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Episiotomy Rates Too High, Say Experts

Researchers Say Episiotomies Are Done in One-Third of Childbirths in U.S.
WebMD Health News

Aug. 25, 2005 - A study looking at episiotomy rates around the world shows that a third of American women get episiotomies during childbirth. Experts tell WebMD that's too many.

Researchers reported that rates of episiotomy -- cutting of the skin between the vagina and anus to ease delivery -- varied greatly from country to country.

South and Central America had some of the highest episiotomy rates. According to government figures compiled by the researchers, these rates ranged from 65% in Argentina to close to 100% in Guatemala.

No Clear Pattern

Rates in other parts of the world ranged from a low of 9.7% in Sweden to close to 100% in Taiwan. China, Spain, South Africa, and Turkey also reported extremely high episiotomy rates, ranging from 63% to almost 90%.

Researcher Ian D. Graham, PhD, of the University of Ottawa, says no clear pattern emerged to explain why some countries embrace routine episiotomies while others do not.

He suggested, however, that there may be a bias toward an interventional, Westernized approach to childbirth in countries where episiotomy rates were high.

"It may be an issue of trying to emulate what is perceived as the best that Western medicine has to offer," he says.

Rates in U.S. Too High

Among English-speaking countries, the U.S. had the highest episiotomy rate, varying greatly from region to region.

One in three mothers who delivered vaginally in the U.S. from 1995 to 2003 had episiotomies. Just under 40% of women delivering in the Northwest got them, compared to 27% of women living in Western states.

Childbirth practices researcher Katherine Hartmann, MD, PhD, estimates that close to 1 million unnecessary episiotomies are performed in the U.S. each year. She says episiotomies are probably medically warranted in fewer than 10% of cases.

Hartmann is director of the Center for Women's Health Research at the University of North Carolina in Chapel Hill.

"It is hard to imagine that most centers couldn't get well below 15% if episiotomies were only done when medically necessary," she tells WebMD.

In a review of studies evaluating routine episiotomy outcomes published in May of this year, Hartmann and colleagues found no evidence that the practice helped women avoid severe tears, improved long-term sexual function, or helped prevent childbirth-related incontinence.

The study appeared in The Journal of the American Medical Association and was supported by the American College of Gynecology (ACOG).

ACOG opposes routine episiotomy, noting in its guidelines that the practice may lead to an increased risk for severe tearing and may delay the ability to resume sexual activity after childbirth.

"Not only were we not achieving the ends that we had hoped for with routine episiotomy, but the evidence suggested that it might be causing harm in some cases," Hartmann says. "With an episiotomy a woman will always need stitches. Women who don't have the procedure may end up needing stitches, but they may not."

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