Improved newborn outcome: None of the trials randomly assigning women to liberal or restrictive use of episiotomy have found any differences in newborn outcomes (2, 12, 19). Two studies of premature babies found that episiotomy did not affect the incidence of brain hemorrhage or low Apgar scores (15, 21). If episiotomy has no value even for these fragile babies, it isn't likely to benefit a healthy, full-term infant.
Facilitation of instrumental delivery: Studies have shown that reducing the use of episiotomy with forceps deliveries decreases the number of anal tears (7, 10, 22).The American College of Obstetricians and Gynecologists recommends not doing an episiotomy with a vacuum extraction until the head is "almost delivered" (1). But if the head is almost delivered, there isn't any reason to do one.
What are the potential problems of episiotomy?
Compared with not doing an episiotomy, episiotomy increases:
- Blood loss (4)
- Pain in the postpartum period (13)
- Infection (9, 11, 23)
- Long-term or chronic pain and/or pain with sexual intercourse (13)
- Rectovaginal fistula (an opening between the vagina and the rectum (11): This is generally precipitated by an episiotomy extension, an infection, or a combination of both.
- Anal incontinence (9, 18, 23): Since anal injury often permanently weakens the anal sphincter, gas incontinence, urgency, or fecal incontinence may occur immediately or later on with aging and further childbearing.