Once considered routine during childbirth, episiotomies are on the decline, according to a study published this month in the Journal of the American Medical Association. Episiotomy is a surgical incision made to widen the opening of the birth canal. The downward trend is good news, says UR Medicine childbirth expert Dr. Loralei Thornburg.
Episiotomy came into routine practice in the 1920s and continued widely through the 20th century, along with other medical interventions—such as using forceps, Cesarean sections and anesthesia—believed to improve and expedite childbirth. Though they became routine, not everyone agreed episiotomies were beneficial. There’s evidence of decreased use in the 1990s but, as recently as 2004, an estimated 25 percent of vaginal births included an episiotomy.
What Experts Recommend
In 2006, the American Congress of Obstetricians and Gynecologists issued a recommendation restricting the use of episiotomies, citing unclear benefits and increased risks of pain and blood loss, infection, and potential long-term complications that could lead to problems like sexual dysfunction and incontinence.
In its practice bulletin on the subject, ACOG encouraged doctors to use clinical judgment in determining the need for episiotomy. The bulletin advised: The best available data do not support the liberal or routine use of episiotomy. Nonetheless, there is a place for episiotomy for maternal or fetal indications such as avoiding severe maternal lacerations or facilitating or expediting difficult deliveries.
The recent study looked at a six-year period following the ACOG recommendation. Researchers reviewed records of more than 2.2 million vaginal births at 510 hospitals, from 2006 to 2012. During that time, the episiotomy rate dropped from 17.3 percent in 2006, to 11.6 percent in 2012. The study also found the percentages significantly high (34.1) among the 10 percent that used the procedure the most, and remarkably low (2.5) in the 10 percent of hospitals that used it the least.
Decades ago, episiotomy became routine due to a belief that a small cut would be preferable to a tear, but we’ve since learned that is not the case. And though the study shows a decline, there is still a considerable variation in practice among doctors and hospitals. It’s concerning that there are pockets of areas that are in need of more strategies to help them practice the best care.
What You Can Do
If you’re pregnant, talk with your doctor about episiotomy as you discuss your childbirth plans. Educate yourself about the procedure and ask your doctor if it’s part of his or her routine practice, and if or when there are circumstances in which it’s used. Open communication is essential to a healthy partnership between a mom-to-be and her health provider.
Loralei L. Thornburg, MD, is an assistant professor in URMC’s Department of Obstetrics and Gynecology and is board certified in both Ob/Gyn and Maternal Fetal Medicine. She offers specialty care for high-risk pregnancy at UR Medicine’s Strong Perinatal Associates and the Women’s Health Center at Lattimore.