No advantages to episiotomies

Here’s a newsflash: In a sytematic review of the literature in this month’s JAMA, researchers have recently found that routine episiotomy offers no benefit to women, and may in fact do more harm than good. Reuters picked up the article here.

I have never understood routine episiotomy, and in my work as a nurse, every time a doctor picks up the bandage scissors to make a cut (even the smallest of cuts), I find myself internally wincing. Sadly, that amounts to a lot of wincing in the course of a work week. According to Reuters, one-third of all women in the U.S. have an episiotomy during childbirth, although some doctors and hospitals perform the procedure on as many as three-quarters of all women giving birth. Three quarters of all women! True, episiotomies can be life-saving in rare cases of shoulder dystocia or true CPD, but how often do those cases occur? An episiotomy is a deep muscle cut, inevitably weakening the pelvic floor (as was pointed out in the above systematic review). Often even the smallest of episiotomies is extended during the course of delivery, growing from a small cut to a large 2nd or 3rd degree laceration, which then requires extensive suturing. There’s no reason for routine episiotomies. If a woman’s perineum is properly supported and protected during crowning, and if the baby is delivered s l o w l y, and with care, it’s possible to keep her from tearing at all—or if she does tear, it’s a superficial tear, rather than a deep muscle cut; harder to repair, true, but infinitely better for the strength and integrity of her pelvic floor. It’s a rare thing to see a doctor being that patient on a consistent basis, although it certainly does happen from time to time. (I can think of one doctor on my unit, for example, who has a nearly perfect intact perineum rate, but in the way she practices I’d say she’s much more like a midwife than a doctor.)

Change is slow, and it takes a long time for medical practitioners to learn new habits and skills. If an OB has been cutting routine episiotomies all his life, he may never change his practice. But having a review like this come out in a magazine as important and influential as JAMA is a step in the right direction. For years doctors were taught that episiotomies were necessary more often than not. Now, thanks to “new” research like this, maybe doctors will eventually be taught that episiotomies are never necessary, except in true emergencies. One can only hope.

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