This puzzled me at first until I realized that, as any surgeon knows, a straight cut, although easier to repair, takes longer to heal. A small tear goes along tissue lines and takes less time to heal although somewhat harder to repair. Thus a small tear may be preferable to a large and unnecessary episiotomy.

In any case, in an estimated 22 percent of episiotomies, tears still occur as an extension of the original cut; and these tears occur in a more precarious position than ordinary tears with possible extension into the rectum and its attendant complications.

Episiotomy Does Not Prevent Later Problems

Some doctors argue that the episiotomy prevents prolapse of the uterus and bladder. Now that a whole generation of women who have had episiotomies has passed, the incidence of uterine and bladder repair has indeed decreased, but the same decline has also been noticed in those countries where episiotomies have not been used routinely.

A few doctors still claim that the episiotomy improves your sex life by making you tight as a "virgin". The return of normal vaginal muscle tone has nothing to do with the performance of the episiotomy. Instead it is dependent on the faithful performance of vaginal muscle contractions ("Kegels") after birth.

In the normal birth, the episiotomy has become an unnecessary and unscientific intrusion. It's time both women and doctors started seriously questioning its routine use.

For Further Reading

EPISIOTOMY AND THE SECOND STAGE OF LABOUR, by Sheila Kitzinger and Penny Simkin (revised 1986). This book has an international perspective on how to prevent episiotomy and preserve the health of the baby.

SOME WOMEN'S EXPERIENCES OF EPISIOTOMY (1981) and EPISIOTOMY, PHYSICAL AND EMOTIONAL ASPECTS (1981), by Sheila Kitzinger, published by the National Childbirth Trust, 9 Queensborough Terrace, London, England, W2 3TB.

THE EXPERIENCE OF CHILDBIRTH (1984), by Sheila Kitzinger.

SPECIAL DELIVERY, THE COMPLETE GUIDE TO INFORMED BIRTHING (revised 1986), by Rahima Baldwin, is a practical guide for couples who want greater responsibility for the birth of their babies, whether at home or in the hospital.