Episiotomies: Not So Routine Any More

If the thought of someone slicing into your perineum as you're in the process of giving birth makes you shudder, take a deep breath and relax—routine episiotomies are definitely on the way out. A study published in Obstetrics & Gynecology, the peer-reviewed scientific journal of the American College of Obstetricians and Gynecologists (ACOG), revealed that, over the past two decades, there has been a significant reduction in the percentage of deliveries involving the use of episiotomy.

A review of more than 34,000 vaginal deliveries at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, found that, during the years 1983 to 2000, the overall episiotomy rate fell from 69.6 percent of all vaginal births in 1983 to 19.4 percent in 2000. White women, whose episiotomy rates decreased from 79 percent to 32.1 percent during that time period, consistently underwent episiotomies more frequently than black women, whose rates fell from 60.5 percent to 11.2 percent.

The ACOG notes: "While one study found that black women are less likely than white women to deliver with vaginal lacerations, the authors (of the journal article) speculate that the racial disparity in episiotomy rates may be due in part to the non-scientific way in which some physicians determine who needs an episiotomy."

The episiotomy, a small incision made to widen the vaginal opening, which (theoretically) allows the baby's head to emerge more easily, first became popular in the 1940s, when childbirth shifted from the home to the hospital.

Although there was little data to support these beliefs, proponents of the procedure contended that a surgical incision could lessen the incidence of serious lacerations or tears to the perineum and reduce the rate of infection. It was also generally believed that this could prevent relaxation of the pelvic floor muscles, which can contribute to later incontinence.

Episiotomies were thought to shorten the pushing stage of labor, thereby reducing the risk of injury to the baby. (Early advocates felt that the pounding of the infant head against the intact perineum during the birth process could lead to intracranial hemorrhage and brain damage, even though the perineum is soft, elastic tissue quite unlikely to cause injury to a baby's skull).

Although a 1983 review of available literature found that the routine use of the episiotomy was unfounded, it was not until recently that the majority of doctors stopped doing them automatically and moved to performing them only when there were clear-cut indications that they were warranted.