Episiotomy in Modern Obstetrics OR Episiotomy: It's Time to Stop Cutting!

Episiotomy consists of incising the perineum to widen the birth canal. It was historically introduced into medical practice in the 18th century. The purpose of the episiotomy would be to reduce the probability of severe perineal lacerations, while the association with the forceps would minimize the risk of fetal trauma and hypoxia, which was accepted for a long time as an indisputable truth. The use of episiotomy spread enormously after the recommendations of famous obstetricians and began to be used on a larger scale in several countries since the 20th century, although there was no reliable scientific evidence of its effectiveness and safety. In the last decades well-conducted clinical studies on the subject were published and the routine use of episiotomy was questioned. Despite of methodological limitations, the first studies contributed to reduce its practice, including the important participation of women's movements and active childbirth campaigns arguing about the episiotomy use. Current evidence shows that routine episiotomy is not supported in clinical practice and a recent World Health Organization (WHO) guideline strongly recommends against it. However, a lack of knowledge remains as the role of episiotomy in obstetric emergencies and, considering the present evidence, what would be the real benefits for performing an episiotomy. This review aims to show the current state of the art running through the historical background of episiotomy and techniques, analyzing its use worldwide in obstetric practice and discussing the published studies concerning the necessity, the effectiveness, and the consequences of the procedure. Ultimately, regarding the accumulated evidence shown, the authors express their conclusions about the use of episiotomy in obstetric modern practice and the possible strategies to reduce its rates.