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Jefferson Researchers Find Education is an Effective Tool in Reducing Episiotomies
A study in the August issue of The Journal of Reproductive Medicine by physicians at Thomas Jefferson University (TJU) in Philadelphia found that episiotomy rates could be effectively reduced
through physician education and documentation of procedure indication.
Performed when a woman is giving birth, episiotomy is a small cut made to widen the opening of a woman's vagina to ease delivery.
“Once a routine component of most vaginal deliveries, episiotomy has become a procedure thought to be best avoided,” says
the study’s lead author, Jay Goldberg, MD, MSCP. Dr. Goldberg is Director, Division of General Obstetrics and Gynecology at
Jefferson Medical College of TJU.
No justification or documentation required
Dr. Goldberg and his colleagues theorize that the reasons routine episiotomy continues to be utilized frequently are that
no justification for, or documentation of, its indication is required. This contrasts with other obstetric procedures and
interventions, such as amniocentesis, labor induction, cesarean section and forceps-and vacuum-assisted deliveries, which
all require a clearly documented indication.
No benefit, increased risks
Multiple studies over the past 20 years have concluded that while offering no maternal or neonatal benefit, midline episiotomy
increases the risk of severe perinea (i.e., the region between the thighs) lacerations — also involving the anal sphincter,
as well as of anal incontinence and rectovaginal fistula (abnormal communication between the rectum and the vagina). Both
midline and mediolateral episiotomy also increase blood loss, post-delivery pain, infection, and time until resumption of
sexual intercourse, and they negatively affect body image, explains Dr. Goldberg, who is also Clinical Professor of Obstetrics
and Gynecology at JMC.
Working though the Philadelphia Department of Health, the authors identified two community hospitals in the Philadelphia area
as having episiotomy rates greater than the national average. Dr. Goldberg and his colleagues designed a study to lower the
episiotomy rates by educating obstetricians on the scientific evidence demonstrating the harmful effects of routine episiotomy
and by requiring a documented indication when an episiotomy was performed. Approval for the study was obtained from the institutional
review board of each hospital.
To determine the success of the study, the authors prospectively looked at 4,211 births over a 15-month period. They divided
the births into two groups: those occurring in the three-month pre-intervention baseline period and those during the yearlong
post-intervention.
Education and documentation fuel decreases
They researchers found that the combination of physician education with documentation was effective. They were able to significantly
decrease the rate of episiotomy by 25 percent for spontaneous vaginal deliveries from 41 percent in the baseline group to
31 percent in the post-intervention group.
Additional Jefferson researchers who participated in the study were Matthew Fagan, MD, and Terry Hyslop, PhD. Nancy Roberts,
MD, at Lankenau Hospital also participated.
For more information or to make an appointment with a Jefferson obstetrician or gynecologist, call
1-800-JEFF-NOW.
