The Use of Episiotomy in a Low-Risk Population in The Netherlands: A Secondary Analysis

Authors

  • A. E. Seijmonsbergen-Schermers MSc, RM,

    Corresponding author
    1. Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
    • Address correspondence to A. E. Seijmonsbergen-Schermers, Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.

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  • C. C. Geerts MD, PhD,

    1. Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
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  • M Prins MSc, RM,

    1. Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
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  • M. T. van Diem MSc, RM,

    1. Department of Obstetrics and Gynecology, University Medical Centre Groningen, Groningen, The Netherlands
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  • T. Klomp MSc, RM,

    1. Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
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  • A. L. M. Lagro-Janssen MD,

    Professor
    1. Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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  • A. de Jonge PhD, RM

    1. Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
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Abstract

Background

To examine the episiotomy incidence and determinants and outcomes associated with its use in primary care midwifery practices.

Methods

Secondary analysis of two prospective cohort studies (n = 3,404).

Results

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%).

Conclusions

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.

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