Unnecessary Episiotomies On The Decline

Ongoing medical research can lead to a decrease in birth injury malpractice as long as the first responders – those medical professionals providing direct patient care and delivering babies – put the research findings into practice.

According to a new study, this has been happening in the area of episiotomies. The study, by Columbia University, looked at insurance data for over 2 million women across 500 hospitals and found the use of routine episiotomies has been falling over the last 7 years in the United States.

Episiotomies once standard procedure

In the recent past, women were routinely given an episiotomy –a surgical cut to the perineum – during childbirth that is repaired with stitches. The traditional reasoning was that an intentional tear would do less damage and heal more quickly than a natural tear. Doctors hoped to prevent the complications that result from a serious tear to the tissue, including prolapse of the bladder and rectum into the vagina after delivery.

Current research, however, shows that women tend to heal quicker from a natural tear rather than an incision and stitches. Episiotomy sites can remain painful and become inflamed and infected.

Therefore, most women do not benefit from episiotomies except in special circumstances, including:

• Larger than average baby, which is more likely to lead to shoulder dystocia or other birth complications
• Breach position, to provide more room to maneuver the baby
• Signs of fetal distress, in order to deliver the newborn quickly

Episiotomy rates vary widely by provider

The Columbia University study found that over the data collection period, the rate of episiotomy dropped by nearly one third, from 17.3% of deliveries to 11.6%. It also found that white women were nearly twice as likely to receive an episiotomy than black women, and that those patients with commercial insurance were more likely than Medicaid recipients to undergo the procedure.

Like Cesarean section rates, the episiotomy rate varied widely from hospital to hospital. In hospitals where the procedure was most common, 34% of the deliveries resulted in an episiotomy. In the hospitals where it was least common, only 2.5% of the delivering women received one. As the study authors point out, this hospital-to-hospital variation transcends patient demographics.

Study focuses on lower-risk births

The recent study was limited to deliveries that did not involve fetal distress, shoulder dystocia, or other signs of fetal distress. Excluding these risks from the study is likely to avoid discouraging hospitals from performing the procedure in these situations.

If medical professionals do not take into account these high-risk situations, it can lead to serious birth injuries and even newborn death. For example, shoulder dystocia, occurring when the baby’s head is delivered but the shoulders get stuck in the mother’s body, can result in permanent nerve damage causing paralysis, or umbilical cord compression leading to lack of oxygen, sometimes leading to brain damage or death.

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