EPISIOTOMY: Doubts of Benefits Cut Procedure Rates
Previously considered "the kindest cut," episiotomies have been preformed on millions of American women during childbirth, but new research suggests that the procedure is "overused" and many hospitals are performing the procedure less often, the Wall Street Journal reports. Based on the theory that a small incision in the mother's perineum would prevent "far more severe lacerations," the procedure became one of the "most common surgical procedures" in the 1970s and 1980s. However, recent studies have indicated that the procedure may actually add to the "trauma ... and complications of delivery." In a 1983 literature review of 350 articles and books on episiotomy, the CDC's Dr. Stephen Thacker concluded that the arguments for the procedure --preventing lacerations, protecting pelvic muscles and sexual function -- "do not withstand scientific scrutiny." In a more recent study, Dr. John Repke, chair of obstetrics at the University of Nebraska Medical Center in Omaha, found that of 600 women who had recently given birth, those who had episiotomies had an increased risk of intestinal problems six months after delivery. Further, women with the incisions experienced more complications than women who had suffered a natural tear during child birth.
Less Use of Cut
The controversy surrounding the procedure has led some teaching hospitals to put the brakes on the procedure. Dr. Michael Greene, director of maternal-fetal medicine at Massachusetts General Hospital, indicated that the rate of episiotomies has dropped to between 10% to 15% of all deliveries. "Quite clearly, it's not appropriate to routinely perform episiotomies on every single normal vaginal delivery," Greene said. At the University of California Medical Center in San Francisco, nurse-midwife Judith Bishop said that by reducing the number of episiotomies from 80% to less than 10% of all deliveries, the hospital had reduced the number of childbearing complications. In its April publication, the American College of Obstetrics and Gynecology, plans to run a study by Canadian researchers that found that episiotomies are still used in 30% of all vaginal deliveries -- a number still too high according to the organization. However, some caution that the procedure remains useful in emergency situations and think that the backlash against episiotomies has gone too far. The procedure is necessary in about 20% of deliveries, according to Dr. Karen Beckerman, assistant professor of obstetrics and gynecology at UCSF. She said, "It's ironic. I was a crusader for selective use of episiotomies. But now I find residents are so turned off that they're not performing them when they're indicated" (Chase, 3/30).