Factors associated with the use of episiotomy during vaginal delivery

OBJECTIVE: To examine factors associated with the performance of episiotomy. METHODS: A retrospective review was performed on 8647 deliveries during 1991 and 1992 at five medical centers. Episiotomy rates were compared based on variables involving patient demographics, obstetric condition, and physician factors for the 6458 vaginal deliveries in the sample. Logistic regression modeling using variables associated in bivariate analysis was performed to examine independent effects of each variable. RESULTS: Several characteristics of the patient, her clinical status, and physician factors were all associated with episiotomy use. The strongest independent predictors of episiotomy were nulliparity (odds ratio [OR] 4.10, 95% confidence interval [CI] 3.59-4.68) and the use of forceps (OR 5.03, 95% CI 3.39-7.46) or vacuum extraction (OR 3.78, 95% CI 2.36-6.04). Provider specialty and the site of care were also associated independently with episiotomy. Episiotomy use was also associated with major perineal lacerations and an increased length of hospital stay. CONCLUSION: Although differences in episiotomy rates mainly reflect clinical circumstances, important site-to-site variations and interspecialty differences point to potential areas where physician behaviors influence the performance of episiotomy.

This article has been cited by other articles:

				M. Alperin, M. A. Krohn, and K. Parviainen Episiotomy and Increase in the Risk of Obstetric Laceration in a Subsequent Vaginal Delivery Obstet. Gynecol., June 1, 2008; 111(6): 1274 - 1278. [Abstract] [Full Text] [PDF]

				R. E. Allen and R. W. Hanson Jr Episiotomy in Low-Risk Vaginal Deliveries J Am Board Fam Med, January 1, 2005; 18(1): 8 - 12. [Abstract] [Full Text] [PDF]

				N. L. S. Howden, A. M. Weber, and L. A. Meyn Episiotomy Use Among Residents and Faculty Compared With Private Practitioners Obstet. Gynecol., January 1, 2004; 103(1): 114 - 118. [Abstract] [Full Text] [PDF]

				A. M. Weber and L. Meyn Episiotomy Use in the United States, 1979-1997 Obstet. Gynecol., December 1, 2002; 100(6): 1177 - 1182. [Abstract] [Full Text] [PDF]

				D A Webb and J Culhane Time of day variation in rates of obstetric intervention to assist in vaginal delivery J Epidemiol Community Health, August 1, 2002; 56(8): 577 - 578. [Full Text] [PDF]

				J. Goldberg, D. Holtz, T. Hyslop, and J. E. Tolosa Has the Use of Routine Episiotomy Decreased? Examination of Episiotomy Rates From 1983 to 2000 Obstet. Gynecol., March 1, 2002; 99(3): 395 - 400. [Abstract] [Full Text] [PDF]

				J. N. ROBINSON, E. R. NORWITZ, A. P. COHEN, and E. LIEBERMAN Predictors of Episiotomy Use at First Spontaneous Vaginal Delivery Obstet. Gynecol., August 1, 2000; 96(2): 214 - 218. [Abstract] [Full Text] [PDF]