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6 May 2005
Study Says Episiotomy Is Of Little Benefit 
A report appearing in the Journal of the American Medical Association suggests that the surgical procedure known as an episiotomy often provides no benefits. Additionally, in some cases, routine use of episiotomy causes more harm to mothers than avoiding its use. An episiotomy is an incision made at the vaginal opening during a birth. The intent, in most cases, is to mitigate the severity of the spontaneous tearing that sometimes occurs during childbirth and to facilitate proper anatomic healing. The procedure also may be performed in cases when the baby's safety is threatened and delivery needs to take place quickly. The study did not address its use in such emergencies. In routine births, women without episiotomy were found to have less pain with faster resolution, and no greater or lesser risk of wound healing complications. In addition, the evidence showed that episiotomy did not protect women against urinary or fecal incontinence or pelvic organ prolapse in the first three months to five years following delivery.
Katherine Hartmann, lead author of the article said that women are more likely to suffer the most severe types of tears, from the vagina into the rectum, when they have an episiotomy. She suggested that a mother-to-be should talk to her doctor about her wishes regarding episiotomy during her prenatal care because it will be too late to have an informed discussion in the delivery room. "You're in charge of what happens to you in your care. Your best bet to reach a clear understanding with your doctor about what this aspect of your birth will be like is to talk about it in advance," said Hartmann. Other findings of the study were that women who had an episiotomy were more likely later to have pain during intercourse than women who did not have the procedure. John Thorp Jr., co-author of the article, said that routine episiotomy had long been a staple of obstetrical practice. "This is embedded in modern obstetrics," Thorp said, adding that episiotomy was introduced as part of the same movement in which the hospital, rather than the home, became the place where most babies are born. "Episiotomy was part of that package." Other aspects of that package, such as frequent use of general anesthesia and routine use of forceps during delivery, have since fallen out of favor due to advances in scientific understanding.
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