Episiotomy, hospital birth and cesarean section: technology gone haywire--what is the sutured tear rate at first births supposed to be?
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One hundred percent of woman having a first vaginal birth from 1940-1990 had an episiotomy. It is still used for first births at a rate of 50-60% in many places. Perineal outcomes on first births are critical because the biggest risk factor for needing suturing on subsequent births is a previous episiotomy. No scientific evidence has demonstrated improved outcomes with episiotomy. This paper documents a rate of 99% intact perineums, 1% sutured perineums, in a group of 80 primipara in their early 20s at attended homebirths, average birth weight 3150 gm. Primipara women in their late-20s with 3400 gm babies experienced a 28% sutured tear rate at planned home-births. This suggests that homebirth with a motivated attendant, young age and birth weight of 3150 gm can almost always deliver vaginally without perineal damage. Episiotomy, hospital birth for healthy pregnancies and elective cesarean surgery are commonly practiced, dangerous, out-of-date medical routines unsupported by research.