title: Episiotomy rates around the world: an update.
abstract: Episiotomy, the unkindest cut of all, persists despite clinical practice guidelines recommending its restrictive use. The purpose of this paper was to compile international statistics on the use of this practice and examine whether current guidance on the restrictive use of episiotomy was being followed.
  
  
  METHODS
  We searched government websites and the Internet, contacted colleagues for references, and checked the references of retrieved citations.
  
  
  RESULTS
  Statistics from around the world revealed overall high rates of episiotomy with a decreasing trend in some countries. Considerable variation occurs in the use of the operation by country, within countries, and even within the same professional provider group.
  
  
  CONCLUSIONS
  Greater efforts are needed than currently in place to reduce the episiotomy rate, particularly in the developing world.
authors.affiliation: School of Nursing at the University of Ottawa and Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham
authors.forename: Guillermo
authors.initials: G
authors.lastname: Carroli
authors.forename: Christine
authors.initials: C
authors.lastname: Davies
authors.forename: Jennifer Mary
authors.initials: JM
authors.lastname: Medves
mesh_terms: D004841:Episiotomy / Q000706:statistics & numerical data*; D005260:Female; D014943:Global Health; D019983:Guideline Adherence; D006801:Humans; D010298:Parity; D017410:Practice Guidelines as Topic; D011247:Pregnancy