Q: Can I avoid an episiotomy?
A: Some research shows that you may be able to minimize your chances of having an episiotomy -- a small cut made in the perineum, the area between your vagina and rectum, to widen the vaginal opening -- by doing perineal massage. This may make the area more flexible during labor and delivery. To do perineal massage, sit in a bath (make sure the water is warm, not hot) and gently massage the area around the perineum for 10 minutes a day starting around week 34 of your pregnancy.
You should know that most women do not need episiotomies -- in fact, they're only performed in about 20 percent of vaginal births. They're usually done to prevent unnecessary physical trauma to the baby, to help a baby in distress be delivered more quickly or to keep the vagina from tearing (although in some cases a natural tear may be less damaging than being cut). You're less likely to need an episiotomy with second or third pregnancies (since your perineum has already been stretched out) and more likely to have one if you're older (since the perineum becomes more rigid and less stretchy over time).
If it turns out that you do need one, an anesthetic is usually given before the cut is made (unless you already have an epidural in place). After your baby is born the cut will be stitched up. Rest assured that your vagina will heal, and the procedure shouldn't have any long-term impact on your sex life once you're all recovered. While it's natural to want to prevent an episiotomy, it's also important to trust the doctor you're working with. If he or she thinks it's necessary, then an episiotomy is probably in the best interests of you and your baby.