Study urges halt to episiotomies

One of the most common surgical procedures performed in the United States – an incision many pregnant women receive to reduce the risk of tissue tears during delivery – has no benefits and actually causes more complications, according to the most comprehensive analysis to evaluate the practice.

Contradicting the long-accepted rationale for the operation, called an episiotomy, the analysis found that it increases the risk of tissue tears, leading to more pain, more stitches and a longer recovery after childbirth. In addition, an episiotomy increases the risk of sexual difficulties later and does not reduce the risk of incontinence, the federally sponsored study found.

As a result, the researchers concluded, routine use of the procedure undergone by more than 1 million U.S. women each year should be discontinued, and the incision should be considered only to speed delivery when the health of the baby is at risk.

Experts say the procedure is an example of a broader problem: Many practices that became common before their effectiveness was tested have become ingrained by tradition and continue to be practiced after their usefulness has been questioned by research.

The new analysis was conducted for the Agency for Healthcare Research and Quality, a federal agency that conducts influential evaluations of medical procedures, at the request of a group of obstetricians and gynecologists amid growing frustration that the procedure was still being done routinely despite strong evidence questioning its usefulness, said Katherine E. Hartmann, director of the Center for Women’s Health Research at the University of North Carolina at Chapel Hill.

The idea of episiotomy is that the incision will make delivery of a child easier and that a deliberate surgical incision will heal more quickly and with fewer complications than tears that occur spontaneously.