Episiotomies, Do They Still Happen?
A lot of mothers ask us during our conversations prior to birth if Episiotomies are still a thing. The thought of someone using a pair of scissors on your perineum isn’t exactly something most women dream of! It is 2019- so are they still happening? Or are they a thing of the past? That my friends is a complex answer. So let’s dig into the topic!
Episiotomies were performed in approximately one third of vaginal births in the United States as of 2006. This number has dropped as of today. However, per ACOG- prophylactic use of the procedure does not result in maternal or fetal benefit and should be restricted. These recommendations were published in April 2006 in a practice bulletin by ACOG. Here are some thoughts from those Practice Guidelines:
“Historically, the purpose of episiotomy was to facilitate completion of the second stage of labor to improve maternal and neonatal outcomes. Maternal benefits were thought to include a reduced risk of perineal trauma, subsequent pelvic floor dysfunction and prolapse, urinary incontinence, fecal incontinence, and sexual dysfunction. Potential benefits to the fetus were thought to include a shortened second stage of labor caused by a more rapid spontaneous delivery or from instrumented vaginal delivery. Despite limited data, this procedure became virtually routine, resulting in an underestimation of the potential adverse consequences, such as extension to a third- or fourth-degree tear, anal sphincter dysfunction, and dyspareunia.
The best available evidence does not support liberal or routine use of episiotomy. However, there still is a place for episiotomy for maternal or fetal indications (e.g., avoiding severe maternal lacerations, facilitating or expediting difficult deliveries).
A systematic review comparing routine episiotomy with restrictive use reported that 72.7 percent of women in the routine-use group underwent episiotomy compared with 27.6 percent in the restricted-use group. The restricted-use group had significantly lower risks of posterior perineal trauma, suturing, and healing complications but a significant increase in anterior perineal trauma. No statistically significant differences were reported for severe vaginal or perineal trauma, dyspareunia, or urinary incontinence.
In 2016, ACOG released recommendations including perineal massage and warm compresses to reduce the occurrence of tearing during delivery. ACOG stated that “rather than using routine episiotomy, obstetrician-gynecologists should take steps to lower the risk for obstetric lacerations during vaginal delivery.” This means that episiotomies should no longer be used unless absolutely necessary. As stated above, the risks of perineal trauma and healing complications were definitely lower in studies where episiotomy use was restricted, not routine.
Bottom line on well- your bottom! Episiotomies DO still happen, but given the studies, it is a fairly reasonable request not to have one unless there is an emergency in your birth plan. This is where having a solid birth plan with specific requests comes in handy. It is almost impossible to know in advance what protocols the doctor who is on call when you come in during active labor will follow. Having a birth plan that states your wishes is the best way to make sure everyone is on the same page.
Need help getting your birth wishes together? Need a doula in Mississippi? Contact me today!