Talk:Episiotomy

WebMD

WebMD is not a good primary source for Wikipedia article. Please make an effort to find primary sources. I'm actually disappointed they only cite the name of one researcher, while many studies are typically the work of several scientists. Also: the Hartmann study was a review, not an original study.

I removed some biased pronouncements, and inserted some history. JFW | T@lk 22:00, 24 May 2005 (UTC)

Maintaining NPOV

I removed the following paragraphs from the article:

The birth position commonly used in Western hospitals, while convenient for hospital staff, works against gravity. The baby must be pushed up and over the perineum, and will tend to slam right into it. Birth will often go easier if the mother chooses a position that avoids this. Good positions include squatting, on all fours, and a very upright sitting or kneeling position with one leg up. These positions also provide the woman with a greater feeling of control and authority, which may be helpful when insisting on the right to refuse unnessesary medical procedures.

Labor induction commonly leads to many other interventions including episiotomy, and thus should be avoided by mothers wishing to avoid this surgery. Birth is easier if the birth canal has naturally softened as it does prior to a natural birth.

It is wise to demand that surgical tools be moved outside of the room. Their use will be less likely if they are not within sight and within arm's reach.

The first paragraph, while possibly accurate, is only of tangential relevance to this article on episiotomies. The second and third paragraphs are, as near as I can tell, a mixture of purely original research and absolutely inappropriate medical advice. If someone would like to step up and explain why phrases like "It is wise to demand that surgical tools be moved outside of the room" are appropriate in a Wikipedia article, I am all ears. Nandesuka 02:03, 28 November 2005 (UTC)

If you think that there are probles with sections of an article, by all means edit these sections and improve them. But wholesale removal of sections of articles that you disagree with undermines peoples willingness of people with different viewpoints to contribute to articles. Amnonc 11:50, 28 November 2005 (UTC)

No Amnonc, if a section appears to be original research or POV, it can just as much be deleted for discussion here. I support Nandesuka's deletion of said material. JFW | T@lk 11:56, 28 November 2005 (UTC)

The comment about labor induction leading to other interventions seems to fit with what I've read. I'm sure you could find studies that back up that perspective, although I'm aware that there is some debate about cause and effect because it's true that situations where labor is induced are more likely to have complications for a variety of reasons. Cazort (talk) 02:55, 4 February 2008 (UTC)

Seems to be written by the EpiNo folks. Not a bad product, and their ideas a pretty good. But I don't like that a Wikipedia article sounds so much like marketing for a product. - Trish Ross —Preceding unsigned comment added by 71.138.141.45 (talk) 22:06, 17 December 2009 (UTC)

Scientific Consensus?

There appears to be a consensus in the scientific literature that (a) routine Episiotomy causes harm and brings no benefits, (b) in cases where tears are inevitable, natural tears cause fewer complications. Would anyone dispute this? I can't find any literature to the contrary. If we can agree on this, I think the article needs to be rewritten somewhat--in that it should emphasize that this is an outdated procedure that is generally agreed upon to cause more harm than good except possibly in special cases. The current first paragraph makes it sound more "ok" than the references argue it is. Cazort (talk) 02:28, 11 February 2008 (UTC)

Which references specifically represent your points (a) and (b)? I agree that our articles should fairly and accurately present scientific consensus. Nandesuka (talk) 03:30, 11 February 2008 (UTC)

[1], [2],[3], [4], [5], [6], [7] etc. The list goes on...if you would like to find more articles, try searching MEDLINE or even google scholar. I have not come across a single article that presents any other viewpoint and there are vast numbers of ones supporting the two points I made (among other, more specific objections to the procedure). The studies have varying strengths of conclusions but I have found none that strongly defend the use of the procedure. Nearly all the articles point to the procedure only being appropriate in special circumstances. Cazort (talk) 13:24, 11 February 2008 (UTC)

The subtlety we need to be careful here is located in the word "routine". "Routine", in this context, is a term of art, indicating an episiotomy that is performed whether or not it is indicated. If we write this incorrectly, we will give the impression that the sources are saying that episiotomies should not be performed period.

So in summary, I'm in favor of citing the research showing that (a) episiotomy is overused and (b) routine episiotomies are no longer in favor, as long as we make sure to not overstate the case and turn this into a screed against a procedure that is, sometimes, appropriate. Nandesuka (talk) 14:10, 11 February 2008 (UTC)

This is true. However...what I am also not finding are any sources describing when and why episiotomy is appropriate, and in these cases, how and why it is beneficial. If there are cases like this, it should be pretty easy to find a number of sources. The idea that an episiotomy is sometimes appropriate or beneficial is, like all the other things on this page, something that needs to be backed up by sources if it is to be included on the page. The perspective I seem to be getting from reading the literature can be summed up in this article: [8] ...which is that there is no consensus about when exactly an episiotomy is indicated. Cazort (talk) 16:00, 11 February 2008 (UTC)

The Agency for Healthcare Research and Quality's overview of episiotomy in obstetrical care is a good place to start: [9]. It gives an overview of the history of the technique and discusses fairly the great variation in its use, attributing most routine use to simple local custom.

It's unquestioned that episiotomy is sometimes the appropriate course of action (For example, a 30 second pubmed search brings up here "CONCLUSIONS: Primiparity and occipitoposterior presentation are strong risk factors for the occurrence of anal sphincter injury during operative vaginal delivery. The highly significant protective effect of mediolateral episiotomies in both types of operative vaginal delivery warrants the conclusions that this type of episiotomy should be used routinely during these interventions to protect the anal sphincters.") We should make sure we do due diligence to both points of view here. Nandesuka (talk) 17:34, 11 February 2008 (UTC)

Thanks, this is a great starting point! I will do some reading before I do any more edits. Cazort (talk) 00:22, 12 February 2008 (UTC)

<unindent> See also WHO guidelines - discussion of when episiotomy is appropriate, and relative frequncy if only done when appropriate. [10] See Section 4.7.2Lcwilsie (talk) 20:49, 6 May 2008 (UTC)