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• W2039815700 abstract "In his ‘Sketches from The Lancet’ (April 24, p 1453)1Kandela P Sketches from The Lancet: clitoridectomy.Lancet. 1999; 353: 1453Summary Full Text Full Text PDF PubMed Google Scholar Peter Kandela describes how over 130 years ago The Lancet played a part in turning support away from one form of female genital mutilation in the UK—clitoridectomy. Hopefully, you can play a part in turning support away from another form of female genital mutilation which is widespread in the UK today—episiotomy.After their review of scientific evidence, Thacker and Banta2Thacker S Banta D Benefits and risks of episiotomy: an interpretive review of the English language, 1860–1980.Obstet Gynecol Surv. 1983; 38: 322-338Crossref PubMed Scopus (356) Google Scholar concluded that an episiotomy rate over 20% cannot be justified. On the basis of this and other evidence, WHO published the recommendation: “The systematic use of episiotomy is not justified. The protection of the perineum through alternative methods should be evaluated and adopted”.3WHO.Appropriate technology for birth.Lancet. 1985; ii: 436-437Google Scholar More recent research presents further evidence against frequent use of episiotomy.4Klein M Gauthier R Jorgensen S et al.Does episiotomy prevent perineal trauma and pelvic floor relaxation?.Curr Clin Trials. 1992; i (document 10)Google ScholarAll this evidence shows that, compared with a natural tear, episiotomy results in more bleeding, more pain, more permanent vaginal deformity, more temporary, and longlasting difficulty with sexual intercourse. Further, the main benefits claimed by proponents of episiotomy—prevention of third-degree tears, prevention of long-term damage to the pelvic floor, and protection of the baby from the adverse consequences of an extended second stage of labour—are not supported by the evidence.Despite the evidence, widespread use of episiotomy continues. In US hospitals “rates for primiparous women in excess of 80% are commonplace”.4Klein M Gauthier R Jorgensen S et al.Does episiotomy prevent perineal trauma and pelvic floor relaxation?.Curr Clin Trials. 1992; i (document 10)Google Scholar Episiotomy rates for all births in Eastern Europe are essentially 100%.5Wagner M Pursuing the birth machine: the search for appropriate birth technology. ACE Graphics, Sydney1994Google Scholar On the other hand, the national episiotomy rate for the Netherlands is 8%, and the rate for planned out-of-hospital births (home or birth centre) managed by midwives in the USA is between 4% and 20%.5Wagner M Pursuing the birth machine: the search for appropriate birth technology. ACE Graphics, Sydney1994Google ScholarClosing the gap between the evidence for and against episiotomy and the practice of episiotomy is as difficult and painful as closing the episiotomy wound. Can The Lancet once more help turn support away from female genital mutilation, in this case its modern form—episiotomy? In his ‘Sketches from The Lancet’ (April 24, p 1453)1Kandela P Sketches from The Lancet: clitoridectomy.Lancet. 1999; 353: 1453Summary Full Text Full Text PDF PubMed Google Scholar Peter Kandela describes how over 130 years ago The Lancet played a part in turning support away from one form of female genital mutilation in the UK—clitoridectomy. Hopefully, you can play a part in turning support away from another form of female genital mutilation which is widespread in the UK today—episiotomy. After their review of scientific evidence, Thacker and Banta2Thacker S Banta D Benefits and risks of episiotomy: an interpretive review of the English language, 1860–1980.Obstet Gynecol Surv. 1983; 38: 322-338Crossref PubMed Scopus (356) Google Scholar concluded that an episiotomy rate over 20% cannot be justified. On the basis of this and other evidence, WHO published the recommendation: “The systematic use of episiotomy is not justified. The protection of the perineum through alternative methods should be evaluated and adopted”.3WHO.Appropriate technology for birth.Lancet. 1985; ii: 436-437Google Scholar More recent research presents further evidence against frequent use of episiotomy.4Klein M Gauthier R Jorgensen S et al.Does episiotomy prevent perineal trauma and pelvic floor relaxation?.Curr Clin Trials. 1992; i (document 10)Google Scholar All this evidence shows that, compared with a natural tear, episiotomy results in more bleeding, more pain, more permanent vaginal deformity, more temporary, and longlasting difficulty with sexual intercourse. Further, the main benefits claimed by proponents of episiotomy—prevention of third-degree tears, prevention of long-term damage to the pelvic floor, and protection of the baby from the adverse consequences of an extended second stage of labour—are not supported by the evidence. Despite the evidence, widespread use of episiotomy continues. In US hospitals “rates for primiparous women in excess of 80% are commonplace”.4Klein M Gauthier R Jorgensen S et al.Does episiotomy prevent perineal trauma and pelvic floor relaxation?.Curr Clin Trials. 1992; i (document 10)Google Scholar Episiotomy rates for all births in Eastern Europe are essentially 100%.5Wagner M Pursuing the birth machine: the search for appropriate birth technology. ACE Graphics, Sydney1994Google Scholar On the other hand, the national episiotomy rate for the Netherlands is 8%, and the rate for planned out-of-hospital births (home or birth centre) managed by midwives in the USA is between 4% and 20%.5Wagner M Pursuing the birth machine: the search for appropriate birth technology. ACE Graphics, Sydney1994Google Scholar Closing the gap between the evidence for and against episiotomy and the practice of episiotomy is as difficult and painful as closing the episiotomy wound. Can The Lancet once more help turn support away from female genital mutilation, in this case its modern form—episiotomy?" @default.
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• W2039815700 title "Episiotomy: a form of genital mutilation" @default.
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