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Why Are So Many Doctors Still Performing Episiotomies?

Photograph by Twenty20

Just a generation ago—likely around the time your mom had you—episiotomies were fairly standard. In the late 1970s, the procedure was used in more than 60 percent of vaginal deliveries across the U.S., according to a new report from Kaiser Health News.

At the time, doctors believed that a clean cut both prevented tearing and was easier to stitch up, while also reducing the damage to pelvic floor muscles (a potential cause of incontinence). But in 2006, the American College of Obstetrics and Gynecology (ACOG) reviewed the research and found no evidence to support either of the claims.

In fact, as the report from Kaiser goes on to say, “research has shown that the cuts sometimes cause serious pain and injuries, including deep tissue tears, incontinence and sexual dysfunction.” What’s more, “the repaired incisions often prove slower to heal than a natural tear.”

And yet, the procedure is still being performed at alarming rates at certain hospitals.

For example, Kaiser’s report points out that while the majority of California hospitals now have episiotomy rates under 10 percent, individual hospitals’ rates can be five or six times as high.

Unfortunately, even when women ask their doctors not to be cut, they aren’t always being heard. Kimberly Turbin of Stockton, Calif., is suing her former obstetrician for assault and battery after he performed an episiotomy on her in 2013. A video of the birth shows Turbin begging the doctor not to make the incision, to no avail. (Her lawsuit will go to trial in the fall.)

The best thing you can do is to make sure you and your doctor are on the same page about episiotomy well before you’re in labor.

While the procedure may be necessary in some cases—such as when a baby’s shoulder is stuck or their heart rate drops, says to Dr. Tracy Flanagan, director of women's health and maternity at Kaiser Permanente in Northern California—you want to make sure your obstetrician doesn’t consider episiotomies to be routine.

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