Episiotomies

Episiotomies more common in private practice

By Charnicia E. Huggins

NEW YORK, Aug 02 (Reuters Health) - Who delivers a baby and how they were trained appears to be the most significant factor predicting use of the episiotomy during delivery, results of a new study suggest.

Episiotomy, a procedure in which an incision is made between the vagina and anus to enlarge the vaginal opening, does not appear to offer mothers any additional benefits and may increase their likelihood of pain and sexual dysfunction, other studies have shown.

And although its use is declining in western countries, a substantial number of women continue to have episiotomies.

According to a report in the August issue of Obstetrics and Gynecology, women with private physicians may be more likely to undergo the procedure than women who use hospital staff physicians or midwives.

"The paper shows that there are different rates (of episiotomy use) depending on the training people have had. And it may be that if they don't do an episiotomy as a matter of practice, or practiced habit, then women will receive less episiotomies, and therefore have less of the problems that may come with an episiotomy," explained lead author Dr. Julian N. Robinson, now assistant professor of obstetrics at Columbia-Presbyterian Medical Center, New York.

An analysis of almost 1,600 deliveries performed at the Brigham and Women's Hospital in Boston, Massachusetts, from December 1, 1994 through July 31, 1995, revealed an episiotomy had been performed in 640 deliveries, a rate of 40.6%.

Women who had episiotomies were more likely to have high birth weight babies, epidural anesthesia, induced or augmented labor, and a prolonged second stage of labor lasting 3 hours or longer including delivery, the report indicates.

But, "the factor most strongly associated with episiotomy was the category of obstetric care provider," the study authors note.

In a comparison of private practitioners, hospital staff practitioners and midwives, the investigators found that private practitioners were four times as likely as midwives to perform an episiotomy, and faculty physicians were almost twice as likely as midwives to perform an episiotomy.

"That difference could not be explained by clinical characteristics of (those giving birth) or demographic factors," Robinson and colleagues write. They add that their findings are consistent with previous research.

"The implications are that there may be a proportion of women who are actually receiving an episiotomy unnecessarily," Robinson said.

He advised that individuals should not be willing to perform or undergo episiotomies unless it is "really necessary," such as in cases where the baby's well-being is threatened, "or in the instances of a very large baby."

In addition, women should not just accept the care that is offered to them, Robinson cautioned. Rather, the patient should be an active participant in their obstetric care, he explained.

SOURCE: Obstetrics and Gynecology 2000;96:214-218.

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