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Web comic summarises Cochrane Review on episiotomy

Tuesday, 23 Jan 2018

Swiss cartoonist Tekai has created a web comic of a recently published Cochrane Review from the Cochrane Pregnancy and Childbirth Group, ’Selective versus routine use of episiotomy for vaginal birth’. The web comic, which aims to make the results of this Cochrane Review more accessible, can be accessed here: http://cookiescience.webcomic.ws/comics/712/. It expertly explains and illustrates the evidence on why day-to-day choices matter and how they all combine, turning even the most difficult topics into lively discussions.  It’s entertaining and accurate, without oversimplifying.

What is the issue addressed in this Cochrane Review?

Normal birth can cause tears to the vagina and the surrounding tissue, usually as the baby's head is born, and sometimes these tears extend to the rectum. These are repaired surgically, but take time to heal. To avoid these severe tears, doctors have recommended making a surgical cut to the perineum with scissors or scalpel to prevent severe tearing and facilitate the birth. This intervention, known as an episiotomy, is used as a routine care policy during births in some countries. Both a tear and an episiotomy need sutures, and can result in severe pain, bleeding, infection, pain with sex, and can contribute to long term urinary incontinence.

Why is this important?

An episiotomy requires suturing and benefits and harms as part of routine management of normal births remains unclear. In particular,we need to know if it does indeed prevent large tears, because women otherwise may be subjected to an unnecessary operation, pain and in some cases long-term problems. The question of whether to apply a policy of routine episiotomy is important for clinical practice and for the health and well-being of women and babies.

Access the full text Cochrane Review here: Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD000081. DOI: 10.1002/14651858.CD000081.pub3


The CIDG editorial base is located at the Liverpool School of Tropical Medicine in Liverpool, UK. The CIDG is led by Professor Paul Garner (Co-ordinating Editor) and Deirdre Walshe (Managing Editor). Over 600 authors from some 52 countries contribute to the preparation of the Cochrane Reviews. They are supported by an international team of Editors, each with topic or methodological expertise. 

The CIDG’s main areas of work are on determination of the effects of interventions on the prevention or treatment infectious diseases of relevance to the United Nations Sustainable Development Goals, particularly malaria, tuberculosis, HIV/AIDS, and neglected tropical diseases. The aims of the CIDG are to impact on policy and research in tropical diseases through the production of high quality and relevant systematic reviews, and to lead developments in review quality improvement and effective dissemination of findings.