Unnecessary episiotomies
Issue 22: 31 Oct 2005
Source: International Journal of Gynecology & Obstetrics 2005; 91: 157-9
Researchers have questioned the continuing widespread use of routine
episiotomy, after finding high rates at some centres in countries in South
America, Asia, and Africa.
Systematic reviews of published trials, including a Cochrane review, have
suggested that episiotomies should not be performed routinely, because of
the associated maternal morbidity.
Some specialists have said that no more than 10 percent of nulliparous women
delivering vaginally should need one, according to the researchers writing
in the latest issue of the International Journal of Gynecology & Obstetrics.
But their study suggests that episiotomy rates are far higher than this at
some hospitals. The researchers, from Uruguay and the USA, analyzed data on
episiotomy rates for nulliparous and multiparous women at hospitals in
Argentina, Brazil, Bolivia, Chile, the Democratic Republic of Congo,
Ecuador, India, Tibet, Uruguay, Venezuela, and Zambia.
The hospitals studied (from 1 to 13 per country) were part of the US
National Institute of Child Health and Human Developments Global Network
for Womens and Childrens Health Research.
Rates above 90 percent
Reporting their findings, the researchers say that episiotomy rates among
nulliparous women were higher than 90 percent in all countries except Zambia
(6.9 percent).
Episiotomy rates for all vaginal births were higher than 20 percent in all
countries except Zambia, and were as high as 80 percent in Brazil. The
exception, Zambia, was unusual in having a lower rate for nulliparous women
than for all vaginal births. The researchers, however, caution that the data
for Zambia were obtained from only one hospital.
They also advise against generalizing the findings beyond the centres
studied. However, they say the data illustrate the widespread use of
routine episiotomy
in contradiction to the evidence questioning its
efficacy.
Unnecessary episiotomies, the researchers write, increase the risk of
morbidity as indicated by the Cochrane review, including posterior perineal
trauma, the need for suturing the perineal wound, and healing complications
at 7 days.
They conclude: Strategies should be developed to decrease episiotomy rates
at a global level.
Leanne Wynne
Midwife in charge of "Women's Business"
Mildura Aboriginal Health Service Mob 0418 371862
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