Much ado about a little cut: Is episiotomy worthwhile?

Methods to prevent perineal trauma during childbirth include avoiding episi otomy and forceps delivery and slowing delivery of the head to allow the pe rineum time to stretch. Each intervention can lengthen the second stage of labor and change the biophysical stresses on infants and the pelvic floor. Available evidence supports the belief that the interventions are safe for infants and do not lead to significant short- or long-term maternal morbidi ty. We should abandon the conventional teaching that a longer second stage and perineal stretching are harmful. Routine episiotomy is no longer advisa ble. Forces that might inhibit physicians from practicing evidence-based te chniques of obstetric delivery include time pressures, malpractice concerns , lack of experience with slow perineal stretching, and an interventionist practice pattern. Changes in practice can be effectively introduced through consumer pressures, opinion leaders, and in teaching institutions, by hous e staff. (C) 2000 by The American College of Obstetricians and Gynecologist s.