In the Journals

Episiotomy procedures decline among vaginal deliveries

Episiotomy rates dropped over a six-year period, possibly because two organizations recommended against their use, including the American Congress of Obstetricians and Gynecologists in 2006 and the National Quality Forum in 2008, according to a recently published study.

“These observations suggest nonmedical factors are related to episiotomy,” the researchers wrote.

Alexander M. Friedman

Alexander M. Friedman, MD, of the department of Obstetrics and Gynecology at Columbia University College of Physicians and Surgeons, and colleagues, used an all-payer database at more than 500 hospitals to assess the rate of episiotomies in women who underwent vaginal deliveries between 2006 to 2012. They excluded women whose deliveries included shoulder dystocia, fetal distress and fetal heart rate abnormalities because these conditions could indicate episiotomy.

Out of 2,261,070 women who were hospitalized for vaginal deliveries, 325,193 women underwent episiotomy (14.4%, 95% CI, 14.4%-14.5%). Results demonstrated episiotomy rates decreased between 2006 (17.3%; 95% CI, 17.2%-17.4%) and 2012 (11.6%; 95% CI, 11.5%-11.7%).

Demographic characteristics were associated with whether women underwent episiotomies. The rate of white women who had episiotomies was 15.7% (95% CI, 15.6%-15.8%) vs. 7.9% of black women (95% CI, 7.8%-8%). Moreover, 17.2% (95% CI, 17.1%-17.3%) of women with commercial insurance received episiotomies compared to 11.2% (95% CI, 11.1%-11.3%) of those with Medicaid. Rural hospital location and hospital teaching status were also associated with fewer episiotomies.

“While episiotomy use is less common, it is still a commonly used obstetrical procedure.  While it should only be performed for specific clinical indications, there are many hospitals where routine use appears common,” Friedman told Healio Family and Internal Medicine.

Disclosure: The researchers report no relevant financial disclosures.

Episiotomy rates dropped over a six-year period, possibly because two organizations recommended against their use, including the American Congress of Obstetricians and Gynecologists in 2006 and the National Quality Forum in 2008, according to a recently published study.

“These observations suggest nonmedical factors are related to episiotomy,” the researchers wrote.

Alexander M. Friedman

Alexander M. Friedman, MD, of the department of Obstetrics and Gynecology at Columbia University College of Physicians and Surgeons, and colleagues, used an all-payer database at more than 500 hospitals to assess the rate of episiotomies in women who underwent vaginal deliveries between 2006 to 2012. They excluded women whose deliveries included shoulder dystocia, fetal distress and fetal heart rate abnormalities because these conditions could indicate episiotomy.

Out of 2,261,070 women who were hospitalized for vaginal deliveries, 325,193 women underwent episiotomy (14.4%, 95% CI, 14.4%-14.5%). Results demonstrated episiotomy rates decreased between 2006 (17.3%; 95% CI, 17.2%-17.4%) and 2012 (11.6%; 95% CI, 11.5%-11.7%).

Demographic characteristics were associated with whether women underwent episiotomies. The rate of white women who had episiotomies was 15.7% (95% CI, 15.6%-15.8%) vs. 7.9% of black women (95% CI, 7.8%-8%). Moreover, 17.2% (95% CI, 17.1%-17.3%) of women with commercial insurance received episiotomies compared to 11.2% (95% CI, 11.1%-11.3%) of those with Medicaid. Rural hospital location and hospital teaching status were also associated with fewer episiotomies.

“While episiotomy use is less common, it is still a commonly used obstetrical procedure.  While it should only be performed for specific clinical indications, there are many hospitals where routine use appears common,” Friedman told Healio Family and Internal Medicine.

Disclosure: The researchers report no relevant financial disclosures.