Study Says Birth Cut Rarely Helps
Women who undergo an episiotomy to aid childbirth or to prevent tearing at the vaginal opening often get no benefit from the procedure and they may be harmed by it, researchers said Tuesday.
Women whose vaginal opening is enlarged surgically during childbirth can suffer rectal injuries. The procedure also may delay the healing process and does not prevent incontinence, a report summarizing the findings of 26 previous studies said.
About one-third of U.S. mothers have an episiotomy during childbirth However, some doctors and hospitals use the procedure on as many as three-quarters of women giving birth, the report said.
Doctors usually make a 3/4 - to 1- 1/2 -inch cut in an effort to ease the emergence of the fetus and to prevent uncontrolled tearing of the perineum, the area below the vaginal opening. However, the researchers said such tears would usually not be as long as the surgical cut and, in some cases, the perineum would have remained intact.
Lead author Dr. Katherine Hartmann of the University of North Carolina at Chapel Hill wrote that episiotomies could be reduced to less than 15% of U.S. births if confined to cases of fetal distress.
“Our systematic review finds no benefits from episiotomy,” she wrote in the Journal of the American Medical Assn. “Clinicians must acknowledge that little, if any, evidence is available to define indications for use; however, it is clear that maternal benefit is not an indication.”
A report posted on the website of the U.S. Agency for Healthcare Research and Quality agreed with her assessment: “Our systematic review finds no health benefits from episiotomy.... Indeed, routine use is harmful to the degree that it creates a surgical incision of greater extent than many women might have experienced had episiotomy not been performed.”
“Routine episiotomy clearly is not necessary,” said Dr. Laura E. Riley, director of labor and delivery at Massachusetts General Hospital in Boston and head of the obstetrics practice committee for the American College of Obstetricians and Gynecologists. “This is a message that’s been out there that’s clearly taken a long time to get universally accepted and universally implemented.”
