Cross-sectional study comparing public and private hospitals in Catalonia: Is the practice of routine episiotomy changing?

Abstract

BackgroundIn Spain, the Strategy for Assistance in Normal Childbirth (SANC) promoted a model of care, which respects the physiological birth process and discards unnecessary routine interventions, such as episiotomies. We evaluated the rate of episiotomy use and perineal trauma as indicators of how selective introduction of the SANC initiative has impacted childbirth outcomes in hospitals of Catalonia.MethodsCross-sectional study of all singleton vaginal term deliveries without instrument registered in the Minimum Basic Data Set (MBDS) of Catalonia in 2007, 2010 and 2012. Hospitals were divided into types according to funding (public or private), and four strata were differentiated according to volume of births attended.Episiotomies and perineal injury were considered dependent variables. The relationship between qualitative variables was analysed using the chi-squared test, and Student’s t-test was used for quantitative variables. Comparison of proportions was performed on the two hospital groups between 2007 and 2012 using a Z-test. Logistic regression models were used to analyse the relationship between episiotomy or severe perineal damage and maternal age, volume of births and hospital type, obtaining odds ratios (OR) and 95% confidence intervals (CI).ResultsThe majority of normal singleton term deliveries were attended in public hospitals, where maternal age was lower than for women attended in private hospitals. Analysis revealed a statistically significant (P < 0.001) decreasing trend in episiotomy use in Catalonia for both hospital types. Private hospitals appeared to be associated with increased episiotomy rate in 2007 (OR = 1.099, CI: 1,057–1,142), 2010 (OR = 1.528, CI: 1,472–1,587) and 2012 (OR = 1.459, CI: 1,383–1,540), and a lower rate of severe perineal trauma in 2007 (OR = 0.164, CI: 0.095–0.283), 2010 (OR = 0.16, CI: 0.110–0.232) and 2012 (OR = 0.19, CI: 0.107–0.336). Regarding severe perineal injury, when independent variables were adjusted, maternal age ceased to have a significant correlation in 2012 (OR = 0.994, CI: 0.970–1.018).ConclusionsEpisiotomy procedures during normal singleton vaginal term deliveries in Catalonia has decreased steadily since 2007. Study results show a stable incidence trend below 1% for severe perineal trauma over the study period.

Prevalence and Factors Associated With Episiotomy in Shahroud City, Northeast of Iran

“…In agreement with the present study, a study by Carvalho et al in Brazil showed mean age of mothers 24.7 years in episiotomy group and 24.7 years in non-episiotomy group (11). Other studies have also shown a relationship between younger maternal age and increased risk of episiotomy (5,12,13). In the present study, logistic regression results confirmed oxytocin as a predictor of episiotomy (OR = 2.874).…”

Risk factors for episiotomy during vaginal childbirth: A retrospective cohort study in Western China

“…The prevalence of episiotomy in our WC cohort was 44% which was generally lower than other Asian countries reported rates of 63.4% (Indian), 66% (Oman), and 75.1% (Yemen) . The WC episiotomy rate was generally higher than that in America (6.7%), Australia (17.2%), and Spain (30.0%); and comparable to one German study reporting 37.7% and 41.4% in Jordan . The WC prevalence of 52.9% among primiparas was lower than 77% reported by Enyindah's Nigerian study and 85.1% in India .…”

Knowledge, attitude and practice regarding pharmacological methods of labor analgesia

“…It was also observed that obstetricians with a higher mean age and longer time working in the delivery room tend to believe in the effectiveness of pudendal nerve block more frequently than younger obstetricians with less time working in this area. This relationship may reflect a decrease in the indication for episiotomy and an increase in the use of the vacuum extraction over forceps in recent years, having an impact on its indication as a method of labor analgesia [27][28][29] .…”