Episiotomies are on the decline, but for some women it can prevent further tearing: study

Click to play video: 'Study finds episiotomies reduce severe tearing risks in assisted births'
Study finds episiotomies reduce severe tearing risks in assisted births
Episiotomies may be on the decline in Canada overall, but new research suggests these surgical cuts could protect a mother from being injured during childbirth – Oct 21, 2019

Episiotomies may be on the decline in Canada overall, but new research suggests these surgical cuts could protect a mother from being injured during childbirth.

According to a study in the Canadian Medical Association Journal published on Monday, episiotomies reduced the risk of getting an injury by 42 per cent when doctors used vacuums or obstetrical forceps. These instruments are used during childbirth to grab the baby’s head.

An episiotomy is an incision that is performed in the perineum, the area between the vaginal opening and the anus, the Mayo Clinic noted. The incision is often made when doctors see the baby’s head.

READ MORE: Canadian mothers increasingly giving birth through c-section

The clinic added for years, the surgery was meant to prevent further vaginal tears during birth, and it is also believed these incisions heal better than natural tears. “The procedure was also thought to help preserve the muscular and connective tissue support of the pelvic floor.”

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The clinic noted, however, other research suggests episiotomies may not prevent problems after all.

The site added doctors can perform the surgery, depending on the position of the baby.

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For example, if the baby’s shoulder is stuck in your pelvic bone or your child has an abnormal heart rate, an episiotomy could help.

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“Your health-care provider might recommend an episiotomy if your baby needs to be quickly delivered,” the site noted.

Breaking down the study

The study, which looked at 2.5 million childbirths in Canada over 13 years, found an increase in anal sphincter injuries when vacuums or obstetrical forceps were used.

“Our results show the pronounced decrease in the episiotomy rate among operative vaginal deliveries, suggesting that the recommendation to move away from routine episiotomy among spontaneous vaginal deliveries has been overgeneralized to apply to all vaginal deliveries, including operative vaginal delivery, where there may be a benefit,” Giulia Muraca, a postdoctoral fellow at the University of British Columbia and study author, said in a statement. 

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However, this doesn’t mean this should be a “blanket practice,” Muraca said.

READ MORE: Mom shares powerful message for anyone who thinks C-sections are ‘easy’

“Generalizing the episiotomy guidelines for spontaneous vaginal delivery to women with operative vaginal delivery can cause harm, particularly in women delivering their first child and in women having a vaginal birth after caesarean.”

The research

Authors added the risk of “severe tearing” was the highest among deliveries using forceps and vacuum — with about 18 per cent of assisted deliveries resulting in injuries in 2017.

Episiotomies were performed for 43.2 per cent of assisted births in 2017, down from 53.1 per cent in 2004. For unassisted births, rates fell to 6.5 per cent in 2017 from 13.5 per cent in 2004.

READ MORE: C-sections — 5 things women need to know

Injuries increased 15 per cent in Canada — but researchers say that could be due to improved detection and reporting, as well as the increasing number of mothers giving birth for the first time.

— with files from the Canadian Press 


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