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Episiotomy rates painfully high: Ottawa scientist
Researcher questions why the procedure is commonly used
By Tom SpearsResearcher questions why the procedure is commonly used
The Ottawa Citizen
Friday, August 26, 2005
Doctors keep doing episiotomies on women who probably don't need them, despite years of studies showing the painful incision doesn't make most births or recoveries easier, an Ottawa scientist has found.
Now Ian Graham is asking: Why?
The procedure involves making an incision back from the vagina during childbirth. For years, it had been thought to be less harmful than the tearing that can occur naturally.
But, Mr. Graham, a health sociologist and senior researcher at the Ottawa Hospital Research Institute, says one clinical study after another, beginning in the 1980s, has shown the incision provides no benefit in most cases. (The exception comes when a delivery goes wrong and has to be speeded up.)
"Historically in North America since the 1950s, it's been quite routine," he said.
Yet rates fell in recent decades as medical studies questioned the use of an incision in a delivery that goes well. Half of women having vaginal deliveries had an episiotomy in 1992; that has fallen to 24 per cent today.
Still, the rate varies tremendously -- from a high of 31 per cent in Quebec to 20 per cent in Alberta and Saskatchewan and 15 per cent in Manitoba, and only three per cent in Nunavut.
In Central and South America, the rate is close to 100 per cent, he found. That's also true in many parts of Asia. Spain, Italy and Turkey have rates above 50 per cent; the United States is at 33 per cent; Denmark's rate is only 12 per cent; New Zealand's is 11 and Sweden's is 9.7 per cent.
The best rate is an elusive number, but is probably between five and 30 per cent for first-time mothers, and lower for later births, he says.
Why the variation from one region to another?
"Well, we don't know," he said. "The generous interpretation is that some people just haven't heard the news yet. The less positive is they either have heard it and don't believe the evidence that it's not beneficial, or think there are other good reasons for doing it."
Obstetricians are the most likely to perform an episiotomy, followed by family doctors who deliver babies, and then midwives, he said.
His work is published in the September issue of a medical journal called Birth: Issues in Perinatal Care.
"It's sort of a quality of life issue for a lot of women," he said.
"If you can deliver without having a cut that has to be sutured, then you're a lot better."
Some women report the incision makes it difficult to position themselves comfortably for breastfeeding; others say it delays resuming their sex lives. And like any surgery, it creates some risk of infection.
The executive vice-president of the Society of Obstetricians and Gynecologists of Canada called the work "an extremely nice article," and a reminder that continuing education is a necessary part of a doctor's life. The society teaches that episiotomies should not be done routinely.
Canada's episiotomy rate of 24 per cent is probably within the ideal range, which is likely somewhere between 15 and 25 per cent, said Dr. Vyta Senikas.
But the study illustrates the cultural differences that still exist in the medical world, she said. "The biggest reason is we're dealing with different populations (with) differences in culture, differences in training."
Note: Reprinted with the permission of the Ottawa Citizen