Outcomes of Routine Episiotomy: A Systematic Review (2005 article)

Okay.... so the possibility of an episotomy freaks me out really.... I have tried not to think too much about it prior to being pregnant, but today it has come up in my searches, and I guess I have to start thinking about all these things...

Anyway, I thought this article summary was interesting, and that others would be interested too...

:

---

JAMA. 2005 May 4;293(17):2141-8.Outcomes of routine episiotomy: a systematic review.

Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J Jr, Lohr KN.
Source

Center for Women's Health Research, Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, NC 27599-7521, USA. khartman@med.unc.edu

Abstract

CONTEXT:

Episiotomy at the time of vaginal birth is common. Practice patterns vary widely, as do professional opinions about maternal risks and benefits associated with routine use.
OBJECTIVE:

To systematically review the best evidence available about maternal outcomes of routine vs restrictive use of episiotomy.
EVIDENCE ACQUISITION:

We searched MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Collaboration resources and performed a hand search for English-language articles from 1950 to 2004. We included randomized controlled trials of routine episiotomy or type of episiotomy that assessed outcomes in the first 3 postpartum months, along with trials and prospective studies that assessed longer-term outcomes. Twenty-six of 986 screened articles provided relevant data. We entered data into abstraction forms and conducted a second review for accuracy. Each article was also scored for research quality.
EVIDENCE SYNTHESIS:

Fair to good evidence from clinical trials suggests that immediate maternal outcomes of routine episiotomy, including severity of perineal laceration, pain, and pain medication use, are not better than those with restrictive use. Evidence is insufficient to provide guidance on choice of midline vs mediolateral episiotomy. Evidence regarding long-term sequelae is fair to poor. Incontinence and pelvic floor outcomes have not been followed up into the age range in which women are most likely to have sequelae. With this caveat, relevant studies are consistent in demonstrating no benefit from episiotomy for prevention of fecal and urinary incontinence or pelvic floor relaxation. Likewise, no evidence suggests that episiotomy reduces impaired sexual function--pain with intercourse was more common among women with episiotomy.
CONCLUSIONS:

Evidence does not support maternal benefits traditionally ascribed to routine episiotomy. In fact, outcomes with episiotomy can be considered worse since some proportion of women who would have had lesser injury instead had a surgical incision.

---

http://www.ncbi.nlm.nih.gov/pubmed/15870418

pretty convinced I'd prefer no tearing as well..... now to research how I can avoid that!!!!

You may also be interested to read Henci Goer's book: A thinking woman's guide to birth. She has gathered a lot of evidence for what works and what doesnt in birth.

I will put it on my list :)

Thanks

Thanks for sharing!

As for no tears, get yourself a copy if the pink kit. It discusses positions to minimize fearing and talks you through perennial massage.

Position can help, no coached pushing (following your body's cues instead), water birth may also help (although that may have more to do with the ability to assume natural positions).

Perenial massage hasn't been shown to really benefit from what I read, but it probably doesn't hurt to try.

I had no tearing and did no perineum preparation.

Whereas I did perineum preparation and tore every time

great article, thanks for posting :)

So it probably comes down to knowing what might work to minimise chances during birth and trying that, with a decent amount of luck thrown in for good measure!