Has the use of routine episiotomy decreased? Examination of episiotomy rates from 1983 to 2000.
OBJECTIVE
To determine if practice patterns have been altered by the large body of literature strongly advocating the selective use of episiotomy.


METHODS
An electronic audit of the medical procedures database at Thomas Jefferson University Hospital from 1983 to 2000 was completed. Univariate and multivariable models were computed using logistic regression models.


RESULTS
Overall episiotomy rates in 34,048 vaginal births showed a significant reduction from 69.6% in 1983 to 19.4% in 2000. Significantly decreased risk of episiotomy was seen based upon year of childbirth (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.86, 0.87), black race (OR 0.29, 95% CI 0.28, 0.31), and spontaneous vaginal delivery (OR 0.40, 95% CI 0.36, 0.45). Increased association with episiotomy was seen in forceps deliveries (OR 4.04, 95% CI 3.46, 4.72), and with third- or fourth-degree lacerations (OR 4.87, 95% CI 4.38, 5.41). In deliveries with known insurance status, having Medicaid insurance was also associated with a decreased episiotomy risk (OR 0.59, 95% CI 0.54, 0.64).


CONCLUSIONS
There was a statistically significant reduction in the overall episiotomy rate between 1983 and 2000. White women consistently underwent episiotomy more frequently than black women even when controlling for age, parity, insurance status, and operative vaginal delivery.
Goldberg
Jay
J
Department of Obstetrics and Gynecology, Division of Research in Reproductive Health, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA. jay.goldberg@mail.tju.edu
Holtz
David
D
Hyslop
Terry
T
Tolosa
Jorge E
JE
D000328:Adult; D000367:Age Factors; D036861:Delivery, Obstetric / Q000379:methods; D004841:Episiotomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D015143:Philadelphia; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011247:Pregnancy; D044469:Racial Groups