An episiotomy is a cut made to the vagina during childbirth, often causing birth injuries. The practice has a long history and was thought to aid in delivery by widening the opening for the baby’s head, but studies have proven that episiotomies are dangerous for the mother, putting her at risk for severe complications. In 2006, national guidelines were changed to reflect the new information, but an analysis done by USA Today showed that more than a decade later, some hospitals have episiotomy rates of 20 percent or higher.
Complications and Difficulty Healing
In an emergency situation where the baby’s shoulder is stuck, an episiotomy may be medically appropriate. However, for routine births, the 2006 guidelines called for letting the vagina tear naturally, which sometimes happened during birth. Making a clean cut or making too large a cut allows the tissue to tear too far and can damage the rectum, requiring surgical repair after the birth. These severe tears are classified as third or fourth-degree lacerations. The wound can become infected and sexual intercourse can become painful. Injuries from an episiotomy can last years. Women may also experience incontinency after an episiotomy, as well as psychological damage to their self-esteem and desire to have more children.
Modernizing Medical Practices
The analysis by USA Today looked at data from more than 500 hospitals in eight states. While some hospitals in the state of Washington had episiotomy rates in the low single digits, others, such as New York- Presbyterian Queens, had rates of almost 40 percent for routine births with no complicating factors. USA Today requested data from all 50 states, but many either declined to make the data public or charged exorbitant fees to release it. Others restricted the data in ways that made it useless for analysis.
Executive director of the National Women’s Health Network stated that full disclosure requirements for frequency of procedures and their outcomes would promote quicker modernization across the board. She added that a person entering a hospital for any medical procedure had the right to expect that they would not be put at unnecessary risk. Women need access to the data that can help them make informed health care decisions. In the heat of delivery, women are often not informed that an episiotomy is being performed. Knowing a hospital’s episiotomy rate beforehand could help women choose where they want to deliver their babies.
Hospitals that were able to effect real change away from traditional episiotomy practices instituted education programs paired with a peer review process. A hospital in Staten Island was able to achieve change by holding a monthly review of all physicians’ episiotomy rates. Sharing feedback and the ability for providers to see how they are doing in comparison to their colleagues are powerful motivators. Similarly, hospitals in Washington state brought the statewide episiotomy rate down by using education events to focus on episiotomy prevention and sharing data across all delivery hospitals.
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