Mothers who have an episiotomy during their first delivery are more likely to require the procedure in subsequent deliveries, according to new research conducted at Ben-Gurion University of the Negev (BGU) and Soroka University Medical Center in Beersheva.

An episiotomy is a surgical cut made at the opening of the vagina during childbirth to aid a difficult delivery and prevent tissues from rupturing. The new research shows that having an episiotomy during a first delivery results in a higher likelihood for future perineal tissue tears  during childbirth that require surgical incisions.

The BGU researchers studied more than 43,000 deliveries at Soroka over 24 years, from 1991 to 2015. They found that 17.5 percent of mothers who underwent an episiotomy during their first delivery required repeat procedures, while only 3.1% of those who did not have an episiotomy the first time required one.

Episiotomies can be helpful for accelerating risky deliveries and for preventing significant vaginal lacerations. But there are also significant side effects, including increased blood loss, inflammation, pain, infection, deformed anatomy and sexual dysfunction.

Episiotomies were fairly routine in the United States until 2006 when the American Congress of Obstetricians and Gynecologists recommended against them. In 2008, the National Quality Forum went further, recognizing that limiting routine episiotomy was an important measure of quality and patient safety. That led to a drop in the US episiotomy rate from 17.3% in 2006 to 11.6% in 2012.

The World Health Organization recommends an episiotomy rate of no more than 10%.

BGU lead researcher Dr. Ayala Zilberman called the new data the largest study to date and said that “now we must focus on using alternative methods to protect this high-risk group.”

The study was published in May 2018 in the Archives of Gynecology and Obstetrics, under the title “Once episiotomy, always episiotomy?”.

Other researchers involved in the study were from BGU’s Faculty of Health Sciences and the Department of Obstetrics and Gynecology at Soroka.