Episiotomies and ethics
George F Winter discusses episiotomy and consent from a global perspective, including whether healthcare professionals consider an episiotomy to be an invasive procedure
The term episiotomy describes a surgical incision made in the vaginal wall and perineum, which is performed during the second stage of labour. It was first coined in 1742 by the Irish doctor and medical writer Sir Fielding Ould (1710–1789) to describe ‘difficult deliveries’ and was aimed at preventing perineal lacerations (Zaami et al, 2019). However, although Kopeć-Godlewska et al (2018) state that ‘perineal protection with avoidance of an episiotomy is now considered to be an indicator of good maternal care’, their study of almost 69 000 childbirths in southern Poland ‘found that episiotomy was commonly conducted, despite numerous reports on its potential adverse repercussions and recommendation by the World Health Organization to limit its use’.
According to Djanogly et al (2022), episiotomy is a feature of 1 in 7 UK births; evidence has shown that its routine use can cause more severe perineal and vaginal trauma for women and a 2017 Cochrane review of episiotomy reported that ‘trials failed to consider women's preferences and views on episiotomy, and the outcomes that mattered to them’. These findings confirm Jha's (2020) observation that consent to perform an episiotomy is not only typically obtained verbally immediately prior to undertaking the procedure, but also that securing consent in this way is probably unlawful, with Prof Jha pointing out that ‘[i]n a recent claim of “obstetrical violence” brought against an obstetrician in Los Angeles, it was alleged that the episiotomy was performed without consent’.
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