Episiotomy use among residents and faculty compared with private practitioners.
OBJECTIVE
To describe trends in episiotomy use among residents, faculty, and private practitioners at an academic institution.


METHODS
We reviewed data from the Magee Obstetric Medical and Infant database, containing details of every delivery at Magee-Womens Hospital since 1995. The study population was women who had spontaneous or operative vaginal delivery of a singleton, liveborn, vertex-presenting infant, at 37 weeks or more, from 1995 to 2000 (completed data set years). The first delivery recorded for a patient in the database was analyzed. Residents and faculty were described as "academic" practitioners. Data were analyzed with the Fisher exact test, chi2 test for linear trend, and logistic regression models.


RESULTS
There were 27702 women with 15190 episiotomies, for an episiotomy rate of 54.8%. The rate of episiotomies decreased from 59.7% to 45.0% during the study period (P <.001). Independent risk factors for episiotomy included age 30 years or more, white race, higher educational status, married, nulliparity, and history of cesarean delivery. The strongest predictor of episiotomy use was practitioner type, with women attending private physicians having an adjusted 7-fold increased risk of episiotomy (odds ratio 7.1; 95% confidence interval 6.5, 7.7). Patient characteristics related to practitioner type included age, race, educational status, marital status, nulliparity, and mode of delivery (P <.001).


CONCLUSIONS
High rates of episiotomy use were found among private practitioners, despite current evidence-based literature that supports restricted use of episiotomy.
Howden
Nancy L S
NL
University of Pittsburgh Health Sciences Center, Magee-Womens Hospital, Department of Obstetrics, Gynecology, and Reproductive Sciences, Pittsburgh, Pennsylvania 15213, USA. nhowden@mail.magee.edu
Weber
Anne M
AM
Meyn
Leslie A
LA
D000328:Adult; D019992:Databases as Topic; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D004841:Episiotomy / Q000706:statistics & numerical data*; D005180:Faculty, Medical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D010414:Pennsylvania / Q000453:epidemiology; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011331:Private Practice / Q000706:statistics & numerical data; D012307:Risk Factors