Good news for stretched perineum in the greater Boston area! The rate of episiotomy at Brigham and Women's Hospital has fallen dramatically over the last 10 years. Wanna know why?
Well, for one thing, women refused them! (Go childbirth ed., birth plans and big mouths!) Also, certified nurse midwives were influential.
Another reason?
Peer pressure. Younger docs stopped doing them routinely and wouldn't let the older ones either. An article in the 2005 Journal of the American Medical Association, know as the Hartmann study, was particularly influential, as it found no reason for routine snips to the muscular skin that stretches as the baby's head emerges.
The drop in episiotomy had already begun in 1997, the first year of the study. Then, episiotomy was performed on nearly 30 percent of all births at that hospital. The decline continued slowly. But after the JAMA article came out in 2005, the rate dropped a staggering 50 percent. By the end of the 10-year study, which included 61,268 women (singleton births, head-down position, at least 36 weeks gestation), the BWH rate was 6 percent. The national rate was 9.
From Medscape:
The study concluded that local peer pressure and response to
significant research, in particular the Hartmann study [the 2005 JAMA paper], contributed to
the substantial reduction in rates of episiotomy across patient and
provider groups over the 10-year period.
It recognized several other contributing factors, including
long-standing CNM service in hospital-based practice, and the addition
of CNMs to Harvard Vanguard Medical Associates in 1990. Institution of
the Balanced Scorecard was a factor, as was the gradual retirement of
older obstetricians trained in routine episiotomy. Younger residents
avoid episiotomy, she observed. Dr. Johnson also recognized the
obstetric chiefs' making episiotomy a priority in 2002 and noted that
labor and delivery nurses were educated about the procedure.
She pointed out that women giving birth also increasingly refused episiotomy.
Midwives performed the fewest episiotomies, followed by female physicians (the study noted that select female physicians performed more than 60 percent of all episiotomies performed by female docs). Older male physicians performed the most episiotomies.
Anybody give birth at BWH? Did you have an episiotomy? Midwife? Select female doc? Old dude?
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Photo: limbsandthings.com
