Vaginal tearing: Why are episiotomies down despite some benefits?

October 21, 2019

In Canada, the rate of episiotomy during childbirth has declined in recent years, but when it comes to births assisted by forceps or vacuum, this downward trend warrants a closer look, suggests new UBC research.

Episiotomy -- a surgical cut that helps widen the birth canal -- is intended to aid childbirth and minimize injury to the perineum, the area between the anus and the vulva. Episiotomy was once considered routine, but its use began to decline in the 1990s when a series of studies revealed the practice was not only ineffective at protecting women from injury, but actually increased pain and extended recovery time. However, this finding applied only to vaginal deliveries that did not need assistance by forceps or vacuum -- instruments that are used to help with the delivery of a baby when problems arise.

A new study, published today in the Canadian Medical Association Journal, found that, while there is a higher risk of severe tears when episiotomy is used in unassisted births, when it comes to assisted births, especially those with forceps, the practice should still be considered.

"The pronounced decrease in the episiotomy rate among vaginal deliveries assisted by instruments suggests that this may be an example of 'clinical creep,' where the recommendation to move away from routine episiotomy among unassisted vaginal deliveries may have been overgeneralized to apply to all vaginal deliveries, including those where instruments are involved and where there may be a benefit," says the study's lead author Dr. Giulia Muraca, a Postdoctoral Fellow with UBC's Department of Obstetrics and Gynaecology and with the Clinical Epidemiology Unit at the Karolinska Institute in Stockholm, Sweden.

For the study, researchers used data provided by the Canadian Institute for Health Information to analyze trends in episiotomy use in more than 2.5 million births in Canada between 2004 and 2017. They found that overall, the rate of episiotomy is declining among both unassisted and assisted deliveries, despite the fact that episiotomy can protect against severe tears among women in the latter group.

The researchers also examined the relationship between episiotomy and obstetric anal sphincter injury (OASI), a condition characterized by severe tears to the perineum. Severe tears in this area can lead to short-term and long-term pain, infection, sexual problems and incontinence. In Canada and other industrialized countries, the rate of OASI has increased by up to 15 per cent in recent years. In 2017 alone, about 18 per cent of women in Canada were diagnosed with OASI after a delivery with forceps or vacuum.

Episiotomy was associated with up to a 42 per cent reduction in risk of OASI among women who had delivered vaginally for the first time.

The findings suggest that obstetricians should be cautious of applying the same episiotomy guidelines to all patients, said Dr. Muraca.

"Generalizing the episiotomy guidelines for all vaginal deliveries can cause harm, particularly in women delivering their first child and in women having a vaginal birth after caesarean section," she said.
-end-
The study was funded by the Canadian Institutes for Health Research.

University of British Columbia

Related Childbirth Articles from Brightsurf:

Consistent nursing care after childbirth boosts breastfeeding rates
New parents who receive attentive, supportive nursing care during labor and immediately after childbirth are more likely to exclusively breastfeed their newborn when leaving the hospital, finds a study published in MCN: The American Journal of Maternal/Child Nursing.

More than 40% of women suffer from constipation during pregnancy and right after childbirth
Women are 2-3 times more likely to suffer from constipation during pregnancy and right after childbirth than at any other time in their life, a new study from the University of Eastern Finland shows.

Research Finds Women Often Overprescribed Opioids After Childbirth
Excessive opioid prescriptions following childbirth may lead to higher rates of addiction within communities, according to a new report in The Journal of the American Osteopathic Association.

Altered lipid metabolism following childbirth predicts later diabetes risk
Scientists have found that disruptions to the metabolism of lipids occur after childbirth in women with gestational diabetes who go on to develop type 2 diabetes.

Genetic variant may explain why some women don't need pain relief during childbirth
Women who do not need pain relief during childbirth may be carriers of a key genetic variant that acts a natural epidural, say scientists at the University of Cambridge.

Opioid prescriptions after childbirth linked to increased risk of overdose, persistent use
Women who are prescribed opioids after childbirth have an increased risk of persistent opioid use or other serious opioid-related events, including overdose, in their first year postpartum, according to a new study by Vanderbilt University Medical Center researchers.

US maternal health spending varies by state, driven by cost of childbirth
The average cost of childbirth varies widely from state to state, according to new national analysis from the Health Care Cost Institute, which also found that spending on postpartum care extended across the full year after delivery.

'Birth Settings' report explores medical disparities of childbirth in the US
A report released earlier this month dives deep into the ongoing inequities surrounding childbirth in the US, with Oregon emerging as a leading example of how to do better.

All women should be educated after childbirth about high blood pressure
After childbirth, it is not uncommon for women to experience high blood pressure.

Study examines the benefits of childbirth education classes during pregnancy
Participating in childbirth classes may help women have normal vaginal deliveries, according to a study published in the International Journal of Gynecology & Obstetrics.

Read More: Childbirth News and Childbirth Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.