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Episiotomy Rates Too High, Say Experts

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

Rates in U.S. Too High continued...

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."

Talk to Your Doctor

Episiotomy rates in the U.S. have been dropping steadily over the past several decades and are now about half what they were in the early 1980s.

But all the experts interviewed by WebMD agreed that too many of the procedures are still being done, and that pregnant women should discuss the issue with their doctor long before delivery if they are concerned.

"It is important to frame the question in the right way," says ob-gyn Iffath Hoskins, MD, of Brooklyn's Lutheran Medical Center.

"Instead of saying, 'I don't want an episiotomy,' ask what (your doctor's) policy and practice is. If he or she tells you that they do them in appropriate circumstances and they do a good job of explaining what those circumstances are, I wouldn't nitpick."

On the other hand, if your doctor doesn't have a good answer or says that they do them routinely, it is important to know this, Hoskins adds.

Hartmann says she is hopeful that rates will continue to come down as more and more women have this discussion with their doctors, in the same way that they began to question the medical need for so many hysterectomies several decades ago.

"This is nothing new to people who make health policy, and it does seem that patients are beginning to tune in to the debate and make their feelings known," she says.

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