Techniques for reducing the need for an episiotomy.

This article briefly traces the events leading to the performance of an episiotomy as a routine obstetrical procedure in the United States. The absolute necessity of this routine for every woman is being questioned more and more. The article describes techniques that a woman and her birth attendant might use during the antepartum and intrapartum periods to avoid the need for an episiotomy. Prenatal factors include finding a willing birth attendant, improving nutritional status, maintaining healthy vaginal mucosa, incorporating the Kegel exercise into a daily exercise program, and implementing perineal massage. Intrapartum factors include the use of intelligent positioning for pushing and pushing only as the parturient is inclined.