Episiotomy as a Controversial Medical Practice

Maternal health is an essential component of the medical industry because it takes care of both mothers and their children. Even though the modern health care system can cope with numerous challenges, there still exist some tendencies that are dangerous for the population. For example, it refers to too little, too late (TLTL) and too much, too soon (TMTS) (Miller et al., 2016). The first term denotes that women are treated using inadequate resources, while the second one stands for over-medicalisation without necessity. Each of these phenomena implies numerous interventions and procedures that influence women’s health substantially. Thus, an episiotomy is an example of a TMTS approach, and this intervention can have an adverse impact on mothers even though some positive results are also reported.

To begin with, one should understand why this controversial practice is requested in the modern world. Clesse, Lighezzolo-Alnot, De Lavergne, Hamlin and Scheffler (2018) argue that episiotomy rates become lower in the world because of its probable harm. However, this intervention is still prevalent in “less industrialised countries and East Asia” (Clesse et al., 2018, p. 644). This situation can be explained by the fact that these nations do not have the health care industry at a decent level. In addition to that, there exist some articles that demonstrate some positive effects of the practice. For example, Sultan et al. (2019) stipulate that “mediolateral episiotomies may play an important role in the prevention of anal sphincter injuries” (p. 192). The idea above is also supported by Verghese, Champaneria, Kapoor and Latthe (2016), who describe the benefits of accurately given episiotomy for the prevention of obstetric and sphincter injuries. However, these results should be questioned because the data above come from non-randomised studies (Verghese et al., 2016). Thus, the following details will show why the given intervention is challenging.

Even though few articles represent the benefits of episiotomy, a more significant part of research reflects the opposite state of affairs. Miller et al. (2016) state that episiotomy is among those interventions that offer harm to the population. Consequently, it is a severe problem that clinicians tend to initiate this procedure in many cases and under various conditions. For example, Miller et al. (2016) stipulate that it is a mistake when medical professionals carry out “a routine episiotomy during spontaneous vaginal birth” (p. 8). As for specific disadvantages of the procedure, it is necessary to emphasize the study by Zilberman, Sheiner, Barrett, Hamou and Silberstein (2018). The scientists point out that episiotomy results in higher rates of perineal tears. Furthermore, it equally refers to the tears of the first and second, as well as the third and fourth degrees (Zilberman et al., 2018).

In addition to that, Shmueli et al. (2017) claim that routine episiotomy should be abandoned at all, while it is necessary to reconsider the approach to a selective procedure. The researchers have generated this conclusion based on their analysis of episiotomy outcomes for nulliparous and multiparous women. Thus, Shmueli et al. (2017) have identified that the intervention does not offer significant benefit to nulliparous women, while it can increase the risk of obstetric and sphincter injuries among multiparous patients. Probably, the distinction between nulliparous and multiparous women explains the fact that the results by Shmueli et al. (2017) are opposite to those of Sultan et al. (2019). When it comes to a non-randomized study, there exists an opportunity that its authors can find inadequate or biased results.

At the same time, Amorim, Coutinho, Melo and Katz (2017) have attempted to analyse whether selective episiotomy implies any significant benefits for the population. For this purpose, the scientists have compared the results of patients from a non-episiotomy protocol group and a selective episiotomy group. The results were surprising because Amorim et al. (2017) have identified that “a non-episiotomy protocol appears to be safe for mother and child” (p. 1). This discovery means that the necessity to conduct the given intervention is debatable. Consequently, the authors question whether any precise indications can justify the use of this procedure in any circumstance.

In conclusion, one can state that episiotomy is a controversial practice in the modern health care industry. On the one hand, the intervention is requested in developing countries that cannot impress with a decent level of medical service. In addition to that, few studies prove the advantages of the procedure, but their results evoke many questions. On the other hand, a significant part of the research demonstrates that episiotomy leads to harmful outcomes. While some circumstances can justify selective episiotomy, it is impossible to deny an adverse impact of routine episiotomy. Among possible health issues, it is necessary to emphasize perineal tears, sphincter injuries, and others. Furthermore, any concerns about whether to use the intervention under consideration disappear because of the discovery that non-episiotomy protocol patients witness positive health outcomes. Thus, even though the given procedure is still used in some countries, developed nations should reconsider their medical practice to avoid it because episiotomy is dangerous for the target population.

References

Amorim, M. M., Coutinho, I. C., Melo, I., & Katz, L. (2017). Selective episiotomy vs. implementation of a non-episiotomy protocol: A randomized clinical trial. Reproductive Health, 14(55), 1-10.

Clesse, C., Lighezzolo-Alnot, J., De Lavergne, S., Hamlin, S., & Scheffler, M. (2018). Statistical trends of episiotomy around the world: Comparative systematic review of changing practices. Health Care for Women International, 39(6), 644-662.

Miller, S., Abalos, E., Chamillard, M., Ciapponi, A., Colaci, D., Comandé, D., … Althabe, F. (2016). Beyond too little, too late and too much, too soon: A pathway towards evidence-based, respectful maternity care worldwide. The Lancet, 388(10056), 2176-2192.

Shmueli, A., Benziv, R. G., Hiersch, L., Ashwal, E., Aviram, R., Yogev, Y., & Aviram, A. (2017). Episiotomy – risk factors and outcomes. The Journal of Maternal-Fetal & Neonatal Medicine, 30(3), 251-256.

Sultan, A. H., Thakar, R., Ismail, K. M., Kalis, V., Laine, K., Räisänen, S. H., & de Leeuw, J. W. (2019). The role of mediolateral episiotomy during operative vaginal delivery. European Journal of Obstetrics & Gynaecology and Reproductive Biolgoy, 240, 192-196.

Verghese, T. S., Champaneria, R., Kapoor, D. S., & Latthe, P. M. (2016). Obstetric anal sphincter injuries after episiotomy: Systematic review and meta-analysis. International Urogynaecology Journal, 27(10), 1459-1467.

Zilberman, A., Sheiner, E., Barrett, O., Hamou, B., & Silberstein, T. (2018). Once episiotomy, always episiotomy? Archives of Gynaecology and Obstetrics, 298(1), 121-124.