Public Release: 

First delivery episiotomies may require repeat procedures -- Ben-Gurion U. researchers

American Associates, Ben-Gurion University of the Negev

NEW YORK...June 19, 2018 - Mothers who have an episiotomy during their first delivery are more likely to require the procedure in subsequent deliveries, according to researchers from Ben-Gurion University of the Negev (BGU) and Soroka University Medical Center in Beer-Sheva, Israel.

In a study published May 21 in Archives of Gynecology and Obstetrics, "Once episiotomy, always episiotomy?," BGU researchers determined that women who had an episiotomy during their first delivery had a higher likelihood for future perineal tissue tears that require surgical incisions during childbirth.

After studying more than 43,000 deliveries at Soroka over 24 years (1991-2015), researchers found that 17.5 percent of mothers who had an episiotomy during their first delivery required repeat procedures, while only 3.1 percent of those who did not have an episiotomy the first time required one.

"To the best of our knowledge, this is the largest study to date that investigated whether an episiotomy in one delivery influences the outcomes of the next one," says Dr. Ayala Zilberman, the lead researcher from BGU and Soroka.

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. While episiotomies can be helpful for accelerating risky deliveries and for preventing significant vaginal lacerations, side effects can include increased blood loss, inflammation, pain, infection, deformed anatomy, and sexual dysfunction.

In 2006, the American Congress of Obstetricians and Gynecologists recommended against routine episiotomy, and in 2008, the National Quality Forum recognized limiting routine episiotomy to be an important measure of quality and patient safety. Subsequently, the episiotomy rate in the United States dropped from 17.3 percent in 2006 to 11.6 percent in 2012, which is closing in on the 10 percent episiotomy rate recommended by the World Health Organization.

"The major finding of this study is that there is an association between episiotomy in the first delivery and repeated episiotomy and perineal damage," says Dr. Zilberman. "Now we must focus on using alternative methods to protect this high-risk group."


In addition to Dr. Zilberman, the BGU research team included Dr. Eyal Sheiner, vice dean for student affairs at BGU's Faculty of Health Sciences and chair of the Department of Obstetrics and Gynecology at Soroka; Dr. Orit Barrett, Ph.D. candidate in BGU's Faculty of Health Sciences; Dr. Tali Silberstein and Dr. Batel Hamou, also of the Department of Obstetrics and Gynecology, Soroka.

About American Associates, Ben-Gurion University of the Negev

American Associates, Ben-Gurion University of the Negev (AABGU) plays a vital role in sustaining David Ben-Gurion's vision: creating a world-class institution of education and research in the Israeli desert, nurturing the Negev community and sharing the University's expertise locally and around the globe. As Ben-Gurion University of the Negev (BGU) looks ahead to turning 50 in 2020, AABGU imagines a future that goes beyond the walls of academia. It is a future where BGU invents a new world and inspires a vision for a stronger Israel and its next generation of leaders. Together with supporters, AABGU will help the University foster excellence in teaching, research and outreach to the communities of the Negev for the next 50 years and beyond. Visit to learn more.

AABGU, which is headquartered in Manhattan, has nine regional offices throughout the United States. For more information, visit

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