When Missy Goodson, 34, of Louisville, Ky., had her first child in 1988, there was simply no discussion about whether she would have an episiotomy. "It was just a given; everybody got one," she says. But by the time she became pregnant recently, the American College of Obstetricians and Gynecologists was recommending against the routine use of the procedure, which involves cutting the perineum area from the vagina toward the anus to enlarge the vaginal opening.

"There have been several trials over the past 20 years that have been consistent in showing there are no benefits to routine episiotomies," says Dr. Erica Eason, OB/GYN and associate professor of obstetrics and gynecology at the University of Ottawa in Ontario, Canada. "In fact, research has shown episiotomies increase the risk of infection, blood loss and pain, and do nothing to decrease urinary incontinence."

Today, episiotomies are only recommended in exceptional situations, such as if the baby is in distress, she says. Instead, women are being encouraged to massage the perineum area before labor, which helps prepare for the stretching that will occur, and to use Kegel exercises to strengthen their pelvic muscles. And their doctors are being urged to use perineum massage during labor to slowly stretch the tissue and avoid an incision.

Nonetheless, when Goodson gave eventually gave birth she received an episiotomy – one that was apparently unnecessary.

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