New evidence links episiotomy to higher risk of postpartum bleeding in anemic women
A recent study published in The Lancet Global Health has found that performing an episiotomy—a surgical cut made to enlarge the vaginal opening during childbirth—significantly increases the risk of severe postpartum hemorrhage (PPH) in women with moderate to severe anemia. The findings highlight a potentially important consideration for labor management and maternal health, especially in settings where anemia remains common among pregnant people.
What the study examined
Researchers analyzed data from a large cohort of birthing individuals to assess how episiotomy interacts with anemia to influence the likelihood of PPH. Postpartum hemorrhage is a major cause of maternal morbidity worldwide and is defined by substantial blood loss after delivery, which can require medical interventions such as blood transfusions or surgical procedures. Anemia, characterized by lower than normal hemoglobin levels, is a known contributor to adverse outcomes in pregnancy and delivery.
Key findings
The study identified that women with moderate or severe anemia who underwent an episiotomy faced approximately double the risk of experiencing PPH compared with anemic women who did not have the procedure. In practical terms, this means that an obstetric intervention commonly used to facilitate birth, especially in trajectories of difficult labor, may carry added danger for a sizable subset of patients if anemia is present.
Why this matters for clinical practice
Health professionals routinely weigh the benefits and risks of episiotomy during vaginal birth. While the procedure can prevent certain severe tears or facilitate delivery in specific scenarios, this new evidence suggests that anemia status should factor into decision-making. Clinicians may need to consider alternative labor management strategies for anemic patients, such as careful monitoring, non-surgical pain relief, or selective use of episiotomy only when clearly indicated by fetal or maternal conditions.
Implications for patients and policy
For expectant families, the finding underscores the importance of anemia screening and treatment during pregnancy. Interventions to improve hemoglobin levels—whether through nutrition, iron supplementation, or treatment of underlying conditions—could not only improve overall maternal health but also reduce the risk of severe bleeding in the event of vaginal delivery. On a policy level, the study adds to the ongoing dialogue about standardizing obstetric practices to minimize unnecessary interventions while safeguarding outcomes for high-risk groups.
Practical takeaways
- Discuss birth plans with your healthcare team, including the potential need for episiotomy and how anemia may affect risk.
- Attend routine prenatal checkups that monitor hemoglobin levels and address anemia promptly.
- When anemia is present, explore all options with your clinician, including non-surgical birth aids and anemia management strategies during pregnancy.
- Ensure a well-equipped delivery setting with access to rapid PPH management if bleeding occurs post-delivery.
Looking ahead
The Lancet Global Health study adds a critical data point to the evolving understanding of how maternal health conditions interact with obstetric interventions. As researchers continue to parse subgroups and refine guidelines, the ultimate goal remains clear: safer births with fewer complications for all patients, including those living with anemia.
