This article traces and analyzes the evolution of obstetric and midwifery doctrine and use of episiotomy in the United States and England. In the US, the routinization of episiotomy eventually resulted from strenuous lobbying efforts of a small group of obstetrician/gynecologists between 1915 and 1935. These physicians claimed episiotomy prevented perineal lacerations, infant morbidity and mortality, and future gynecological problems. In England, the liberal use of episiotomy came about during the 1970s from pressure from obstetricians although no overt campaigning for the practice occurred. In both countries routine episiotomy was encouraged by medical and extra medical factors which involved changes occurring in the dominant belief system in obstetrics, maternity care practices, and the obstetric and midwifery professions.
In more recent years, eventual declines in episiotomy use resulted from childbirth activists and others questioning of the practice and calling on obstetricians to produce evidence that the operation was in fact beneficial. This was facilitated, particularly in England, by midwifery interest in resisting obstetric control.
While scientific evidence showing episiotomy beneficial was not responsible for the adoption of routine episiotomy in either the US or England, the lack of evidence was central to the initial rejection of routine episiotomy in England and resulted in the launching of randomized controlled trials designed to produce evidence of the operation's effectiveness.
This case-study offers insight into some of the diverse factors implicated in bringing about change in obstetric knowledge and practice.
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