Obstetrics & Gynecology News Archive Featured in the Media JeffNEWS

A study in the August issue of TheJournal of Reproductive Medicine by physicians at Thomas Jefferson University in Philadelphia found that episiotomy rates may 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 Jay Goldberg, M.D., MSCP, lead author, who is director, Division of General Obstetrics and Gynecology at Jefferson Medical College of Thomas Jefferson University in Philadelphia.

Dr. Goldberg and his colleagues theorize that the reasons routine episiotomy continues to be utilized frequently is 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.

Multiple studies over the past 20 years have concluded that while offering no maternal or neonatal benefit, midline episiotomy increases the risk for severe perineal lacerations, those also involving the anal sphincter, along with their risks of anal incontinence and rectovaginal fistula. Both midline and mediolateral episiotomy also increase blood loss, post-delivery pain, infection, time until resumption of sexual intercourse and negatively affect body image, explains Dr. Goldberg, who is also clinical professor of Obstetrics and Gynecology at Jefferson Medical College of Thomas Jefferson University.

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.

They found that the combination of physician education with documentation were effective tools. The researchers 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 researchers at Jefferson who participated in the study are Matthew Fagan, M.D., and Terry Hyslop, Ph.D. Nancy Roberts, M.D. at Lankenau Hospital also participated.

For information or to make an appointment with a Jefferson obstetrician or gynecologist, call 1-800-JEFF-NOW.