Routine use of episiotomy for uncomplicated vaginal births has no benefits and actually causes more complications, according to a review of scientific evidence sponsored by the HHS Agency for Healthcare Research and Quality (AHRQ).
Episiotomy, one of the most common surgical procedures in the U.S., is the surgical cutting of the perineum -- the skin between the vaginal opening and the anus -- and is a common procedure used in an estimated one-third of vaginal deliveries to hasten birth or prevent tearing of the skin during delivery.
But in an article in this week's issue of the Journal of the American Medical Association, researchers reported that episiotomy did not achieve any of the goals it is commonly believed to achieve.
The researchers concluded that routine use of the procedure -- now undergone by more than 1 million U.S. women each year -- should be discontinued, and the incision should only be considered to speed delivery when the health of the baby is at risk.
When providers restricted their use of episiotomy, women were more likely to give birth without perineal damage, less likely to need suturing, and more likely to resume intercourse earlier.
Women who experienced spontaneous tears without episiotomy had less pain than women with episiotomies. Complications related to the healing of the perineum were the same with or without episiotomy.
In addition, the evidence showed that episiotomy did not protect women against urinary or fecal incontinence, pelvic organ prolapse or difficulties with sexual function in the first three months to five years following delivery. No research described the long-term impact of episiotomy later in adult life when incontinence is most likely to occur.
"The routine use of episiotomy has been standard for years, with apparently limited research to support it," said Carolyn M. Clancy, M.D., director of AHRQ. "This evidence could help many women with uncomplicated births avoid a procedure that is of no benefit to them."
The evidence report concludes that any possible benefits of the procedure do not outweigh the fact that many women would have had less injury without the surgical incision. The scope of the review did not include neonatal outcomes, and therefore the report cannot comment on possible benefits of episiotomy for the babies.
The review was conducted by AHRQ's Evidence-based Practice Center at RTI-International-University of North Carolina at Chapel Hill and Raleigh, North Carolina.