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A recent study conducted in France shows a dramatic decrease in episiotomy procedures over a decade, with no corresponding rise in obstetric anal sphincter injuries, challenging previous notions about the necessity of episiotomies.
This is significant because it suggests that restrictive episiotomy policies can be safely implemented without increasing the risk of severe perineal trauma, thus influencing future clinical guidelines and practices.
A study published in PLOS Medicine reveals that from 2010 to 2021, France witnessed a notable decline in episiotomy rates without a corresponding rise in obstetric anal sphincter injuries (OASI) for most women, based on data from national perinatal surveys. The study highlights that the overall prevalence of episiotomy dropped from 25.8% to 8.3%, while OASI rates slightly increased from 0.7% to 1.0%, with statistical insignificance. The research prompts a reevaluation of episiotomy practices, especially during instrumental deliveries in nulliparous women.
Episiotomy rates can be significantly reduced without adverse outcomes.
The significant decrease in episiotomy rates in France illustrates the potential for reducing unnecessary surgical interventions in childbirth.
Lowering episiotomy rates did not correlate with a significant increase in obstetric anal sphincter injuries.
If reducing episiotomy rates does not lead to increased injuries, then these procedures may be unnecessary for most women.
France implemented a restrictive policy on episiotomy starting in 2005, aiming to minimize unnecessary interventions. This study analyzed data from 29,750 women over a decade, showing a significant drop in episiotomy rates from 25.8% in 2010 to 8.3% in 2021.
The analysis suggests that a reduced rate of episiotomy did not lead to a statistically significant increase in severe perineal injuries. This finding challenges the long-held belief that episiotomies are essential to prevent such injuries.
Obstetric anal sphincter injuries do not significantly increase with reduced episiotomy rates.
The prevalence of obstetric anal sphincter injuries has remained relatively stable despite fewer episiotomies, suggesting other factors are at play.
Data shows that the increase in OASI from 0.7% to 1.0% is statistically insignificant.
Observations from the data imply that factors other than episiotomy rates influence OASI prevalence.
"Our results and recent literature suggest that there is a need to reconsider indications of restrictive episiotomy policies for instrumental deliveries in nulliparous women," said Raphaele Houlbracq.
This quote underscores the idea that episiotomies may not be as protective against severe perineal trauma as previously thought, which is crucial for revising clinical practices.
Restrictive episiotomy policies should be reviewed in light of new evidence.
Given the evidence, clinical guidelines could favor more restrictive episiotomy use without compromising maternal outcomes.
The study indicates that routine episiotomy may not be as beneficial as assumed, particularly in terms of reducing OASI.
If reduced episiotomy rates do not increase OASI, and if OASI is not increasing, then restrictive episiotomy policies can be justified.
The implications of this research are substantial for obstetric practices worldwide. If episiotomies can be minimized without increasing the risk of severe perineal injuries, then restrictive practices should be reconsidered.
Future research should focus on identifying those women who might genuinely benefit from episiotomy and refining the indications for its use during childbirth.
Houlbracq R, Le Ray C, Blondel B, Lelong N, Chantry AA, Desplanches T, et al. (2025). Episiotomies and obstetric anal sphincter injuries following a restrictive episiotomy policy in France: An analysis of the 2010, 2016, and 2021 National Perinatal Surveys. PLOS Medicine.