Read on Twitter
I’m about to take a ton of heat for this, but I want to respond to this post (and responses on it’s thread), because there is a lot of nuance missing here.
Sweeping statements of “I have done near zero episiotomies - save the pelvic floor!” are actually dangerous and wrong.
1/ https://twitter.com/DraMariamSavabi/status/1347740755306053635
Sweeping statements of “I have done near zero episiotomies - save the pelvic floor!” are actually dangerous and wrong.
1/ https://twitter.com/DraMariamSavabi/status/1347740755306053635
First of all, @DraMariamSavabi is completely right that routine episiotomy (ie. surgical cut before birth) is wrong. The evidence is overwhelming that episiotomy for normal vaginal birth leads to worse outcomes than natural tears.
We should all advocate against routine use.
2/
We should all advocate against routine use.
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However, messages like this suggest that episiotomy is never indicated, and that is also not true. In the setting of operative vaginal birth (ie. forceps or vacuums), the use of episiotomy in patients having their first vaginal birth actually protects against OASIS...
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OASIS stands for obstetrical anal sphincter injury, also known as 3rd and 4th degree tears.
There are stories from some very brave people on @4thDegreeTears about the devastating effects of these tears after birth.
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There are stories from some very brave people on @4thDegreeTears about the devastating effects of these tears after birth.
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In the field of urogynecology, we see so many patients who live with the consequences of OASIS, and the long term effects can be devastating.
This study shows that in patients having forceps, episiotomy decreases the risk of OASIS by 10 times!
https://pubmed.ncbi.nlm.nih.gov/28721483/
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This study shows that in patients having forceps, episiotomy decreases the risk of OASIS by 10 times!
https://pubmed.ncbi.nlm.nih.gov/28721483/
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And in vaccum-facilitated births, episiotomy reduces OASIS by 5 times!
As an Obstetrician, and someone who is training as a pelvic floor specialist, I would argue that - in specific cases - episotomy is also a part of "Save the Pelvic Floor"
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As an Obstetrician, and someone who is training as a pelvic floor specialist, I would argue that - in specific cases - episotomy is also a part of "Save the Pelvic Floor"
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And for those who want to say that operative births are also universally bad, they are one (of many) tools we have to reduce the rate of cesarean section.
Cesarean section is still a MAJOR abdominal surgery with complications.
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Cesarean section is still a MAJOR abdominal surgery with complications.
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Not to mention that cesareans performed after a patient has started to push have much higher morbidity and increase risks of complications...
Sometimes, the options for birth are operative vaginal birth vs. c-section - and as OBs, we must offer both to patients safely
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Sometimes, the options for birth are operative vaginal birth vs. c-section - and as OBs, we must offer both to patients safely
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So, all this is to say that bold sweeping statements do not do our patients any justice. One doctor even suggested that anyone who does an episiotomy is either lazy or stupid.
They contribute to rhetoric of “episiotomy = always bad”, rather than educating patients and OBs.
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They contribute to rhetoric of “episiotomy = always bad”, rather than educating patients and OBs.
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What is more important than these statements is actually patient education and conversation.
We must have conversations with our patients about the preferences and values, and help them make choices that are the safest and best for THEM.
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We must have conversations with our patients about the preferences and values, and help them make choices that are the safest and best for THEM.
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And once in a while, her choice may include an episiotomy.
This study, from the international urogyn journal, shows that patient education around OB tears and episotomy reduced anxiety and helped make decisions: https://pubmed.ncbi.nlm.nih.gov/31243496/
This study, from the international urogyn journal, shows that patient education around OB tears and episotomy reduced anxiety and helped make decisions: https://pubmed.ncbi.nlm.nih.gov/31243496/
Let's work together toward shared goals:
-Reducing cesarean section rates
-Reducing OASIS rates
-Improving the experience for patients during and after birth, and
(most of all)
-Ensuring our patients are given all the information they need to make their best choices.
12/12
-Reducing cesarean section rates
-Reducing OASIS rates
-Improving the experience for patients during and after birth, and
(most of all)
-Ensuring our patients are given all the information they need to make their best choices.
12/12
