Study finds epi­siotomies re­duce se­vere tear­ing risks in as­sisted births

The Peterborough Examiner - - ARTS & LIFE - CAS­SAN­DRA SZKLARSKI

TORONTO — Epi­siotomies dur­ing child­birth have de­clined in Canada, but a new re­port says the sur­gi­cal cuts could re­duce the chance of a mother be­ing se­verely in­jured when for­ceps or a vac­uum are in­volved.

A large study pub­lished Mon­day in the Cana­dian Med­i­cal As­so­ci­a­tion Jour­nal found epi­siotomies re­duced the risk of in­jury by as much as 42 per cent when first-time moth­ers re­quired as­sis­tance from a vac­uum or for­ceps, which are broad pin­cers used to grab a baby’s head.

In con­trast, a sur­gi­cal cut posed greater risk of in­jury when for­ceps or a vac­uum were not in­volved.

Study au­thor Gi­u­lia Mu­raca, a post­doc­toral fel­low at the Uni­ver­sity of Bri­tish Columbia, says guide­lines that dis­cour­age rou­tine epi­siotomies have been over­gen­er­al­ized to ap­ply to all vagi­nal de­liv­er­ies, when data sug­gests they could help in as­sisted births.

“Gen­er­al­iz­ing the epi­siotomy guide­lines for spon­ta­neous vagi­nal de­liv­ery to women with op­er­a­tive vagi­nal de­liv­ery can cause harm, par­tic­u­larly in women de­liv­er­ing their first child and in women hav­ing a vagi­nal birth af­ter cae­sarean,” Mu­raca said Mon­day in a re­lease.

An epi­siotomy is a sur­gi­cal cut made to the open­ing of the vagina when the baby’s head ap­pears. It’s meant to cre­ate more room and min­i­mize se­vere tears, which could in­clude ob­stet­ric anal sphinc­ter in­jury and cause pain, in­fec­tion, sex­ual prob­lems and in­con­ti­nence.

Re­searchers say the risk of se­vere tear­ing was high­est among de­liv­er­ies by for­ceps and vac­uum, with about 18 per cent of as­sisted de­liv­er­ies re­sult­ing in such in­juries in 2017.

The study ex­am­ined more than 2.5 mil­lion births in Canada be­tween 2004 and 2017 and found the pro­ce­dure de­clined among vagi­nal de­liv­er­ies, whether they in­volved in­stru­ments or not.

They in­volved 43.2 per cent of as­sisted births in 2017, down from 53.1 per cent in 2004. For unas­sisted births, rates dropped to 6.5 per cent in 2017, from 13.5 per cent in 2004.

Nev­er­the­less, in­juries in­creased 15 per cent in Canada and other in­dus­tri­al­ized coun­tries — but re­searchers say that’s pos­si­bly due to im­proved de­tec­tion and re­port­ing, and the in­creas­ing num­ber of older first-time moth­ers.

Ran­dom­ized con­trolled tri­als in the 1990s showed epi­siotomies to be in­ef­fec­tive in pro­tect­ing women from se­vere tear­ing, in­stead in­creas­ing pain and ex­tend­ing re­cov­ery time.

From 2015 to 2017, as­sisted de­liv­er­ies ac­counted for 10 per cent to 13 per cent of de­liv­er­ies in Canada, the U.K. and Aus­tralia. The rate of as­sisted de­liv­ery is no­tably lower in the United States, at 3.1 per cent in 2015, where ef­forts to in­crease as­sisted de­liv­er­ies and re­duce cae­sarean de­liv­ery rates are un­der­way.

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