Routine episiotomy offers women no benefits or relief: review notes longer recovery, some harm.(News)

Routine use of episiotomy for uncomplicated vaginal births provides no maternal benefits and may harm some who would have had lesser injury without a surgical incision, according to a literature review.

When providers restricted their use of episiotomy, women were less likely to have severe perineal lacerations and to need suturing, and were more likely to have an intact perineum and to resume sexual intercourse earlier, reported Katherine Hartmann, M.D., University of North Carolina at Chapel Hill, and her associates.

None of the studies reviewed found pain to be lessened by routine episiotomy. The evidence showed that the procedure did not protect women against fecal and urinary incontinence, pelvic organ prolapse, and difficulties with sexual function in the first 3 months to 5 years after delivery (JAMA 2005;293:2141-8).

Data were absent later in life when persistent or severe incontinence or pelvic organ prolapse is most likely to occur.

About one-third of women in the United States who gave birth vaginally in 2000 had an episiotomy, according to the investigators.

"The routine use of episiotomy has been standard for years, with apparently limited research to support it," Carolyn M. Clancy, M.D., director of the Agency for Healthcare Research and Quality, which sponsored the study, said in a statement.

"This evidence could help many women with uncomplicated births avoid a procedure that is of no benefit to them," she added.