Unkindest Cut?

No matter how many books you may have read on the subject of labor and delivery, when you're going through it for the first time, you don't really know what to expect. So, if an obstetrician offers to shorten the time it takes for your baby to be born by making a little incision in the tissue below the birth canal, chances are you'll be tempted to gasp out a yes! The procedure, called an episiotomy, may bring you immediate relief, but it often leads to a longer recovery, more pain and other postdelivery complications. Most of the time, it doesn't even benefit the baby. In fact, under normal circumstances, there's really no point in performing what has perhaps been misleadingly called "the kindest cut."

At least that's the conclusion of Dr. Erica Eason of the University of Ottawa in Ontario and Dr. Perle Feldman of McGill University in Montreal, who have reviewed all the data available from the past 30 years. "Episiotomy should no longer be routine," they wrote in last week's issue of Obstetrics and Gynecology. "[It should be] reserved for exceptional circumstances."

One common justification for an episiotomy is to avoid tears in the perineum, the tissue just below the opening of the birth canal. "But people generally underestimate how well the perineum stretches," Feldman says. All it takes is a little time and holding off on pushing to give the perineum a chance to adjust. Also perineal massage during the final six weeks of pregnancy reduces the risk of tears 40%.

That doesn't mean episiotomies need always be avoided. They are critical if a baby's heartbeat drops for an extended period or if the infant's shoulders are too big to come out. Generally, though, it's best to let nature take its course.