- The Washington Times - Tuesday, May 3, 2005

CHICAGO (AP) — A study shows episiotomies, incisions to enlarge the vaginal opening during childbirth, are linked with a higher risk of injury, more trouble healing and more pain.

Doctors originally thought that having the procedure would prevent spontaneous tearing that would be more difficult to repair. They also thought the procedure would help women avoid incontinence and improve their sex lives.

It turns out those notions were myths.

Episiotomies also had no effect on incontinence, pelvic floor strength or sexual function, says a review of 26 research studies. Women who had the procedure waited longer to resume sex after childbirth, and their first post-birth intercourse caused them more pain.

“This review puts together in one place all the evidence that we’re not getting the results we want,” said Dr. Katherine Hartmann, lead author of the study and a researcher at the University of North Carolina.

The review was published today in the Journal of the American Medical Association.

An episiotomy is usually a small cut — deeper than the width of a large metal paper clip and about as long, she said. But spontaneous tears often are smaller and don’t need stitches.

Many women and their doctors know episiotomies haven’t proved beneficial, Dr. Hartmann said, adding that rates are dropping, but not fast enough.

She estimated that 1 million women each year have unnecessary episiotomies, citing studies that indicate the procedure is performed in about 30 percent of vaginal births.

Figures show that 616,702 episiotomies were performed in 2002, but Dr. Hartmann said the procedures are underestimated in hospital records.

Since 1983, the American College of Obstetricians and Gynecologists has said episiotomies should not be performed routinely. Dr. Laura Riley, of the college’s obstetrical practice committee, said most doctors know episiotomies should be performed only when the baby is in distress.

“I think the message has been out there awhile,” she said. Her hospital, Massachusetts General in Boston, performs the procedure in about 8 percent of births, she said.

However, the numbers vary widely. Women are more likely to get an episiotomy at some hospitals, Dr. Hartmann said. One study from the mid-1990s found that episiotomy rates at Philadelphia hospitals varied from 20 percent to 73 percent.

The Agency for Healthcare Quality and Research, which funded the review, planned to post a summary on its Web site. Pregnant women should discuss the procedure with their doctors or midwives, Dr. Hartmann said.

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