Elsevier

Obstetrics & Gynecology

Volume 96, Issue 2, August 2000, Pages 214-218
Obstetrics & Gynecology

Original articles
Predictors of episiotomy use at first spontaneous vaginal delivery

https://doi.org/10.1016/S0029-7844(00)00868-1Get rights and content

Abstract

Objective: To identify factors associated with the use of episiotomy at spontaneous vaginal delivery.

Methods: We studied 1576 consecutive term, singleton, spontaneous vaginal deliveries in nulliparas at Brigham & Women’s Hospital between December 1, 1994 and July 31, 1995. The association of demographic variables and obstetric factors with the rate of episiotomy use were examined. Adjusted odds ratios (OR) and confidence intervals (CI) were estimated from multiple logistic regression analysis.

Results: The overall rate of episiotomy was 40.6% (640 of 1576). Midwives performed episiotomies at a lower rate (21.4%) than faculty (33.3%) and private providers (55.6%) (P = .001). After controlling for confounding factors with logistic regression, private practice provider was the strongest predictor of episiotomy use (OR, 4.1; 95% CI, 3.1, 5.4) followed by faculty provider (OR, 1.7; 95% CI, 1.1, 2.5), prolonged second stage of labor (OR, 1.8; 95% CI, 1.2, 2.7), fetal macrosomia (OR, 1.6; 95% CI, 1.1, 2.5), and epidural analgesia (OR 1.4, 95% CI, 1.1, 1.8).

Conclusion: The strongest factor associated with episiotomy at delivery was the category of obstetric provider. Obstetric and demographic factors evaluated did not readily explain this association.

Section snippets

Materials and methods

We reviewed the medical records of all women who delivered at Brigham and Women’s Hospital between December 1, 1994 and July 31, 1995. The project was approved by the human research committee at the hospital. Practitioners were grouped into three categories according to who performed the delivery. Private practice included all physicians in private practice or part of health maintenance organizations. Faculty included residents (all of whom were supervised by faculty practitioners) and the

Results

The overall episiotomy rate was 40.6% (640 of 1576 deliveries). The particular type of episiotomy was clearly documented in 600 of 640 women who had episiotomies. Six of those had mediolateral episiotomies (1%) and 596 had midline episiotomies (99%). The demographics and characteristics of women with and without episiotomies differed significantly in several ways (Table 1). Women with episiotomies were more likely than those without to have macrosomic infants, epidural anesthesia, to have labor

Discussion

Midline episiotomy is associated with increased incidence of third and fourth degree perineal lacerations.1, 2, 3 Awareness of independent risk factors might help to reduce its use and decrease unwanted sequelae. Our results showed that, in women who delivered spontaneously at term, the factor most strongly associated with episiotomy was the category of obstetric care provider. The proportion of women who had episiotomies was more than double when cared for by a private practitioner than a

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