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Your Delivery Options

Can I avoid an episiotomy?

Ouch alert: Some deliveries require an episiotomy, a small cut made between the vagina and rectum to ease delivery. But your doctor should have a good reason for doing it, since data shows that episiotomies can lead to unpleasant outcomes, including a more difficult recovery, a greater chance of incontinence, and sexual difficulties. As a result, many practitioners now allow the tissue to tear naturally, after which it appears to heal more easily.

The ACOG has renounced the routine use of episiotomy, but some old-school practitioners continue to perform it as a matter of course. So it's wise to know your doctor's position on the procedure long before you go into labor.

"The generation of doctors who performed them without thinking is nearing retirement," Dr. Shanahan says. "But it's still worth the discussion." Keep in mind that an episiotomy is the right call if your baby is in distress, if forceps or a vacuum extractor are needed, if the child is in a breech position, or if the baby's head has emerged but his or her shoulders are lodged inside the birth canal.

How can I know that my ob-gyn will honor my birth plan?

Discuss your plan (and contingencies) with your caregiver long before you're at the hospital. "When you're in labor is not the time to explain your point of view," says Jerri Hobdy, a certified nurse-midwife and program director of the Midwifery Institute at Philadelphia University.

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