The WHO says physicians should aim to perform episiotomies in about 10 percent of births.
An episiotomy, or an incision made along the vagina, was once a routine part of childbirth.
The surgical incisions are meant to expand the vaginal opening and speed up delivery.
In the past, doctors thought the procedure helped prevent severe vaginal tearing and that the surgical cuts would heal better than natural tears.
Over the years, though, it became clear that episiotomies weren’t only unnecessary, they were actually quite painful and risky.
Consequently, in 1996, the World Health Organization (WHO) recommended that doctors cut back on the incisions and aim for an episiotomy rate of about 10 percent.
The American College of Obstetricians and Gynecologists (ACOG) followed suit in 2006, advising doctors against frequently performing the surgical cuts.
Last week, an investigation conducted by USA Today found that episiotomies are still very common in some hospitals.
Dozens of hospitals across the country have episiotomy rates of 20 percent or higher, according to the report.
“In this day and age, it is inappropriate for hospitals to have more than 20 percent episiotomy rate, which is double the recommended rate as per the WHO,” Dr. Adi Davidov, a board-certified OB-GYN and the interim chair of the department of obstetrics and gynecology at Staten Island University Hospital, told Healthline.
“In today’s modern obstetrical practice, episiotomies are performed selectively based on the clinical scenarios,” Davidov added.
Typically, episiotomies are performed when there’s no other option to help the baby be born safely.
The procedure should be done on a case-by-case basis for rare and dangerous situations, according to health experts.
“One example of this is when the baby’s heart rate has slowed substantially, which can be a sign that the baby isn’t getting enough oxygen and could die if the birth is not expedited. Another example is when the baby’s shoulders get stuck,” Dr. Elissa Serapio, a board-certified OB-GYN and research fellow with the Bixby Center for Global Reproductive Health at the University of California, San Francisco, told Healthline.
Unfortunately, episiotomies are oftentimes performed for other reasons, many of which aren’t medically justified, Serapio added.
The risks and side effects associated with episiotomies vary, but can include infection, excessive vaginal tearing, and painful sex.
“Every patient who is having a vaginal birth is at risk of having a vaginal tear. But if an episiotomy is cut, the vaginal tear can extend farther, toward the anus,” Serapio explained.
When these tears extend toward the muscles surrounding the anus, some patients may experience fecal incontinence.
First and foremost, look up the episiotomy rate at the hospital you’re considering giving birth at.
Several hospitals list it on their websites. The Leapfrog Group, an organization that monitors hospital performance, also tracks episiotomy rates. They recommend hospitals have an episiotomy rate of about 5 percent at most.
If you can’t find your hospital’s rate, contact the maternity unit and ask them for it along with whether or not they’re taking any steps to reduce their rate.
In addition, ask your healthcare provider about their approach to episiotomies — specifically, how often they perform the procedure and for what reasons.
“The answer you want to hear is, ‘I do them only when absolutely necessary,’” Serapio said.
If you have any specific preferences, be sure to share them with your doctor before, or even during, delivery.
Generally, the best way to lower the chances that you’ll need an episiotomy is to eat a well-balanced diet and exercise regularly throughout your pregnancy, health experts say.
This will help reduce the chances that your baby will be too big to naturally pass through the vagina.
There’ve also been some studies suggesting that massaging the lower part of the vagina in the weeks leading up to childbirth could lower your risks. While results have been mixed, some women may benefit from this, says Serapio.
Lastly, keep in mind that some women may truly benefit from an episiotomy.
“Understand that episiotomies may be valuable in certain situations and that repair is almost always uncomplicated and can be and should be performed with adequate anesthesia,” said Dr. William Schweizer, obstetrician and clinical associate professor in the department of obstetrics and gynecology at NYU Langone Health.
It’s crucial to be your own advocate. Do your research, ask your physician in what instances they’d perform the procedure, and only get an episiotomy if it’s absolutely necessary.
A new investigation from USA Today found that several hospitals across the United States are performing episiotomies at an alarming rate.
The procedure involves making incisions to the vagina during childbirth. It was once a routine childbirth practice but is much less common now due to the pain and risks associated with it.
The World Health Organization (WHO) recommends hospitals have an episiotomy rate of 10 percent, which is significantly lower than the rate at several U.S. hospitals.
