Doctors urged to restrict episiotomies
Doctors urged to restrict episiotomies
LOS ANGELES (Reuters) - Obstetricians should avoid performing an episiotomy to aid childbirth unless there is a risk of severe tearing or need to speed up a difficult delivery, the group representing doctors dealing with health care for women said on Friday.
The American College of Obstetricians and Gynecologists said data suggest that women who undergo the surgery to widen the vaginal opening do not have significantly improved labor, delivery, and recovery compared with those who do not have an episiotomy.
In addition, the risk of a further tear, anal sphincter dysfunction and painful sex following an episiotomy is higher than previously thought, the group said.
More than a quarter of U.S. woman who gave birth vaginally in 2002 had episiotomies, making the procedure one of the most commonly performed in obstetrics.
Use of the incision technique has declined in recent years, but it is still routinely used by some doctors and hospitals.
"A lot of us were trained that episiotomies would be better for the baby ... but most people are not doing it routinely anymore," said Dr. Albert George Thomas, assistant professor in obstetrics/gynecology at Mt. Sinai Medical Center in New York.
A report in the Journal of the American Medical Association last May summarized findings of 26 previous studies to conclude that women who undergo an episiotomy often get no benefit from the procedure, but can suffer rectal injuries and delayed healing.
Thomas said he performs an episiotomy only when heart rate monitors show fetal distress or when the mother is too tired to push and forceps or other means have to be used to extract the baby.
"In the case of episiotomy, as with all medical and surgical therapies, we need to continually evaluate what we do and make appropriate changes based on the best and most current evidence available," said Dr. John Repke, author of the new ACOG guidelines.
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