For years, some doctors believed that an episiotomy (search), an incision to enlarge the vaginal opening during childbirth, would prevent spontaneous tearing that would be harder to repair. They also believed the procedure would help women avoid incontinence and improve their sex lives.
It turns out those beliefs were myths.
A new review of 26 research studies shows that episiotomies are linked with a higher risk of injury, more trouble healing and more pain.
Episiotomies also had no effect on incontinence (search), pelvic floor (search) strength or sexual function. Women who had the procedure waited longer to resume sex after childbirth. And their first post-birth intercourse caused them more pain.
"This review puts together in one place all the evidence that we're not getting the results we want," said Dr. Katherine Hartmann, the study's lead author and a researcher at the University of North Carolina.
The review was published in Wednesday's Journal of the American Medical Association.
An episiotomy is usually a small cut — deeper than the width of a large metal paperclip and about as long, she said. But spontaneous tears often are smaller and don't need stitches.
Many women and their doctors already know episiotomies haven't proven beneficial, Hartmann said, adding that rates are dropping, but not fast enough.
She estimated that 1 million women each year have unnecessary episiotomies, citing studies that indicate they are done in about 30 percent of vaginal births.
An Associated Press analysis of hospital data found there were 616,702 episiotomies in 2002, but Hartmann said the procedures are underestimated in hospital records.
Since 1983, the American College of Obstetricians and Gynecologists (search) has said episiotomies should not be done routinely. Dr. Laura Riley, of ACOG's obstetrical practice committee, said most doctors already know they should be done only when the baby is in distress.
"I think the message has been out there a while," she said. Her hospital, Massachusetts General in Boston, only does them in about 8 percent of births, she said.
However, the numbers vary widely. Women are more likely to get an episiotomy at some hospitals, Hartmann said. One study from the mid-1990s found that episiotomy rates at Philadelphia hospitals varied from 20 percent to 73 percent.
The Agency for Healthcare Quality and Research, which funded the review, planned to post a summary on its Web site Tuesday afternoon. Pregnant women should discuss it with their doctors or midwives, Hartmann said.
"Just in time for Mother's Day," Hartmann said. "This is a big gift for future mothers."