Should we stop doing episiotomies?

Routine episiotomies-performed on more than 1 million pregnant women each year in the United States-have no benefits, cause more complications, and should be stopped immediately, according to the authors of a systematic review of the medical research.

The investigators, from the University of North Carolina, reviewed both randomized controlled trials and epidemiological studies that compared routine episiotomies to more restricted use of the procedure and research that assessed both short- and long-term outcomes.

They found that severity of perineal laceration, pain, and pain medication use were no better with routine episiotomy than they were with more judicious use of the procedure. Since no one has followed incontinence and pelvic floor outcomes into the age range in which women would be most likely to develop these problems, the investigators concluded it was impossible to determine whether the procedure is beneficial in these regards. And they found no evidence to suggest that episiotomy reduces impaired sexual function. In fact, they found pain with intercourse to be more common among women who received the procedure. Lastly, they found insufficient evidence to determine whether midline or mediolateral episiotomy results in fewer adverse outcomes.

Hartmann K, Viswanathan M, Palmieri R, et al. Outcomes of routine episiotomy: a systematic review. JAMA. 2005;293:2141-2148.