MEDICINE CHILDBIRTH : Study Opposes Routine Use of Episiotomy Procedure
Liberal use of episiotomy, the surgical procedure done during childbirth to enlarge the birth canal, should be abandoned in favor of a more conservative case-by-case approach, according to a new Canadian report that suggests the surgery has fewer benefits than some obstetricians realize.
The study of 703 uncomplicated births found that restricting episiotomy use to specific reasons related to the health of the mother and fetus was just as safe as routine use of the procedure. Moreover, routine episiotomies were no more effective in preventing such birth-related problems as weakening of the pelvic muscles or severe tears of the tissue between the vagina and rectum.
In the United States and Canada, an episiotomy is performed in about 80% of first vaginal births and half to 60% of subsequent births, according to Dr. Michael C. Klein of McGill University in Montreal, the principal author of the study. “Episiotomy at the current high rates . . . can’t be justified,” he said.
Concern about overuse of the frequently performed incision is not new in obstetrical circles. “The pendulum has swung toward becoming more selective in the use of episiotomy,” said Dr. Raul Artal, professor of obstetrics at the USC School of Medicine.
An episiotomy is a surgical incision into the perineum, the tissue between the vagina and rectum. It is usually made with scissors during the last stage of labor just before birth. The advantages of episiotomy are reduced risk of an uncontrolled laceration of the vagina during birth and a speeding of delivery, obstetricians said. The disadvantages include pain and bleeding.
The study, published Wednesday, is one of the first presented in The Online Journal of Current Clinical Trials, a new medical journal that is only available through a computer terminal.
Launching of the electronic journal was hailed by its editor, Dr. Edward J. Huth, as heralding “a new era in scholarly publishing for medicine” that will speed the dissemination of important scientific information.
The journal is a joint project of the American Assn. for the Advancement of Science, the publishers of Science magazine, and the OnLine Computer Library Center in Dublin, Ohio. Klein submitted his study to the new journal on April 28, after he said it had been rejected by the New England Journal of Medicine and the Journal of the American Medical Assn., the leading general medical journals in the United States.
In an interview, Klein said he was intrigued by the new publishing format and did not want his report to be “buried” in an obstetrical journal. Articles in the on-line journal can also be published more quickly and run longer.
The McGill study compared two groups of women--those on whom episiotomy was performed at a “liberal” rate (81% of first births) and those who underwent the procedure at a “restricted rate (57% of first births).
There was no difference between the two groups of patients in postpartum pain and other symptoms, although the rate of spontaneous minor tears of perineal tissue was significantly increased in women for whom episiotomy was restricted. However, the lasting effects of the tearing were no worse than the effects of the episiotomy, the report said.
