Episiotomy is an incision (cut) from the bottom of the vagina to the top of the anus. It has been used over the last 100 years by doctors in the United States to enlarge the opening of the vagina and help facilitate vaginal delivery. It is used especially while using forceps to deliver a baby. In recent times a woman having her first baby in the U.S. could expect to have an episiotomy 90+% of the time. Doctors belived that prophylactic episiotomy would save the vagina from greater injury by tearing.

However in other countries this has not been the case. The English and European custom is to refrain from episiotomy unless absolutely necessary. They believe that by doing episiotomy you actually do more harm than good. They feel that if the perineum (the area between the vagina and anus) is allowed to stretch, that even if the vagina tears in the delivery that the total damage would be less than if episiotomy was done. In fact some doctors and many midwives in this country are strong believers in avoiding episiotomy unless necessary.

Six years ago, in our practice, we decided to change our approach to episiotomy, and the rate changed from 90% to 30% of women having their first baby. With more than 1000 cases delivered since then, we are convinced that less episiotomy means less total damage to the vagina and rectum.

- David C. Giammittorio, M.D.