There's good news and bad news about episiotomy  -- the common childbirth practice in which a doctor makes a cut into the area between the vagina and the anus (the perineum) to ease a baby's delivery. The good news is that rates of this questionable procedure are declining. Case in point: Thomas Jefferson University Hospital in Philadelphia, where episiotomy rates fell from almost 70 percent in 1983 to 19 percent in 2000, due most likely to increased awareness about its risks, according to a recent study in Obstetrics & Gynecology.

Now for the bad news: Women giving birth in a hospital still have a near 40 percent chance of getting an episiotomy. Once thought to protect against tears, incontinence, and weakening of the pelvic floor muscles, episiotomies actually increase your chances of encountering such problems, according to data accumulated over the past 20 years. The procedure has been shown to raise a woman's risk for experiencing healing problems, chronic pain, anal incontinence, and sexual dysfunction, among other birth-related woes. According to study author Jay Goldberg, M.D., clinical assistant professor of ob-gyn at Jefferson Medical College, only two circumstances warrant the procedure: when the fetus is in trouble and a quick delivery is important, and in certain forceps or vacuum-extraction-assisted deliveries. To avoid an episiotomy, let your doctor know that you don't want one unless it's absolutely necessary. Then reinforce your wishes at the time of delivery.

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