Episiotomy May Not Help Most Mothers

May 4, 2005 -- Episiotomy -- a surgical cut routinely done to reduce the risk of tears during vaginal delivers -- offers no health benefits to women.

The finding comes from a team of researchers including by Katherine Hartmann, MD, PhD, co-director of the North Carolina Program for Women's Health Research and assistant professor at the schools of medicine and public health at the University of North Carolina, Chapel Hill.

"We are probably done with routine episiotomies," Hartmann tells WebMD.

The study appears in the May 4 issue of The Journal of the American Medical Association.

Since the 1980s, fewer and fewer doctors routinely perform episiotomies. Yet about a third of women having vaginal deliveries still routinely undergo the procedure.

Sometimes there's a good reason for an episiotomy -- for example, to speed the birth of an infant that is in distress during delivery. But if there's no danger to the baby, can the procedure be helpful for a woman? A too-narrow birth canal can tear during delivery, notes Michael K. Lindsay, MD, director of maternal-fetal medicine at the Emory University School of Medicine in Atlanta.

"Sometimes you can look at a birth outlet and see it is too small," Lindsay tells WebMD. "So in those instances, episiotomy is probably appropriate. It is a subjective call. Sometimes it is done because we anticipate that if we continue to let the patient push, she will tear."

Episiotomy: No Insurance Against Complications

But is it better to routinely give women a surgical wound than to let them risk a traumatic tear? Hartmann's team looked at the evidence. They found 26 clinical trials that examined women's outcomes after episiotomy.

Analysis of this data turned up no evidence that routine episiotomy offers women any benefits:

• Rectal incontinence was no less frequent in women who had episiotomies.
• Urinary incontinence was no less frequent in women who had episiotomies.
• Sexual function was no better in women who had episiotomies.
• Painful intercourse was no less frequent in women who had episiotomies.

"You get comparable results in women who had episiotomies and those who didn't. That being the case, why do them?" Hartmann says. "There was good logic behind episiotomy, but now the science has caught up on this. Our good intuitions turned out not to be right. ... In the face of continued evidence, for doctors to say, 'I am continuing to do this' is a little bit weak."

Twenty years ago, Lindsay was taught that episiotomy was a good way to protect the vagina and surrounding tissue against traumatic tears. Today he supervises the training of new obstetricians -- and teaches that routine episiotomies are not a good idea.

"We teach not to do an episiotomy unless absolutely necessary," Lindsay says. "This debate has gone back and forth for years. Some doctors advocate never doing an episiotomy, and some want to do one on every patient who walks through the door. There is probably some middle ground."

Don't Wait for Episiotomy Discussion

Hartmann advises pregnant women to discuss their preferences regarding episiotomy with their doctors.

"This discussion can't go on in the delivery room," she says. "People have to talk with their doctors beforehand. If you say to your doctor, 'I have been hearing this buzz about episiotomy. Given no indication for it, I would prefer not to have one,' that is a perfectly legitimate conversation to have."