I wonder if this is just a US thing? Because both times in my pregnancy, my antenatal classes have been very quick to point out that we can decline any medical procedure (but obviously we should take the doctor's advice in mind when they suggest something drastic if it's necessary). And even when I gave birth to twins, I was told that an episiotomy would only be done if it was essential. I ended up having one (and believe me, it was in the top 3 things I wanted never to experience in childbirth) and while they didn't ask me explicitly if I wanted one, I don't think they rushed into it either. Now the birthing options for twins...that's another issue entirely!

Yeah, I'm a bit confused about how exactly you can decline the surgery in the sense that- well, how do you know (in the final, painful throes of actual labor) if yours is one of the times an episiotomy truly does improve the situation? You have to trust your doctor or midwife to make that call. In the US, hospital practice has been pretty slow to catch up with the news that they should not be routine... But from my totally anecdotal experience, US mothers have definitely caught on and are demanding statistics about episiotomies from their doctors in advance of labor. Since the consumer is always right... maybe this will encourage docs to hold back when it's not totally crucial?