New Childbirth Consensus Emerges Against Routine Use of Episiotomies by Carolyn Cosmos Is your doctor up to date? It matters—and when it comes to childbirth practices, there’s a new medical consensus that matters a lot to expectant moms. It involves episiotomies, the practice of making a surgical incision at the entrance of the birth canal to help a baby emerge. Medical experts in the United States and around the world now think that an automatic episiotomy is not in the best interests of most women giving birth, and they cite recently published studies—one came out in May of this year—to support this view. “There’s no evidence episiotomy helps except in specific circumstances,” said Dr. Raymond Cox, head of obstetrics and gynecology at Prince George’s Hospital Center in Maryland. “I don’t know anyone who’s routinely doing it right now myself, but the evidence against it has been accepted with varying degrees in the obstetric community.” Cox agreed that two overview studies of episiotomy evidence, one published in 2004 and another in 2005, have been crucial to the new views, but he also noted that the trend had been building for 15 years. He said one of the pioneers of this trend was Dr. John Thorpe, a University of North Carolina physician now in his 90s w ho did some early studies and became convinced that the reigning ideas about episiotomies were wrong. Midwives have also been episiotomy educators who deserve much credit for the turnaround, Cox added. The Turnaround Traditional medical thinking supported the routine use of episiotomy incisions during childbirth because doctors argued the procedure prevented ragged tearing of over-stressed tissue and made giving birth easier and less injurious for moms. They also thought that mothers who had episiotomies would experience less pain and faster healing immediately after the birth, as well as fewer sexual and incontinence (bladder) problems later on. However, scientific studies now show that most mothers don’t need an episiotomy during delivery. They experience fewer problems in the long run if the entrance to the birth canal is allowed to stretch naturally, on its own—even if the mother’s tissues tear somewhat as the baby is born. Although midwives welcome the new consensus, they’ve been practicing what’s newly preached all along. “Midwives have always been trained to not do an unnecessary episiotomy,” said Fran Knoll, a certified nurse midwife at Prince George’s Hospital and assistant director of midwifery practices at Dimensions OB/GYN Associates in Laurel, Md. “I’m glad to see the evidence-based consensus is progressing, but it’s something we midwives already know and do. “We are trained to use episiotomies only in specific situations,” Knoll explained, “such as when the baby’s heartbeat is low, and there’s need for a quick delivery. We [ordinarily] guide the baby’s head out slowly. The body knows what to do. The vagina can tear but the tissue there is easily healed. However, an episiotomy is cutting muscle and that requires more healing. “Most women do just fine without an episiotomy,” Knoll continued. “When a baby is being born, the baby is flexed, the chin is on the chest as it’s delivering. You slowly and gently guide the baby and help the mother stay in control of her pushing. By going slowly you allow the tissues to stretch. It’s like pulling a turtleneck over a little kid’s head.” Next Page