Is routine use of episiotomy justified?

Abstract

Episiotomy, one of the most common surgical procedures, was introduced in clinical practice in the eighteenth century without having strong scientific evidence of its benefits. Its use was justified by the prevention of severe perineal tears, better future sexual function, and a reduction of urine and fecal incontinence. With regard to the first assumption, the evidence that is based on five randomized controlled trials shows a 9% reduction in severe perineal tears in the selective use of episiotomy, but this effect fluctuates between a 40% reduction and a 38% increase. In relation to long-term effects, women in whom management includes routine use of episiotomy have shown poorer future sexual function, similar pelvic floor muscle strength, and similar urinary incontinence in comparison with women in whom episiotomy is used in a selective manner. In summary, there is no reliable evidence that routine use of episiotomy has any beneficial effect; on the contrary, there is clear evidence that it may cause harm such as a greater need for surgical repair and a poorer future sexual capability. In view of the available evidence the routine use of episiotomy should be abandoned and episiotomy rates >30% do not seem justified. (AM J OBSTET GYNECOL 1996;174:1399-402.)