RTI International - News Release - 5.3.2005
RTI-UNC Evidence-Based Practice Center Study Finds Routine Episiotomies Offer No Benefits
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Dr. Meera Viswanathan |
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RESEARCH TRIANGLE PARK, N.C. -- According to a systematic review conducted by the RTI International-University of North Carolina Evidence-based Practice Center, under contract to the Agency for Healthcare Research and Quality, the surgical procedure known as an episiotomy, performed in up to 35 percent of U.S. vaginal births, usually provides no benefits.
Moreover, the researchers found that, in some cases, routine use of episiotomy causes more harm to mothers than avoiding its use.
The study’s findings are the basis of an article that appears in the May 4 issue of the Journal of the Medical American Association. (View Abstract or Full Text)
An episiotomy is an incision made at the vaginal opening during a birth. The intent, in most cases, is to mitigate the severity of the spontaneous tearing that sometimes occurs during childbirth and to facilitate proper anatomic repair. The procedure also may be performed in cases when the baby’s safety is threatened and delivery needs to take place quickly. This study addressed routine use only, not emergencies.
In routine births, women without episiotomy were found to have less pain with faster resolution, and no greater or lesser risk of wound healing complications. In addition, the evidence showed that episiotomy did not protect women against urinary or fecal incontinence or pelvic organ prolapse in the first three months to five years following delivery.
The EPC study 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 study was conducted by a team of researchers, led led by co-authors Dr. Meera Viswanathan, senior health analyst at RTI International and Dr. Katherine Hartmann, assistant professor at UNC Chapel Hill. (View Summary or Full Report)
These studies were consistent in demonstrating that routine episiotomy provided no benefit over restrictive episiotomy in terms of the severity of laceration, pain and pain medication use, the researchers said. Episiotomy also provided no benefit in terms of preventing problems such as fecal and urinary incontinence, or in reducing impaired sexual function. In fact, women who had an episiotomy were more likely later to have pain during intercourse than women who did not have the procedure.
The researchers concluded that the evidence does not support the benefits traditionally ascribed to routine episiotomy.
Under its Evidence-based Practice Program, AHRQ develops scientific information for other agencies and organizations on which to base clinical guidelines, performance measures and other quality improvement tools. Use of episiotomy in obstetrical care was nominated as a topic for review by the American College of Obstetricians and Gynecologists.