The hospital with a high episiotomy rate

I have been an OB/GYN hospitalist at a busy suburban community hospital for almost one year. I truly love my job. However, I’ve noticed something unexpected that’s prompted me to pause. There are several physicians — good, clinically competent, kind physicians — who frequently perform episiotomies. Routine episiotomy is not recommended. In my training and eight years of practice prior to becoming a hospitalist I rarely saw it used. So this experience has been surprising. There are a number of reasons physicians with high episiotomy rates is bothersome, and it brings to mind issues we all face in medicine. An episiotomy is a cut in a woman’s perineum (the tissue between the vagina and anus). It is made at the time the fetal head is crowning in a vaginal delivery. Episiotomy increases the amount of soft tissue space, and as a result, will decrease the amount of time for delivery of the fetal head. The increased space also allows more room to perform maneuvers to relieve a shoulder dystocia. Episiotomy is, in general, not frequently performed. It was done in 12 percent of vaginal deliveries in 2012 (compared to 61 percent in 1979). Although the ideal episiotomy rate is undefined, restrictive use of episiotomy is preferred over routine use. Since 2006 the American Congress of Obstetricians and Gynecologists has recommended against routine episiotomy use. It is troublesome to see any physicians with high episiotomy rates, as the procedure is not necessary...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions OB/GYN Source Type: blogs