A small surgical incision sometimes made in the perineum area during a baby’s delivery is an episiotomy. This cut is performed most commonly for the purpose of avoiding tears. The main idea of routine cutting is that a cut can be repaired more easily and will also heal quicker than a tear. There are some extreme situations when an episiotomy may be unavoidable such as in the case of fetal distress, but well over half of them performed today are not from medical necessity. Episiotomy rates continue their slow decline, although more than 50% of all first-time mothers still have the procedure.

A new study reported in the June 2008 issue of Obstetrics & Gynecology looks at women who had an episiotomy with their first vaginal delivery and then subsequent vaginal deliveries. Researchers were looking at whether women who had an episiotomy were more or less likely to suffer lacerations during future deliveries. Dr. Marianna Alperin and her colleagues at the University of Pittsburgh reviewed records of more than 6,000 women who had their first and second consecutive vaginal deliveries at Magee-Womens Hospital over a period of 10 years (1995-2005), but not those with an episiotomy the second time around.

The study results concluded that women who undergo an episiotomy during their first delivery have a significantly increased risk of suffering tears in subsequent deliveries. Out of all the women, close to half (47.8%) had the procedure during their first delivery. Only 26.7% of the women who never had an episiotomy experienced tearing during their second delivery, while 51.3% of the women who had an episiotomy with their first delivery experienced moderate tearing. As for severe tearing, the percentages were 1.7% compared to 4.8%, according to the report. Dr. Marianna Alperin said, “In the past, episiotomy was thought to be an innocuous procedure and possibly even protective against severe perineal lacerations. It has since been clearly shown that episiotomy increases the risk of severe obstetrical lacerations in that delivery.” She went on to say, “The findings of our analysis demonstrate yet another detrimental aspect to episiotomy and we encourage obstetric care pro viders to further restrict the use of routine episiotomy.”

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