Intended for healthcare professionals


Routine episiotomy in developing countries

BMJ 1998; 316 doi: (Published 18 April 1998) Cite this as: BMJ 1998;316:1179

Time to change a harmful practice

  1. A Maduma-Butshe, Maternal and child manager,
  2. Adele Dyall, Formerly senior nursing officer,
  3. Paul Garner, Head
  1. Organisation for Rural Programmes for Women, Khumalo, Bulawayo, Zimbabwe
  2. Keewatin Regional Health Board, Government of the Northwest Territories, Canada
  3. International Health Division, Liverpool School of Tropical Medicine, Liverpool L3 5QA

    More women in developing countries are delivering their babies in hospitals. In Latin America institutional births account for 70% of all deliveries; in Africa, 36%; and in developing countries overall some 40%.1 What is becoming apparent is that in some countries virtually all the women delivering in hospital will be surgically cut. If they miss out on a caesarean section they will have an episiotomy. For example, Brazil has caesarean section rates of greater than 30%, and Argentina has episiotomy rates of greater than 80% for vaginal births. Questions about high caesarean sections rates have been raised in the past, but unnecessary episiotomies have not been widely debated.

    Obstetricians in the tropics continue to instruct health staff to apply a policy of “avoid …

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