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03 May 2005
Women
whose vaginal opening is enlarged surgically during childbirth
can suffer rectal
injuries, and the procedure may
delay the healing process and does not deter incontinence,
a report summarizing the findings of 26 previous studies said.
Roughly one-third of U.S. women have an episiotomy during childbirth
overall, although among some doctors and hospitals as many
as three-quarters of women giving birth have the procedure,
the report said.
Doctors usually make a 3/4- to 1-1/2-inch
(2- to 4-centimetre) cut in an effort to ease the emergence
of the fetus and to prevent uncontrolled tearing of the perineum,
the area below the vaginal opening. However, the researchers
said such tears would usually not be as long as the surgical
cut and, in some cases, the perineum would have remained intact.
Lead author Dr. Katherine Hartmann of the University of North
Carolina at Chapel Hill wrote that episiotomies could be reduced
sharply to fewer than 15 percent of U.S. births if confined
to cases of fetal distress.
"Our systematic review finds no
benefits from episiotomy," she wrote in the Journal of the
American Medical Association.
"Clinicians must acknowledge
that little, if any, evidence is available to define indications
for use; however, it is clear that maternal benefit is not
an indication," she wrote.
A report posted on the Web site
of the U.S. Agency for Healthcare Research and Quality agreed
with her assessment: "Our systematic review finds no health
benefits from episiotomy ... Indeed, routine use is harmful
to the degree that it creates a surgical incision of greater
extent than many women might have experienced had episiotomy
not been performed."
Source: Reuters
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