An episiotomy should be rare. What pregnant women can do to avoid one during childbirth

Women used to expect to receive an episiotomy during childbirth. Today, these surgical cuts to the vagina are supposed to be rare – and yet a new USA TODAY investigation finds they remain common at some hospitals.

At issue: Studies have found episiotomies put mothers at greater risk of suffering severe lacerations than if they were allowed to tear naturally during birth. National guidelines have warned doctors since 2006 to restrict their use of the cuts to certain emergencies, such as when a baby’s shoulders get stuck.

Here are three things pregnant women can do to avoid unnecessary episiotomies:

1. Research episiotomy rates. Women delivering at some hospitals are far more likely to receive episiotomies than those who deliver at other hospitals. While the federal government doesn’t require hospitals to publicly report their episiotomy rates, data is available on some hospitals from USA TODAY, the Leapfrog Group and some state health organizations. Leapfrog, a nonprofit group that monitors hospital quality, says hospitals should have episiotomy rates of 5% or less. If your hospital isn’t listed, contact its maternity unit to ask what its rate is – and whether it has taken actions to educate its doctors about episiotomies and track their rates.
2. Talk about your concerns. Prenatal appointments are a good time to ask your healthcare provider about how often they make the cuts and for what reasons. “You want to hear: I rarely cut episiotomies,” said Dr. Sara Cichowski, an assistant professor of OB/GYN at the University of New Mexico, who has helped write national guidelines for preventing childbirth lacerations. Women should discuss their preferences – and understand the risks and benefits of procedures – before they go into labor or an emergency arises. “What has to happen is a shared decision-making conversation between the woman and her delivering healthcare professional,” said Dr. Barbara Levy of the American College of Obstetricians and Gynecologists, who notes that some women might choose a C-section over an episiotomy. 
3. During delivery, ask for an explanation – and alternatives.  If you’re in the midst of delivering a baby and you’re told an episiotomy is going to be cut, try to get a quick explanation about why it’s necessary. “Ask: Is there something I can do to make the situation less critical?” suggested Cichowski. “Are there things that can help me push better and more effectively?” Studies have found that the simple use of a warm compress on the area around the vagina during pushing reduces the incidence of severe lacerations, she noted.

"As a woman and new mother do your research. Go in there with the armor of knowledge," said Allison Snyder of Cedar Point, N.C., who suffered a severe laceration from an episiotomy during the birth of her first child in 2013. Snyder said she had assumed episiotomies were such an outdated practice that she didn't need to ask her providers about them during her prenatal care. 

"You have to be your own advocate," she said. "Take charge of your own health care." 

Read USA TODAY's full investigation at: maternal.usatoday.com.