Episiotomies: Uses, Guidelines, and Recent Findings

A recent story in HuffPost entitled “Why Are We Still Cutting Women’s Vaginas During Birth?” tells the story of a woman named Rachel who experienced an episiotomy during childbirth (1). An episiotomy is an incision made to the perineum, the area between the vaginal opening and the anus, to aid in delivery (2). 

Rachel heard her OB-GYN tell a medical student in the room that the baby was going to be big and that she needed to perform the incision. Rachel’s epidural had worn off by this time, so when the doctor cut her vagina open, she felt all of it. She wailed in pain, shock, and confusion. In the days and weeks following Rachel’s delivery, she felt the pain from her episiotomy constantly, during urination, sexual intercourse, and even sitting. Although her episiotomy healed well, Rachel was deeply traumatized by the experience and its aftermath.

Why are episiotomies performed?

Episiotomies were a routine part of childbirth for decades, because they gave babies more room to exit the vagina. Episiotomies were believed to offer the following benefits (2):

  • Providing a larger space from which the baby could exit
  • Healing more easily than a natural tear that could result from childbirth
  • Preventing more extensive vaginal tearing
  • Preserving pelvic floor muscle and tissue

Since then, however, it has been well established that episiotomies are typically not a necessary part of deliveries. They remain useful in certain instances, such as (1, 2, 3, 4):

Updated recommendations

The American College of Obstetricians and Gynecologists (ACOG) recommended against routine episiotomies in its guidelines for 2006 (3). The guidelines explained that, although 53-79% of vaginal deliveries involved some laceration, the majority of them did not affect the function of muscles and tissues (3). Additionally, there was not enough data to support their purported benefits (4). Because of these changes in recommendations, the number of vaginal births in America that involved episiotomies went from 33% in 2000 to 12% in 2012 (3). 

Episiotomies have been associated with increased risk of the following (3,4):

  • Anal incontinence
  • Unsatisfactory results (obstetric fistula, asymmetrical healing, etc.)
  • Infection and dehiscence (wound separation)
  • Extension of the incision into a third or fourth degree tear (one study found that episiotomy was associated with a 3 cm longer perineal laceration than no episiotomy)
  • Increased blood loss
  • Perineal laceration in future deliveries

If the doctor decides an episiotomy is necessary, they should ensure that the patient gives informed consent (see below) and does not feel the incision (2, 4). If the patient hasn’t had anesthesia or the anesthesia has worn off, the doctor can administer a local anesthetic to the area.

Episiotomy and consent

An episiotomy requires informed consent (4). There are some emergencies in which an episiotomy might be required immediately, as stated above (1). However, an episiotomy is a surgical procedure that requires informed consent whenever possible (i.e. in cases that are not an immediate emergency).

In a 2017 news story for The Daily Beast, new mom Kimberly Turbin sued her doctor for assault-and-battery after he performed an episiotomy without her consent (5). She had video footage that demonstrated her refusal to have the surgery and showed that an emergency in which an episiotomy was required had not occurred. Informed consent is a patient right, and failure to obtain it is medical malpractice

About ABC Law Centers

ABC Law Centers was established to focus exclusively on birth injury cases. A “birth injury” is any type of harm to a baby that occurs just before, during, or after birth. This includes issues such as oxygen deprivation, infection, and trauma. While some children with birth injuries make a complete recovery, others develop disabilities such as cerebral palsy and epilepsy.

If a birth injury/subsequent disability could have been prevented with proper care, then it constitutes medical malpractice. Settlements from birth injury cases can cover the costs of lifelong treatment, care, and other crucial resources. 

If you believe you may have a birth injury case for your child, please contact us today to learn more. We are happy to talk to you free of any obligation or charge. In fact, clients pay nothing throughout the entire legal process unless we win. 

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Related Reading

Sources

  1. Pearson, C., & Pearson, C. (2019, June 18). Why Are We Still Cutting Women’s Vaginas During Childbirth? Retrieved July 3, 2019, from https://www.huffpost.com/entry/childbirth-episiotomy-rates_l_5d03ddf6e4b0304a120f3400
  2. Episiotomy: When it’s needed, when it’s not. (2018, October 23). Retrieved July 3, 2019, from https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/episiotomy/art-20047282
  3. Women’s Health Care Physicians. (n.d.). Retrieved July 3, 2019, from https://www.acog.org/About-ACOG/News-Room/News-Releases/2016/Ob-Gyns-Can-Prevent-and-Manage-Obstetric-Lacerations?IsMobileSet=false
  4. Berkowitz, L. R., & Foust-Wright, C. E. (n.d.). Approach to episiotomy. Retrieved July 10, 2019, from https://www.uptodate.com/contents/approach-to-episiotomy
  5. Zadrozny, B. (2015, June 05). New Mom Begged Doc: ‘No, Don’t Cut Me!’ Retrieved July 10, 2019, from https://www.thedailybeast.com/new-mom-begged-doc-no-dont-cut-me

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