If I have a vaginal delivery, will I need an episiotomy?

Q: I'm pregnant with my first baby. If I have a vaginal delivery, will I automatically need an episiotomy?

A: Not necessarily. The use of episiotomy—an incision made to the perineum during labor—has decreased in recent years. In fact, the American College of Obstetricians and Gynecologists discourages its "liberal or routine" use while saying the procedure is nevertheless indicated in some situations, such as to prevent perineal tears or facilitate delivery.

Though you should trust your caregiver to decide if an episiotomy is necessary, do speak frankly with him about your preferences. Also talk with him about the right weight gain for you; putting on too many pounds increases your risk for having a too-large baby—which in turn raises your risk for episiotomy. And ask him about having your partner do perineal massage during labor—some experts say it helps prevent episiotomy while decreasing perineal tears.