Episiotomies questioned

A study published in the most recent issue of JAMA (Journal of the American Medical Association) found that routine episiotomies harm women more than they help them. Epistiotomies were first conducted on pregnant women in labor during the 1930s (a time period in which OB/GYN was a very male-dominated field), and since then have increasingly become a routinized childbirth practice. Currently, about 1 million women receive them each year. The presumed rationale for them is that they make labor easier and prevent less vaginal tearing.

The JAMA study discovered, however, that episiotomies may actually cause more health problems than they prevent. In most women, episiotomies do not make childbirth easier. In addition, they cause more--rather than less--vaginal tearing. Finally, they make post-pregnancy healing more difficult, and post-pregnancy intercourse more painful. Given these findings, the study recommends that the procedure only be conducted in high risk situations, and not as a routine childbirth practice.

So how did episiotomies become routinized if they actually harm women more than they help them? It turns out that they became established medical practice not because there was research backing up their health benefits but because their benefits were simply assumed and taken for granted. New generations of doctors practiced them because the older generations did (In other words, "If everyone else is doing it, it must be good"). Thus, the more that doctors and the medical profession got on board with them, the more that the procedure was presumed to be beneficial and acceptable. Moreover, episiotomies became routinized and established practice as U.S. medicine became more professionalized/institutionalized, and pregnancy/childbirth in particular became more medicalized.

Here's a link to an NPR interview with the study's primary investigator, Dr. Katherine Hartmann, that was conducted on May 4th.

The routine practice of episiotomies is not the only case of a medical procecure becoming institionalized based on factors other than ample scientific evidence. Other routine pregnancy/childbirth practices and the use of X-Rays (particularly during the 1940s and 50s), among other things, have similar histories.