Original researchEpisiotomy use in the United States, 1979–1997☆
Section snippets
Materials and methods
The data used in this study were from the National Hospital Discharge Survey, a survey that has been conducted continuously by the National Center for Health Statistics since 1965. This study used data from 1979 to 1997. National Hospital Discharge Survey data were collected from a sample of inpatient records acquired from a national probability sample of hospitals. Only general hospitals with an average length of stay of fewer than 30 days for all patients were included. Federal, military, and
Results
All differences noted were statistically significant with P < .001, unless otherwise specified. The database represented an estimated 73,253,000 deliveries over the 19 years from 1979 to 1997, of which 54,085,000 (74%) were vaginal deliveries. During this time period, the age-adjusted rate for all deliveries stayed relatively stable, varying slightly from year to year, from a low of 62.6 (in 1986) to a high of 69.8 (in 1993) deliveries per 1000 women aged 15–44 (P = 0.1). The number of
Discussion
Recent reviews have conclusively determined that the routine use of episiotomy should be abandoned and that perineal trauma is decreased when episiotomy is not performed.16, 17 However, the optimal rate of episiotomy for maximizing maternal and fetal well-being is not known. Similar to rates of cesarean delivery, the “right” rate has not been identified by scientific evidence and is subject to change based on nonmedical factors. The strongest evidence-based support of the optimal rate of
References (23)
- et al.
Factors related to perineal trauma in childbirth
J Nurse Midwifery
(1996) - et al.
Is there a benefit to episiotomy at spontaneous vaginal delivery? A natural experiment
Am J Obstet Gynecol
(1996) Factors associated with the use of episiotomy during vaginal delivery
Obstet Gynecol
(1996)- et al.
Effect of academic affiliation and obstetric volume on clinical outcome and cost of childbirth
Obstet Gynecol
(2001) - et al.
Is there a benefit to episiotomy at operative vaginal delivery? Observations over ten years in a stable population
Am J Obstet Gynecol
(1997) - et al.
Has the use of routine episiotomy decreased? Examination of episiotomy rates from 1983 to 2000
Obstet Gynecol
(2002) Regional differences in operative obstetricsA look to the South
Obstet Gynecol
(1998)- et al.
Preventing perineal trauma during childbirthA systematic review
Obstet Gynecol
(2000) - et al.
Determinants of vaginal-perineal integrity and pelvic floor functioning in childbirth
Am J Obstet Gynecol
(1997) - et al.
A prospective cohort study of women after primary repair of obstetric anal sphincter laceration
Am J Obstet Gynecol
(1999)
A randomized clinical trial comparing primary overlap with approximation repair of third-degree obstetric tears
Am J Obstet Gynecol
Cited by (64)
Evaluation of a policy of restrictive episiotomy on the incidence of perineal tears among women with spontaneous vaginal delivery: A ten-year retrospective study
2020, Journal of Gynecology Obstetrics and Human ReproductionEvolution of the episiotomy rate in a community hospital, between 2003-2009. Severe perineal tears risk factors
2013, Clinica e Investigacion en Ginecologia y ObstetriciaRegardless of where they give birth, women living in non-metropolitan areas are less likely to have an epidural than their metropolitan counterparts
2013, Women and BirthCitation Excerpt :Furthermore, a Swedish population-based cohort study concluded that differences in epidural rates were influenced by attitudes to epidural analgesia within maternity units.6 Other studies have found increased rates of birth interventions in primiparous women,7,8 women with private health insurance,9,10 and older women.11,12 This paper explores whether differences in birth intervention rates are due to maternal characteristics and women's residence at the time of birthing, regardless of where they actually give birth.
Critical Obstetric and Gynecologic Procedures in the Emergency Department
2013, Emergency Medicine Clinics of North AmericaCitation Excerpt :Moreover, it is less often performed because of many complications, including bleeding, hematoma formation, third- and fourth-degree lacerations, incontinence, infections, swelling, and dyspareunia.11,12 Thus, the routine episiotomy is no longer recommended, but a selective approach is now encouraged.13 Indications for selective episiotomy14 include breech delivery, preterm labor, and imminent perineal tearing (Box 3).
The association between hospital obstetrical volume and maternal postpartum complications
2012, American Journal of Obstetrics and GynecologyCitation Excerpt :We deliberately acquired SID data from the 11 states that were included in this study because they represented all regions of the United States, because they included a disproportionate percentage of the US population, and because they covered a mix of urban and rural regions. SID data include many elements that are included on the Uniform Billing claim form (UB-92) hospital discharge abstract and have been used extensively in previous health services research, including previous obstetrics studies.21-23 Key data elements include patient demographics, admitting hospital, primary and secondary diagnoses and procedures (as captured by ICD-9-CM codes), the diagnosis related group, admission source (eg, emergency department, transfer from another hospital), admission and discharge dates, patient's primary insurance (categorized as Medicare, private insurance, Medicaid, self-pay, other), type of insurance (fee-for-service or health maintenance organization), and disposition at the time of hospital discharge (eg, transfer to another acute care hospital, deceased).
- ☆
This research was financially supported by the Department of Obstetrics, Gynecology and Reproductive Sciences at Magee-Womens Hospital in Pittsburgh, PA.