May 9, 2002 -- Episiotomy rates have declined steadily among women giving birth in the U.S. to about half of what they were two decades ago. Approximately one in three deliveries now involve episiotomies, but many experts say that is still way too many.
Data from a nationwide survey revealed that 31% of women having babies in U.S. hospitals received episiotomies in 1997, compared with 56% in 1979. Women having the procedure were more likely to be young, white, and covered by private insurance.
"Episiotomies have traditionally been performed to protect women from tearing, but in fact the exact opposite is true," says Anne Weber, MD, who presented the findings in Los Angeles at the annual meeting of the American College of Obstetricians and Gynecologists (ACOG).
"Studies now suggest that women who have episiotomies tear more instead of less. The only time they might be justified is during a true medical emergency, when a baby needs to be delivered a few seconds faster than would happen naturally," she tells WebMD.
During an episiotomy, a surgical cut is made through the muscle in the perineum, the area between the vagina and the anus. It was once done routinely by obstetricians who felt that a surgical incision would heal faster than a natural tear. The procedure was also believed to shorten labor and reduce pelvic muscle damage, which increases the likelihood of urinary and bowel incontinence.
But several studies in the 1980s found no evidence that any of these medical benefits exist. Instead, the procedure was found to increase the risk of infection, blood loss, and postpartum pain. Weber tells WebMD that obstetricians trained since those studies were released seem to have gotten the message, while older doctors may not have.
In a second study presented at this week's ACOG meeting, Weber and colleagues at the University of Pittsburgh Medical Center reviewed records from 1995 until 1999. The researchers found that 54% of women who gave birth had the procedure, but the episiotomy rate among women delivered by private practitioners was more than three times that of women delivered by hospital residents in training and faculty.
"I think that private practitioners are more likely to do episiotomies, because that is what they were taught in medical school," she says. "These days, obstetricians are taught to restrict its use, and that is happening."
Weber tells WebMD that one out of five women who has the procedure experiences tears into the rectum as a result. She adds that about half of these women experience some degree of gas or bowel incontinence as a result. A pregnant woman who wants to avoid an episiotomy should find out how often her obstetrician performs the procedure.
"All obstetricians know their personal cesarean rate and they should know their episiotomy rate, as well," she says. "Most obstetricians say they only perform episiotomies when medically necessary, but for one doctor that might be 90% of the time and for another it might be 10%."