Episiotomies Becoming Less Routine
First-time moms are often surprised by many things that happen during pregnancy, labor and post-delivery that nobody warns them about. Perhaps other women don’t want to scare them unnecessarily, especially when these unpleasant things that may occur really can’t be helped. Naturally-occurring obstetrical lacerations and episiotomies (surgical incisions in the perineum) are likely to be high up on that list.
Looking to speed along delivery and reduce vaginal tearing, obstetricians once performed episiotomies in as many as 60 percent of vaginal births. While a surgical incision is easier to stitch than a tear, the American College of Obstetricians and Gynecologists has been discouraging their routine use since 2006.
Darren Tate, M.D., OB/GYN and physician on the medical staff at Texas Health Fort Worth, says episiotomies are being performed less and less.
“Their routine use is discouraged and we have to explain exactly why we cut each and every one,” he explains. “There have to be indications that it’s necessary, such as if a baby is in distress. Natural tears are harder for us to see and repair because they occur deeper in the vagina, but that isn’t enough reason.”
ACOG released a practice bulletin last summer to encourage obstetricians to reduce the risk of severe lacerations during delivery and avoid routine episiotomy, while also acknowledging that between 53 and 79 percent of vaginal deliveries will include some level of laceration. Rather than relying on episiotomy, the organization recommends techniques such as perineal massage and warm compresses to reduce the risk of severe lacerations, including obstetric anal sphincter injuries.
As a result of ACOG’s recommendation against routine episiotomies, the practice has drastically declined. Between 2006 and 2012, researchers found that at the 510 U.S. hospitals studied, 2.3 million women gave birth vaginally, and of those births, about 325,000 required episiotomies. That comes out to almost 14.5 percent.
“Episiotomies are a tool to be used only when medically necessary. It’s tempting to push things along, but episiotomies are shown to cause more trauma in the long run.”
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