Tuesday, May 23, 2006

Episiotomy

Obstetricians change their practice based on clinical research. Episiotomy is a case in point.

Has the Use of Routine Episiotomy Decreased? Examination of Episiotomy Rates From 1983 to 2000
Obstetrics & Gynecology 2002;99:395-400
Jay Goldberg, MD, David Holtz, MD, Terry Hyslop, PhD and Jorge E. Tolosa, MD, MS

ABSTRACT

OBJECTIVE: To determine if practice patterns have been altered by the large body of literature strongly advocating the selective use of episiotomy.

METHODS: An electronic audit of the medical procedures database at Thomas Jefferson University Hospital from 1983 to 2000 was completed. Univariate and multivariable models were computed using logistic regression models.

RESULTS: Overall episiotomy rates in 34,048 vaginal births showed a significant reduction from 69.6% in 1983 to 19.4% in 2000. Significantly decreased risk of episiotomy was seen based upon year of childbirth, black race, and spontaneous vaginal delivery. Increased association with episiotomy was seen in forceps deliveries, and with third- or fourth-degree lacerations. In deliveries with known insurance status, having Medicaid insurance was also associated with a decreased episiotomy risk.

CONCLUSION: There was a statistically significant reduction in the overall episiotomy rate between 1983 and 2000. White women consistently underwent episiotomy more frequently than black women even when controlling for age, parity, insurance status, and operative vaginal delivery.

6 Old Comments:

OB's are starting to change their practice. Yipee! Why did episiotomy become routine in the first place?

Danielle

By Blogger Mama Liberty, at 5:41 PM  

this is great that there is a study-- the local city hospitals have not been doing routine episiotomies for a while now as well. I know one doc who had to cut an epis a couple years ago and it was the first she had cut in her practice.
progress is slow, and isn't every where - the very small outlying regional hospitals the docs there are still doing episotomies routinely-- don't know how long it will take them to change-

By Anonymous Anonymous, at 7:51 PM  

I'm just curious why more white women underwent episiotomies? Is there a physiological factor influenced by race?

By Anonymous Amka, at 9:04 PM  

Amka:

"I'm just curious why more white women underwent episiotomies? Is there a physiological factor influenced by race?"

I really don't know. I am going to check if other studies had similar results.

By Blogger Amy Tuteur, MD, at 9:13 PM  

I think it is great that the medical community can change in light of scientific research. I am a medical scientist and the reason I do research is to hopefully lead to better treatment options, although my research is on a basic science level. However, what scares me is that many procedures, particularily many procedures used during childbirth, have not been studied sufficiently to determine whether they cause more harm than good. Episiotomies are just one example. There is no reason that they should have become routine in the first place. It was a medical mistake that has caused a great deal of suffering for many women and unfortunately still does.

Dawn

By Blogger Dawn, at 7:57 AM  

Was there every quality studies that confirmed the benefits and advantages of routine episiotomy?

If no, then how do we justify or explain the prevalence of this procedure?

By Anonymous Anonymous, at 1:06 AM