Your mom certainly had one ¿

It wasn't until giving birth in hospitals became the norm, starting in the 1920s, that episiotomies took hold. Women frequently tore during delivery, and making a preemptive cut was considered kinder — a way to prevent pain and protect moms from problems blamed on childbirth, such as incontinence and sexual dysfunction. Doctors were trained to do one with nearly every birth, and it became a standard of care by the 1950s.

But when researchers finally got around to scrutinizing the common wisdom by the 1970s and 1980s, study after study showed that routine episiotomies do not lessen pain or prevent urinary or anal incontinence or sexual problems –– and that sometimes they actually cause rectal problems and increase pain. "Episiotomy does more harm than good," says Katherine Hartmann, M.D., Ph.D., director of the Center for Women's Health Research at the University of North Carolina in Chapel Hill, which reviewed four decades' worth of data on episiotomy for the Journal of the American Medical Association.

Studies show that women who get episiotomies have the same rates of infection, healing, and pelvic pain, and they may resume sex later. They also have a greater risk for damage to the anal sphincter, which can cause lifelong bowel incontinence. An episiotomy increases a woman's risk of third- and fourth-degree lacerations by 13 percent. (A third-degree tear goes through the anal sphincter; a fourth-degree goes all the way into the rectal muscle.)

In fact, some doctors now believe that episiotomies promote further injury by providing a starting place for more serious tears. "I had an episiotomy, but I still ended up being torn from my vagina to my rectum," says Sonja Angell of Jasper, Georgia, who gave birth to an 8-pound, 9-ounce girl two years ago. "So what was the point?" Most U.S. women have a midline episiotomy, which is cut straight down and is more likely to cause a serious tear than those cut at an angle.

...but you and your daughter probably shouldn't

Thankfully, the tide is turning against episiotomy. The American College of Obstetricians and Gynecologists (ACOG) has denounced routine episiotomy, and medical schools have done a 180. The rates of episiotomy are dropping as newly minted OBs start their careers. Twenty years ago, more than 80 percent of births involved the unkind cut –– today it's just one in three.

Yet, as many as a million women still get unnecessary episiotomies every year. Old habits die hard – especially when it comes to medical practices, says Dr. Hartmann. If you'd rather not be surprised by a scalpel, your best bet is to stay informed, and talk to your doctor or midwife. Follow these steps, from pregnancy through delivery day.

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