The Use of Episiotomy in a Low-Risk Population in The Netherlands: A Secondary Analysis
Article first published online: 17 DEC 2013
© 2013, Copyright the Authors Journal compilation © 2013, Wiley Periodicals, Inc.
Volume 40, Issue 4, pages 247–255, December 2013
How to Cite
Birth 40:4 December 2013
- Issue published online: 17 DEC 2013
- Article first published online: 17 DEC 2013
- Manuscript Accepted: 2 OCT 2013
- maternal outcomes
To examine the episiotomy incidence and determinants and outcomes associated with its use in primary care midwifery practices.
Secondary analysis of two prospective cohort studies (n = 3,404).
The episiotomy incidence was 10.8 percent (20.9% for nulliparous and 6.3% for parous women). Episiotomy was associated with prolonged second stage of labor (adj. OR 12.09 [95% CI 6.0–24.2] for nulliparous and adj. OR 2.79 [1.7–4.6] for parous women) and hospital birth (adj. OR 1.75 [1.2–2.5] for parous women). Compared with episiotomy, perineal tears were associated with a lower rate of postpartum hemorrhage in parous women (adj. OR 0.58 [0.4–0.9]). Fewer women with perineal tears reported perineal discomfort (adj. OR 0.35 [0.2–0.6] for nulliparous and adj. OR 0.22 [0.1–0.3] for parous women). Among nulliparous women episiotomy was performed most frequently for prolonged second stage of labor (38.8%) and among parous women for history of episiotomy or prevention of major perineal trauma (21.1%).
The incidence of episiotomy is high compared with some low-risk settings in other Western countries. Episiotomy was associated with higher rates of adverse maternal outcomes. Restricted use of episiotomy is likely to be beneficial for women.