from CNN's health reporter. i don't usually trust CNN to give me the "full picture" when it comes to the world around me but it appears they got this one right.
i am impressed that they had the guts to (accurately) classify an episiotomy as an operation. if you're having a baby in a hospital, before you sign ANY paperwork, read it closely to ensure that you're not consenting to an episiotomy or anything else that you might now want.
and speaking of operations, i was just told by a client that a hospital in downtown toronto has a 40% c-section rate for first time mothers! talk about an operation you should try to avoid!!
"At least 12,000 Americans die each year from unnecessary surgery, according to a Journal of the American Medical Association report. And tens of thousands more suffer complications.
Surgery is a trauma, regardless of the surgeon's skills.
The fact is, no matter how talented the surgeon, the body doesn't much care about the doc's credentials. Surgery is a trauma, and the body responds as such -- with major blood loss and swelling, and all manner of nerve and pain signals that can stick around sometimes for months.
Those are but a few reasons to try to minimize elective surgery. And I found even more after talking with more than 25 experts involved in various aspects of surgery and surgical care, and after reviewing a half-dozen governmental and medical think tank reports on surgery in the United States. Here's what you need to know about five surgeries that are overused and alternative solutions that may be worth a look.
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Episiotomy
It can sound so simple and efficient when an OB-GYN lays out all the reasons why she performs episiotomy before delivery. After all, it's logical that cutting or extending the vaginal opening along the perineum (between the vagina and anus) would reduce the risk of pelvic-tissue tears and ease childbirth. But studies show that severing muscles in and around the lower vaginal wall (it's more than just skin) causes as many or more problems than it prevents. Pain, irritation, muscle tears, and incontinence are all common aftereffects of episiotomy.
Last year the American College of Obstetricians and Gynecologists released new guidelines that said that episiotomy should no longer be performed routinely -- and the numbers have dropped. Many doctors now reserve episiotomy for cases when the baby is in distress. But the rates (about 25 percent in the United States) are still much too high, experts say, and some worry that it's because women aren't aware that they can decline the surgery.
"We asked women who'd delivered vaginally with episiotomy in 2005 whether they had a choice," says Eugene Declercq, Ph.D., main author of the leading national survey of childbirth in America, "Listening to Mothers II," and professor of maternal and child health at the Boston University School of Public Health. "We found that only 18 percent said they had a choice, while 73 percent said they didn't." In other words, about three of four women in childbirth were not asked about the surgery they would soon face in an urgent situation. "Women often were told, 'I can get the baby out quicker,'" Declercq says, as opposed to doctors actually asking them, 'Would you like an episiotomy?'"
What to do instead
Communicate. The time to prevent an unnecessary episiotomy is well before labor, experts agree. When choosing an OB-GYN practice, ask for its rate of episiotomy. And when you get pregnant, have your preference to avoid the surgery written on your chart.
Get ready with Kegels. Working with a nurse or midwife may reduce the chance of such surgery, experts say; she can teach Kegel exercises for stronger vaginal muscles, or perform perineal and pelvic-floor massage before and during labor."
http://www.cnn.com/2007/HEALTH/07/27/healthmag.surgery/index.html
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car, picked up the cigarette butt and handed it back to the driver and said very politely "you dropped this." 
