Too many women get episiotomy in childbirth

Many women worldwide continue to undergo a painful procedure during childbirth that experts say should be used only in limited circumstances, according to a new report.

The procedure, called Episiotomy, involves making an incision to enlarge the vaginal opening during childbirth. Episiotomies were once performed routinely in the U.S. and elsewhere, in part because doctors believed it helped prevent vaginal tearing that can occur during delivery.

But in many countries, rates of episiotomy have fallen sharply since the 1980s, after mounting evidence began to show no benefit from routinely performing the procedure. The incision takes weeks to heal, during which time walking, using the bathroom and even sitting can be painful. At worst, Episiotomy can lead to a laceration in the anal sphincter, a difficult-to-repair tear that can cause long-term incontinence.

Though Episiotomy is necessary in some cases to ensure a safe delivery, a range of professional medical organizations now agree that it should be used sparingly - in cases of fetal or maternal distress, for instance.

There is, however, no agreement on what constitutes an acceptable rate of Episiotomy. And in the new study, Canadian researchers found that rates vary widely from country to country, among regions within the same country, and even among providers in the same medical network.

Episiotomy rates are generally highest in Asia and Central and South America, while they are lowest in English-speaking countries and some European nations, the researchers report in the medical journal Birth.

Episiotomies were once routinely performed in an attempt to prevent tearing during labor, particularly to avoid tears that reach to the anus. The number of episiotomies performed remains high in the U.S., but there is now a great deal of controversy over whether they should be routine. Recent studies have shown that women who do not have an episiotomy might have a small tear, which is in most cases not worse than an episiotomy.

To perform an episiotomy, local anesthesia (numbing just the immediate area) is usually used. Just before the baby is born, the obstetrician makes an incision at the bottom of the vaginal opening. This enlarges the vaginal opening. The incision is closed after the baby and placenta have been delivered.

Sweden had the lowest rate, at less than 10 percent of vaginal births in 1999-2000. In contrast, it's estimated that in Guatemala and Taiwan, all first-time mothers who delivered vaginally received an episiotomy.

In Western Europe, episiotomy rates for all vaginal deliveries ranged from 13 percent in England, in 2002-2003, to 87 percent in Spain, in 1995.