Trends in the use of episiotomy in the United States: 1980-1998.
BACKGROUND
Despite a relative paucity of clinical evidence justifying its routine use, approximately 40 percent of all vaginal deliveries include an episiotomy. The purpose of this study is to examine trends in episiotomy in the United States from 1980 through 1998, a period during which calls increased to abandon routine episiotomy.


METHODS
Data were obtained from the National Hospital Discharge Survey, which is conducted annually and based on a nationally representative sample of discharges from short-stay non-Federal hospitals.


RESULTS
From 1980 through 1998 the episiotomy rate in the United States dropped by 39 percent. Rates decreased for all age and racial groups investigated, in all four geographic regions, and for all sources of payment. Significant differences remained between groups in 1998, including a higher rate for white women than for black women, and a higher rate for women with private insurance than for women with Medicaid or in the self-pay category. The incidence of first- and second-degree lacerations to the perineum increased for women without episiotomies, but the more severe third- and fourth-degree lacerations remained more frequent for women with episiotomies. Women with episiotomies were more likely to have forceps-assisted deliveries or vacuum extractions.


CONCLUSIONS
Despite dramatic declines in the use of episiotomy during the last two decades, it remains one of the most frequent surgical procedures performed on women in the United States, and it continues to be performed at a higher rate for certain groups of women.
Weeks
J D
JD
Population Epidemiology Branch, National Center for Health Statistics, CDC/DHHS, 6525 Belcrest Road, Hyattsville, MD 20782, USA.
Kozak
L J
LJ
D000328:Adult; D000367:Age Factors; D003625:Data Collection; D004841:Episiotomy / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D006801:Humans; D015994:Incidence; D007743:Labor, Obstetric; D011247:Pregnancy; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology