HOME HELP CONTACT US SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

Rapid Response to:

Original Articles: Richard E. Allen and Ronald W. Hanson, Jr Episiotomy in Low-Risk Vaginal Deliveries J Am Board Fam Pract 2005; 18: 8-12 [Abstract] [Full text] [PDF]

Rapid Response: Submit a response to this article

Responses published:

EBM and Obstetrics: Two Ships Passing in the Night

Brian Crownover   (8 March 2005)

EBM and Obstetrics: Two Ships Passing in the Night 8 March 2005
Brian Crownover, Family Physician Eglin AFB Family Medicine Residency Send response to journal: Re: EBM and Obstetrics: Two Ships Passing in the Night bkcrown{at}hotmail.com Brian Crownover	I commend the authors for highlighting the nonintuitive findings that half of routine low-risk deliveries at a major hospital still receive episiotomies. These results are less gratifying than a recent review of 34,048 vaginal births at Thomas Jefferson University. Goldberg et al showed a significant reduction in overall episiotomy rates from 69.6% in 1983 to 19.4% in 2000.(1)The sobering news is that the reduction occured in the absence of any specific policy or educational initiative regarding episiotomy. How many additional unnecessary episiotomies could have been avoided with major organizational support? Given the extensive data summarized by the authors showing the clear net harm from routine episiotomies, it is astounding that clinical practice has not caught up to the available evidence. I hope that readers will thoughtfully consider the implications of this article, and that ACOG or other major organization will publicly give routine episiotomies in low -risk women the equivalent of a US Preventive Services Task Force D rating: fair evidence to exclude service. (1) Goldberg J, Holtz D, Hyslop T, Tolosa JE. Has the use of routine episiotomy decreased? Examination of episiotomy rates from 1983 to 2000. Obstet Gynecol. 2002 Mar;99(3):395-400.