Study Questions Value of Episiotomies
ROBERT SIEGEL, host:
This is ALL THINGS CONSIDERED from NPR News. I'm Robert Siegel.
MELISSA BLOCK, host:
And I'm Melissa Block.
Women who have episiotomies, or incisions to prevent tearing during childbirth, are undergoing needless and, at times, harmful surgical procedures. That's the conclusion of a study published today in the Journal of the American Medical Association. It says there's no benefit from episiotomy, even though it's one of the most common surgical procedures performed on women in the United States. Dr. Katherine Hartmann is lead author of the study.
And, Dr. Hartmann, explain a bit about exactly what an episiotomy is and how common they are.
Dr. KATHERINE HARTMANN (Director, Center for Women's Health Research, University of North Carolina): An episiotomy is an incision made at the posterior part of the vaginal opening at the time of childbirth. It's a little bit deeper than the width of your finger and usually about as long as two or three fingers. Its intention is to help prevent additional injury at the time of childbirth, when it's used routinely, and we know that it's happening in 30 to 35 percent of vaginal deliveries in the United States.
BLOCK: And that adds up to how many?
Dr. HARTMANN: Probably a million procedures in a year.
BLOCK: Well, the idea behind episiotomy has been it's better to cut than to tear during vaginal delivery.
Dr. HARTMANN: Exactly. There's sound logic and sound thinking about anatomy behind the concept of episiotomy. The things that we hoped for from episiotomy were a surgically controlled smaller incision that was easier to repair and that you could get a better anatomic result. We also hoped that that would give us better healing and fewer complications.
BLOCK: And what did you find?
Dr. HARTMANN: The literature about the short-term outcome shows that we're not getting those benefits, that women with spontaneous tears do just as well and, in some case, better, and also that the act of performing the episiotomy is depriving some women of having the opportunity to have no serious tears and no stitches at the time of their childbirth.
BLOCK: When you were looking at short-term effects, what were you looking for exactly?
Dr. HARTMANN: Our questions addressed issues like pain and comfort, wound healing complications such as infection and, importantly, also addressed whether or not the tear was severe involving the area near the rectum.
BLOCK: And when you looked at those things with episiotomy, what did you find?
Dr. HARTMANN: We find that in most cases, the outcomes are completely comparable, whether or not the woman had a routine episiotomy or not, and that in some cases, the episiotomy is creating the opportunity for a more severe injury.
BLOCK: You also looked at long-term effects of the incisions, and what did you find there?
Dr. HARTMANN: Correct. We'd hoped that this would help prevent incontinence problems and that it would help preserve good sexual function. Instead, we found that the procedure does not improve the probability that you have urinary incontinence in the future, so those rates are the same, but that difficulty with rectal continence is more common in women who'd had episiotomies and that sexual function is no better among women who'd had episiotomies. And, in fact, shortly after childbirth, when they resume intercourse, they're more likely to have pain.
BLOCK: It does seem like there's been a lot of talk about whether episiotomies are necessary and some consensus that they may not be. If that's the case, why are so many still being performed?
Dr. HARTMANN: I think that once we're invested in a concept having potential benefit, when, in our career, we begin to have a particular practice pattern, it can be very hard to change practice patterns. In some circumstances, providers who do routine episiotomy, it is literally routine. It's part of the package; it's something that they intend to do on most occasions when they're in a birthing room. It may be that the residual rate we're seeing of continued use of routine episiotomy is among providers for whom it's literally part of their routine.
BLOCK: Dr. Hartmann, thanks for talking with us today.
Dr. HARTMANN: Thank you. It's been a pleasure.
BLOCK: Dr. Katherine Hartmann is director of the Center for Women's Health Research at the University of North Carolina at Chapel Hill.
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