Women in labor are often given an episiotomy—a short incision to enlarge the opening the baby is about to come out of—to prevent tearing of perineal tissues between the opening of the vagina and the anus. Preventing that injury has long been thought to reduce the risk of later incontinence, among other negative consequences of the injury. But many obstetricians say that those benefits are unproven. Researchers in North Carolina went through a stack of studies on episiotomies to look for evidence for the risks and benefits of the procedure.

What the researchers wanted to know: What are the long-term effects of episiotomies?

What they did: The researchers sought out previously published studies that included more than 40 women and reported the outcomes of episitomies and perineal injury. They found 26 such articles and reviewed results on perineal injuries, pain, and healing in the short term, and urinary and fecal incontinence, pelvic floor muscle strength, and sexual function over the longer term.

What they found: Epiosotomies did not benefit women. Women with episiotomies were more likely to need surgical repair, were in no less pain a few days after giving birth, and were equally likely to have incontinence problems over the long haul. Some studies suggested that the procedure might even increase the risk of incontinence. And some found that women who had had episiotomies were more likely later on to experience pain during intercourse.

What the study means to you: Routine episiotomies should be abandoned, the researchers write. They compare routine episiotomy to routine tonsillectomy for children, another procedure that originally seemed like it made sense but has been virtually abandoned as it has become clear that the sketchy benefits do not outweigh the risks. There are still occasions when episiotomies may be necessary for the health of the baby, say the researchers. But these studies show doctors shouldn't perform episiotomies to benefit the mother. They also suggest that doctors may prefer episiotomy because it is easier for them to sew up a surgical cut than it is to repair the tear that sometimes occurs when an episiotomy is not done.

Caveats: The study with the longest follow-up on incontinence lasted only four years. It is possible that having an episiotomy might turn out to be better in terms of incontinence over the long term.

Find out more: Read an encyclopedia entry from the National Library of Medicine that explains episiotomies.

Read the article: Hartmann, K., et al. "Outcomes of Routine Episiotomy." Journal of the American Medical Association. May 4, 2005, Vol. 293, No. 17, pp. 2141-2148.

Abstract online: http://jama.ama-assn.org