Benefits and Risks of Episiotomy

The benefits and risks of episiotomy are very disproportionate.  When compared together, the research supports that routine episiotomy should be banished as a practice of the past.  Even ACOG's position on episiotomy is that the research does not support its routine use.


RATIONALE:  

To widen the perineal opening for the baby's head and prevent tearing.


REALITY:   

Episiotomy cuts through muscle tissue as well as skin, which often lead to urinary incontinence.  It is also linked with creating more perineal trauma and is actually the cause of additional perineal tearing.  Local anesthetics given with episiotomies will cause the perineal tissues to swell, decreasing their flexibility and increasing the chance of a tear. Tears actually heal better than episiotomies.  With proper perineal support, both tearing and episiotomy can be avoided.  Over 1 million unnecessary episiotomies are performed each year.


Benefits

a. Can allow the baby to be born more quickly when in distress


Risks

a. Damages muscle tissue

b. Can cause tearing in addition to the episiotomy

c. Can lead to urinary incontinence

d. Local anesthetics can cause more tearing by swelling tissues

e. Is usually done for convenience

f. Is usually completely unnecessary

g. Take a long time to heal

h. Requires stitching

i. Increases recovery time

j. Very uncomfortable

k. Episiotomy scar tissue can be inflexible and affect future birthings


Routine episiotomy is not an evidence-based practice.  Despite the evidence that the benefits and risks of episiotomy are not justified, some obstetricians persist in using it routinely for convenience, to finish the delivery more quickly. In other cases, some obstetricians believe that all first-time mothers will require an episiotomy, to the detriment of their patients.


References

Evidence Report/Technology Assessment No. 112, The Use of Episiotomy in Obstetrical Care: A Systematic Review (AHRQ Publication No. 05-E009-2).

Murray W. Enkin MD, FRCS(C), D.J. Hunter MD, FRCOG, FRCS(C), Laura Snell RN, SCM (1984)
EPISIOTOMY: EFFECTS OF A RESEARCH PROTOCOL ON CLINICAL PRACTICE
Birth 11 (3), 145–146.  doi:10.1111/j.1523-536X.1984.tb00768.x

Hartmann K, Viswanathan M, Palmieri R, Gertlehner G, Thorp J, Lohr KN. Outcomes of routine episiotomy: a systematic review.JAMA 2005;293:2141-8.

University of North Carolina, Center for Women's Health Research. Routine episiotomy does not provide benefits: the importance of asking questions about common things.

Viswanathan M, Hartmann K, Palmieri R., Lux L, Swinson T, Lohr KN, Gartlehner G, Thorp J. The use of episiotomy in obstetrical care: a systematic review; summary. Agency for Healthcare Research and Quality (Evidence Report/Technology Assessment: Number 112.)

Carroli G, Belizan J. Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews 1997, Issue 2. Art. No.: CD000081. DOI: 10.1002/14651858.CD000081

Roberts CL, Tracy S, Peat B. Rates for obstetric intervention among private and public patients in Australia: a population based descriptive study. BMJ. 2000;321:137–141.

Senate Community Affairs Reference Committee. Rocking the cradle: a report of childbirth procedures. Canberra: Commonwealth of Australia; 1999. www.aph.gov.au/senate_ca. . ( www.aph.gov.au/senate_ca.). ).

Roberts JM. Recent advances: Obstetrics. BMJ. 2000;321:33–35.

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