Although the episiotomy is an invasive procedure, the survey shows that 73 percent of the mothers who received an episiotomy were not asked if they wanted one. That is, approximately 730,000 American women per year may be given an episiotomy without informed consent. Fortunately, learning about and discussing episiotomy is something that parents can begin early in pregnancy.

Here are some things you should know about episiotomy:

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