Women with Episiotomies Have More Pain, Complications, Are No Less Likely to Be Incontinent after Childbirth, Study Says

Main Category: Women's Health / Gynecology
Article Date: 05 May 2005 - 8:00 PDT

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Episiotomy - a 3/4- to 1 1/2-inch incision performed during many deliveries to enlarge the vaginal opening and reduce the risk of uncontrolled tearing of the perineum during delivery -- provides no benefits and might cause harm to women, according to a study published in the May 4 issue of the... Journal of the American Medical Association, Reuters reports (Reuters, 5/3). Dr. Katherine Hartmann, director of the Center for Women's Health Research at the University of North Carolina-Chapel Hill, and colleagues searched for all studies conducted between 1950 and 2004 that assessed episiotomy outcomes. Of 986 studies found, the researchers selected 26 studies that contained the most useful research on the benefits and risks of the procedure. The researchers found that women who had undergone episiotomy had more pain, stitches and tissue tears than women who did not have an episiotomy. In addition, women who had had episiotomies were 53% as likely to experience pain during intercourse in the three months following delivery as women who did not have the procedure. Although doctors originally believed that episiotomies would reduce a woman's risk of being incontinent, the researchers found that the procedure does not reduce the risk of fecal or urinary incontinence for three months to five years after delivery and might increase fecal incontinence in the first three months following delivery. The study was funded by HHS' Agency for Healthcare Research and Quality (Stein, Washington Post, 5/4).

Conclusions, Reaction
About one-third of pregnant U.S. women undergo episiotomy during childbirth, although some hospitals say as many as 75% of women undergo the procedure during delivery, Reuters reports. However, the researchers conclude that episiotomies should be performed in no more than 15% of U.S. births and only in cases of fetal distress (Reuters, 5/3)."The evidence is clear: routine use of episiotomy is not supported by research and should stop," Hartmann said, adding, "Women need to know this information so they can talk with their care providers before they are in labor." Other experts agreed with the study findings, saying that the overuse of episiotomy shows a "broader problem in medicine" that procedures become common before their effectiveness is fully tested, according to the Post. Laura Riley, director of labor and delivery at Massachusetts General Hospital and chair of the obstetrics practice committee for the American College of Obstetrics and Gynecology, said, "Routine episiotomy clearly is not necessary," adding, "This is a message that's been out there that's clearly taken a long time to get universally accepted and universally implemented" (Washington Post, 5/4). AHRQ Director Carolyn Clancy said, "The routine use of episiotomy has been standard for years, with apparently limited research to support it," adding, "This evidence could help many women with uncomplicated births avoid a procedure that is of no benefit to them" (AHRQ release, 5/3). ACOG since 1983 has recommended against routine episiotomies (Johnson, AP/USA Today, 5/4).

"Reprinted with permission from kaisernetwork.org kaisernetwork.org. You can view the entire Kaiser Daily Reproductive Health Report, search the archives, or sign up for email delivery at www.kaisernetwork.org/dailyreports/repro The Kaiser Daily Reproductive Health Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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