Doctors have been delivering babies for so long, you would think they'd know how to do it by now. But a report in the Journal of the American Medical Association suggests that a common procedure many obstetricians perform for the good of their patients may actually be doing them harm.
At issue is the operation known as an episiotomy, a small incision made in the perineum just before delivery to prevent tearing. Even as recently as 20 years ago, when I started medical school, doctors were performing episiotomies routinely. Since then, many studies have cast doubt on the value of the operation. But the report in J.A.M.A.--which pooled the results of 26 medical articles (out of nearly 1,000 on the subject)--is the most definitive. The review showed that episiotomies are linked to higher risk of injury, more difficult healing and more pain. The procedure does nothing to prevent incontinence or improve women's sex lives. Indeed, it is likely to make things worse.
Dr. Katherine Hartmann, the report's lead author, estimates that 1 million women in the U.S. have an unnecessary episiotomy each year. There may be cases in which the procedure is called for--the one you will hear most commonly is fetal distress, which necessitates delivering the baby quickly, before a woman has had time to fully dilate--but according to Hartmann, they are a lot rarer than many obstetricians think.
The lesson for me as an expectant father (my first child is due in June) is that couples should talk to their doctor about episiotomy long before they get into a delivery room. If you would prefer not to have one, say so. My wife's obstetrician, I was pleased to hear, rarely, if ever, performs one, and most of his colleagues don't either.
Sanjay Gupta is a neurosurgeon and CNN medical correspondent