It’s intended to help new mothers recover from labor faster. But episiotomy — a short incision made during labor to enlarge the vaginal area — usually provides no benefits, according to a review article in the May 4, 2005, issue of the Journal of the American Medical Association.
The researchers also found that, in some cases, routine use of episiotomy causes more harm to mothers than does avoiding its use.
The study, led by Katherine Hartmann, associate professor of obstetrics and gynecology in the School of Medicine, addressed routine use of episiotomy only, not emergencies. The authors reviewed all published studies of episiotomy from 1950 to 2004. In routine births, women who did not have an episiotomy were found to have less pain with faster resolution, and they showed no difference in risk of wound-healing complications. The review also showed that in the first three months to five years following delivery, episiotomy did not protect women against urinary or fecal incontinence or pelvic-organ prolapse, as previously thought.
The findings also contradict the traditional thinking that a deliberate incision would heal more quickly and with fewer complications than a spontaneous tear, says John Thorp Jr., coauthor of the study and a professor in Carolina’s Department of Obstetrics and Gynecology. Hartmann adds, “The literature we reviewed suggests that the outcomes with spontaneous tears, if they happen, are better than with episiotomy.” And, the study showed that women who have episiotomies are more likely to suffer the most severe types of tears, from the vagina into the rectum.
Episiotomies became routine in the 1920s. Today, they are performed in up to 35 percent of vaginal births in the United States. Though the original rationale for routine episiotomy seems logical, evidence doesn’t back it up, Hartmann writes in a “Good Medicine” column published by UNC HealthCare in July 2005. She adds that other methods to ease delivery and avoid injury, such as perineal massage or avoiding pushing in the final moments, deserve further study.
Expectant mothers should talk to their doctors about their wishes regarding episiotomy early in prenatal care, Hartmann says, 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,” she says. “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.”
