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Episiotomies discouraged

Rating

5 Star

Episiotomies discouraged

Our Review Summary

This story summarizes a recent American College of Obstetricians and Gynecologists (ACOG) bulletin promoting evidence-based practice for episiotomy during labor and delivery. Episiotomy has few proven benefits, but several potential complications. It is largely an unnecessary surgical procedure for many women, however, the story does provide instances when episiotomy might be medically necessary.

The story provides no quantitative evidence on the risks and benefits of episiotomy; however, there is a good narrative summary of the research presented in the American College of Obstetricians and Gynecologist bulletin: The majority of women do not benefit from having an episiotomy. Women who do not have this procedure are more likely to give birth without damage to the perineum and less likely to experience typical complications of the surgical procedure, including prolonged pain and sexual dysfunction.

The story does not mention the cost of treatment, however, the focus here is on forgoing a surgical procedure, with potential cost savings. For working mothers, reduced recuperation time is also a cost-savings. There are several obstetricians quoted who discuss some pros and cons of the procedure and provide clinical perspective on the practice of episiotomy.

This story is very well done, with a thoughtful summary. And it achieved a 5-star score with only 710 words in the story – quite an accomplishment.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story does not mention the cost of treatment, however, the focus here is on foregoing a surgical procedure, with potential cost savings.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The story provides no quantitative benefits of having or not having the procedure, but there is a good narrative summary on the lack of evidence for the procedure for many women.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story does a nice job summarizing research on the potential harms of episiotomy, though there is no data on the incidence of these harms.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story summarizes the research presented in the American College of Obstetricians and Gynecologist report: most women do not benefit from an episiotomy; they are more likely to give birth without damage to the perineum, while they are less likely to experience typical side effects of the surgical procedure, including pain and sexual dysfunction.

Does the story commit disease-mongering?

Satisfactory

There is no evidence of disease mongering. The story reports a decline in episiotomies: 1.6 million in 1992 to 716,000 in 2003. The American College of Obstetricians and Gynecologists (ACOG) report is appropriately promoting evidence-based practice.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

Sources of information are appropriate and there appears to be no conflict of interest as there is no promotion of a drug, device or procedure.

Does the story compare the new approach with existing alternatives?

Satisfactory

The focus here is on avoiding a procedure that has few proven benefits, but several potential complications. The story also provides examples when episiotomy might be medically necessary.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story is clear that episiotomy is still practiced in women for whom the procedure is necessary.

Does the story establish the true novelty of the approach?

Satisfactory

The story states that the practice of routine episiotomy during labor and delievery is no longer appropriate due to a lack of clinical evidence for its benefit in most women. The story mentions that evidence against routine episiotomy has been available for a while, but some doctors still perform the procedure regularly.

Does the story appear to rely solely or largely on a news release?

Satisfactory

There are several obstetricians quoted other than the authors of the report. Sources discuss pros and cons of the procedure and provide clinical perspective on the report and the practice of episiotomy.

Total Score: 10 of 10 Satisfactory

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