Little or no benefit to episiotomy.

There is little or no benefit to the routine use of episiotomies for uncomplicated vaginal births. In fact, most of the reputed benefits of episiotomies can not be substantiated by evidence. The Agency for Healthcare Research and Quality (AHRQ), part of the Department of Health and Human Services, recently released a review of the scientific literature entitled "Use of Episiotomy in Obstetrical Care: A Systematic Review."

The rate of episiotomies was influenced by factors such as the type, size, and location of the health care facility, time of day and the practitioners preference rather than by the physiology of a vaginal birth. It is estimated that one third of vaginal births include an episiotomy in order to hasten the birth or prevent tearing.

However, women who tear in fact have less injury and no more or less complications in healing. Women who do not have a surgical incision are less likely to have perineal damage, less need for suturing, report less pain and are more likely to resume intercourse earlier. Having an episiotomy does not help protect a woman's pelvic floor or avoid problems with urinary or fecal incontinence.

The American College of Obstetricians and Gynecologists will translate this research into clinical practice guidelines. The full report is available at ww.ahrq.gov/downloads/pub/evidence/pdf/ episiotomy/episob.pdf. You can also call the AHRQ's Publications Clearinghouse at 1-800-358-9295 to request a copy.