The Leapfrog Group, a Washington D.C.-based nonprofit group striving to improve health care quality and safety, released its 2017 Maternity Care Report yesterday. While there were some promising improvements found in the report, like a significant reduction in the hospital rate of early elective birth (via induction or cesarean), the report showed a rate of unnecessary episiotomies and c-sections in the United States that is still too high.
Routine episiotomy, a procedure where the skin and muscle between the opening of the vagina and the anus (the perineum) is surgically cut, has not been found to provide any benefit or improve health outcomes for parent or baby, and in fact has shown to increase tearing and both short- and long-term recovery complications. A c-section can be a life-saving procedure when it is used for medically necessary reasons, but unfortunately is performed too often for reasons other than medical necessity.
For those who are pregnant or are planning a family in the future, it's important to know how best to avoid procedures that are routinely over-used without benefit. When it comes to avoiding a c-section, there are several factors to consider to reduce your chance of having cesarean surgery. Check out our most popular article on 10 tips for avoiding a first-time cesarean. Ultimately, however, the best, most important decision you can make to avoid interventions like cesarean and episiotomy is this:
Choose your doctor, OB, or midwife AND your place of birth -- hospital, birth center, or home -- with utmost care, investigation, and thought.
Just last year, Consumer Reports revealed to families that your biggest risk for c-section may be the hospital you choose to give birth. Similarly, for both c-section and outdated interventions like routine episiotomy, your choice of care provider, whether OB or midwife, will increase or decrease your chance of having those procedures depending on how often your provider performs them and what she does to support or discourage them.
In order to increase your chances of avoiding a cesarean and episiotomy, be sure to thoroughly interview and investigate your care provider and place of birth long before you go into labor. In many cases, it is possible to change practices and/or place of birth prior to your due date time. Want tips for choosing and interviewing your care provider and place of birth? We have an in-depth resource page with all you need to know!
Be sure to also read the complete Leapfrog Maternity Care Report on their website, where you can also find other hospital performance information relevant to childbearing.
Figure 3 image from The Leapfrog Group Maternity Care Report 2017