Original articlesPredictors of episiotomy use at first spontaneous vaginal delivery
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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