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In The News:
~ Episiotomy During Delivery More Common Among Private Obstetricians Than at Teaching Hospitals, Study Says

Kaisernetwork.org Daily Reproductive Health Report ~ January 5, 2004

The use of an episiotomy, a surgical incision of the perineum used to facilitate childbirth, is more common among private obstetricians than doctors who work at teaching hospitals, according to a study published in the Jan. 1 issue of Obstetrics & Gynecology, the Wall Street Journal reports. Nancy Howden, Leslie Meyn and colleagues at the University of Pittsburgh Medical Center and the Magee-Womens Hospital in Pittsburgh studied approximately 28,000 women who delivered at either facility between 1995 and 2000. During the course of the study, 55% of the women studied underwent an episiotomy -- 67% of women attended by private obstetricians underwent an episiotomy, compared with 18% of women who were assisted by doctors at teaching hospitals. After taking into account the women's ages and infants' birthweights, private doctors performed episiotomies seven times more often than academic doctors, according to the study. Episiotomies were performed in approximately 62% of all deliveries nationwide as recently as 1987, but the American College of Obstetricians and Gynecologists in 1992 stated that routine use of episiotomy is unnecessary and can lead to severe lacerations and harm a woman's ability to resume a normal sex life. Since then, the percentage of women receiving episiotomies in the United States has declined, with the procedure performed in approximately 28% of births in 2001, according to the Journal.

Discussion
According to the researchers, the fact that private obstetricians continue to perform episiotomies regularly could be "a symptom of medicine's slow evolution of some medical specialties," the Journal reports. The researchers said that it takes time for doctors to adopt changes in practice, adding that some "tradition-bound doctors would rather consult an authority figure than search online for the latest study in evidence-based medicine," while doctors at academic institutions may be more likely to adopt and teach new practices, according to the Journal (Chase, Wall Street Journal, 12/31/03).

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