Episiotomy rates decreasing, but procedure still overused

May 07, 2002

LOS ANGELES, May 7 - While episiotomy rates have continued to decrease over the past 19 years, the procedure is still overused, according to researchers at the University of Pittsburgh School of Medicine.

"There has been a substantial drop - from 56 percent in 1979 to 31 percent in 1997 - but the rate is still too high," said Anne Weber, M.D., an associate professor of obstetrics, gynecology and reproductive sciences and an associate investigator at the Magee-Womens Research Institute. "Plus, this is a national average so it means that some hospitals, regions and individual doctors have rates that are even higher."

The finding is significant because women who undergo episiotomy - a deliberate incision into the perineum to enlarge the opening and ostensibly prevent tearing during birth -- have a higher risk of damage to underlying musculature, which can result in rectal dysfunction and fecal incontinence.

"Obviously, this is a horrible situation for a young mother to be in," said Dr. Weber, who presented the study at the 50th annual meeting of the American College of Obstetricians and Gynecologists. "These women also have a much higher risk of developing these problems in later years, even if they do not develop them right away."

Using data from the National Hospital Discharge Survey, Dr. Weber and her colleagues found that the number of episiotomies performed in the United States ranged from a high of 1.9 million in 1981 to a low of slightly less than 1.1 million in 1997, with an annual rate between 18 and 36 per 1,000 women ages 15 to 44. Rates were compared for vaginal and operative deliveries, with both rates declining over time.

Data analysis also revealed that women undergoing episiotomy were more likely to be younger, white and covered by private insurance than those who did not have the procedure.

For further review, similar data was used from the Magee-Womens Hospital of the UPMC Health System, a National Center of Excellence in Women's Health and a teaching hospital dedicated to the care of women and infants.

From 1995 to 1999, Dr. Weber and her colleagues found an overall episiotomy rate of 54 percent, according to the Magee-Womens Hospital Outcomes of Mothers and Infants database. Women who underwent episiotomy at Magee tended to be older, white and giving birth for the first time.

"Surprisingly, women undergoing operative vaginal delivery, say with forceps or vacuum, were less likely to receive episiotomy than those who spontaneously delivered," said Dr. Weber.

Magee residents and faculty had a very low percentage of episiotomy use (17.2 percent), compared to private practitioners (65.7 percent).

"What this analysis demonstrates is the persistence of high rates of episiotomy, particularly among private practitioners, despite current evidence-based recommendations to restrict use of the procedure," Dr. Weber said.
In addition to Dr. Weber, study authors include Leslie Meyn, M.S.; and Nancy Howden, M.D.

Magee-Womens Research Institute is the country's first research institute devoted to women and infants. It was formed in 1992 by Magee-Womens Hospital of the UPMC Health System. The University of Pittsburgh School of Medicine's department of obstetrics, gynecology and reproductive sciences is one of the top three departments in the nation in National Institutes of Health funding.

University of Pittsburgh Medical Center

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