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Reply to: Episiotomy Use Has Changed


Thorp, John M., Jr. (2009). Reply to: Episiotomy Use Has Changed. American Journal of Obstetrics & Gynecology, 201(1), e18.


Dr Weber's cogent comments on episiotomy practice in the United States are appreciated and reflect a decline that I would describe as gradual. Nevertheless, the fact that there is NO evidence base for the routine use of this procedure begs the question of why so many women in the United States are exposed to a practice with no benefits and substantial harms. If this is progress, then we are changing at a glacial pace; thus, my suggestion is a fresh look at how we use evidence to influence practice.
Moving forward in time into the “age of urogynecology,” one cannot help but see similarities between Delee and Pomeroy's advocacy for routine episiotomy that led to the fad that we know today and the current trend toward doing elective abdominal deliveries to “protect” the pelvic floor. The ancient and wise adage that “Dame Nature is the best midwife” is a testable hypothesis; however, until evidence demonstrates otherwise, spontaneous vaginal delivery should continue to be preeminent. These practice fads that lack an evidence base seem to be far easier to ignite than they are to extinguish.


Reference Type

Journal Article

Year Published


Journal Title

American Journal of Obstetrics & Gynecology


Thorp, John M., Jr.