Goodbye episiotomy

in many delivery rooms, a routine becomes less routine

by laurie tarkan

the new york times 2/23/02

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the practice of delivering babies has long been influenced by traditions, based on the theories of popular obstetricians rather than on scientific proof.

recently, though, some routine practices have been put through the rigors of scientific testing and have been found ineffective at best and harmful at worst.

one such procedure is the episiotomy, an incision that widens the vaginal opening to allow the baby's head to pass through.

for decades, a vast majority of women delivering babies were routinely given episiotomies, which involve painful recoveries and come with great risks of complications, including incontinence, later in life.

now, at some leading teaching hospitals, doctors have virtually abandoned the practice. at other hospitals, episiotomy is still used, but the number of procedures has declined drastically over 20 years.

among woman having vaginal deliveries in hospitals, 64 percent had episiotomies in 1980 compared with 39 percent in 1998, a study published in the september issue of the journal birth found. the rates are higher among first-time mothers.

some hospitals fall well below the average, with rates of less than 10 percent. at the university of california at san francisco, for instance, the surgery is performed on 2 percent to 3 percent of women, said dr. bill parer, director of perinatal medicine and genetics there.

http://www.nytimes.com/2002/02/26/health/policy/26baby.html

...the mayo clinic, the rate is about 60 percent for first babies, whereas it was almost 100 percent 20 years ago.

get with the times, mayo!

[RNKitty]

My experience has been that episiotomies are no longer in vogue. The docs (and midwives) certainly don't hesitate if they feel the fetus is in danger and must come out now. However, they usually allow time for the tissue to stretch. One family practice doc commented that she does much less stitching when the women is allowed to deliver without an epis, even if she tears. YEAH!

[Furball]

I had an episiotomy with my first child. Was miserable and couldn't walk without EXTREME pain for almost 2 weeks. Real nice set up with a newborn...

Second kid, no episiotomy. At the crucial point in the delivery the doc said you're gonna tear you need a cut. "No freakin way!" I yelled "Let me freakin' tear" I didn't actually say "freakin", I said that really naughty word. Yup...he was right ...I tore a bit. Took some sutures but had zero pain....who woulda thunk it?

[OBNURSEHEATHER]

So many of my patients have said the same thing you just have. Every single gravida 2 without an epis, as opposed to their first w/ an epis, they say it is soooooo different.

Anyone else notice the difference between docs and midwives epis rates? Astonishing!

Heather

[joyrochelle]

well about stinkin' time they rethought that butchery! Geez! and mayo, really now, kids...let's think here....perhaps some time on the postpartum unit would prove a point? How many ice packs can YOU tie in an hour?

very glad that it's being devalued as a practice, though.

[NicuGal, MSN, RN]

I had 2 epis and a fourth plus tear...a C/S would have hurt less than that! The epis took forever to heal!

Most of our docs don't do them...I only did cuz DD was stuck by the cord and needed out NOW!