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Episiotomy

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Updated May 13, 2013

Agency for Healthcare Research and Quality’s mission is to try to provide the evidence for evidence based medicine, so the treatment patients get is based on science, and medical practice keeps up with that ever emerging science. Recently they’ve done a great review of episiotomy as a part of their mission. Below you’ll find some answers from Dr. Carolyn Clancy, MD, Director, Agency for Healthcare Research and Quality (AHRQ).

What are the findings of your study?

Our study, which was a systematic review of all published research on episiotomies, found that routine use of episiotomy for uncomplicated vaginal births does not provide any immediate or long term benefits to the mother.

In fact, the evidence shows that women who experienced spontaneous tears without episiotomy had less pain than women with episiotomies. Complications related to the healing of the perineum were the same with or without episiotomy.

Episiotomy did not protect women against urinary or fetal incontinence, pelvic organ prolapse or difficulties with sexual function. When doctors or midwives restricted the use of episiotomy, women were more likely to give birth without perineal damage, less likely to need suturing, and more likely to resume intercourse earlier.

The evidence report concludes that any possible benefits of the procedure do not outweigh the fact that many women would have had less injury without the surgical incision. The scope of the review did not include neonatal outcomes, and therefore the report cannot comment on possible benefits of episiotomy for the babies.

Why did you do this study?

We undertook this review, at the request of the American College of Obstetricians and Gynecologists, to provide clinicians and patients information based on scientific evidence that they can use to make decisions about health care.

ACOG has translated the findings into clinical practice guidelines for OB/GYNs.

When should you discuss episiotomy with your doctor?

You should talk to your doctor as soon as you are concerned about something, and ask lots of questions. The first visit isn’t too soon.

The only stupid question is the one you don’t ask.

Because being pregnant brings up so many questions, particularly for first time mothers, it's a good idea to write down your questions before the visit and bring them with you. Before you leave the office, see if there is a way that you can ask questions that occur to you after the appointment, for example, via e-mail or if the clinician has phone hours

Will my doctor or midwife bring it up or should I initiate the conversation?

If your doctor or midwife doesn’t raise the issue, ask about episiotomy or anything else on your mind. Because it is possible that your baby may be delivered by the on-call obstetrician in the practice and not specifically by your obstetrician, it is important to ask if the office has a policy on the use of episiotomies. You should also ask how other clinicians in the practice feel about the use of the procedure.

Is there a better way to talk about this with my practitioner? Is there certain language to use or avoid?

The best way to raise it with your physician or midwife is to say that you have seen research that says that routine use of episiotomies is not recommended and that it offers no benefits to the mother. This will help open a dialogue.

What should the answer be? Is there a percentage? Or should they say specifics or generalities?

The answer will be different depending on first or second or more births and other elements of your history (i.e. large baby, diabetes). I guess I would prefer to hear a physician say " I don't do routine episiotomies, but only perform them when there is a reason, like the baby needs to come out sooner rather than later. "

What do I do if I don't like the answer?

You should have a frank discussion with your clinician about why he/she feels that you should or shouldn’t have an episiotomy. If you are not satisfied, you should seek a second opinion so you have more information which to make a decision.

Should this be part of my birth plan?

A birth plan should cover all your preferences concerning the birth of your child including the issue of an episiotomy.

To learn more about what AHRQ says about episiotomies you can read it on their site. They also have information on prenatal depression and HIV screening in pregnancy.

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