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~ Episiotomies Do Not Reduce Risk of Injury to Infants During Complicated Childbirth, Study Says
Kaisernetwork.org Daily Reproductive Health Report ~ October 6, 2004
During childbirth, performing an episiotomy -- a small surgical cut between the vagina and rectum sometimes used to widen the opening to allow an infant's shoulders to be delivered -- does not reduce the risk of infant injury during a complicated delivery, according to a study published in the Oct. 5 issue of the American Journal of Obstetrics and Gynecology, BBC News reports (BBC News, 10/4). Lead author Dr. Edith Gurewitsch, an assistant professor at Johns Hopkins School of Medicine, and colleagues analyzed medical record data on 592 births in which doctors had trouble delivering infants' shoulders, aiming to determine whether episiotomy, physical manipulation of the infant in the birth canal or a combination of both is the best way to minimize shoulder injury or damage to the nerves of the arms -- known as brachial plexus palsy -- in the infant. Of the 127 most severe cases of shoulder dystocia, researchers found that the rate of brachial plexus palsy was not significantly different between infants who were delivered using rotation only and infants delivered using a combination of rotation and episiotomy. In addition, infants delivered using only rotation without episiotomy were 35% less likely to experience shoulder injuries than infants delivered with an episiotomy. Approximately half of the women studied who did not undergo an episiotomy did not experience vaginal tearing during delivery, according to the study.
"An episiotomy is a surgical procedure that should only be performed when it is absolutely necessary," Gurewitsch said, adding, "We now know that it does not help prevent brachial plexus palsy in the infant during shoulder dystocia, whereas the procedure may cause harm to the mother through unnecessary trauma from surgery. Indeed, the procedure puts the mother at increased risk of postsurgical infection, bleeding and pelvic floor disorders, such as long-term discomfort during intercourse, flatulence and possible incontinence" (Johns Hopkins School of Medicine release, 10/4). Patrick O'Brien, a consultant obstetrician at University College Hospital in London, said that the study's findings are "very interesting, and it would be great if this was proved to be the case because it would save women having unnecessary interventions. But they have not proved it." O'Brien said that only a randomized trial, where women are assigned either to deliver infants with or without an episiotomy, would produce a "definitive" answer. However, he acknowledged that such a study could be considered unethical, BBC News reports. O'Brien added that episiotomies likely would be useful for some women to prevent uncontrolled tearing during childbirth (BBC News, 10/4).
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