title: The use of episiotomy in a low-risk population in the Netherlands: a secondary analysis.
abstract: BACKGROUND
  To examine the episiotomy incidence and determinants and outcomes associated with its use in primary care midwifery practices.
  
  
  METHODS
  Secondary analysis of two prospective cohort studies (n = 3,404).
  
  
  RESULTS
  The episiotomy incidence was 10.8 percent (20.9% for nulliparous and 6.3% for parous women). Episiotomy was associated with prolonged second stage of labor (adj. OR 12.09 [95% CI 6.0-24.2] for nulliparous and adj. OR 2.79 [1.7-4.6] for parous women) and hospital birth (adj. OR 1.75 [1.2-2.5] for parous women). Compared with episiotomy, perineal tears were associated with a lower rate of postpartum hemorrhage in parous women (adj. OR 0.58 [0.4-0.9]). Fewer women with perineal tears reported perineal discomfort (adj. OR 0.35 [0.2-0.6] for nulliparous and adj. OR 0.22 [0.1-0.3] for parous women). Among nulliparous women episiotomy was performed most frequently for prolonged second stage of labor (38.8%) and among parous women for history of episiotomy or prevention of major perineal trauma (21.1%).
  
  
  CONCLUSIONS
  The incidence of episiotomy is high compared with some low-risk settings in other Western countries. Episiotomy was associated with higher rates of adverse maternal outcomes. Restricted use of episiotomy is likely to be beneficial for women.
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: A E
authors.initials: AE
authors.lastname: Seijmonsbergen-Schermers
authors.forename: C C
authors.initials: CC
authors.lastname: Geerts
authors.forename: M
authors.initials: M
authors.lastname: Prins
authors.forename: M T
authors.initials: MT
authors.lastname: van Diem
authors.forename: T
authors.initials: T
authors.lastname: Klomp
authors.forename: A L M
authors.initials: AL
authors.lastname: Lagro-Janssen
authors.forename: A
authors.initials: A
authors.lastname: de Jonge
mesh_terms: D000328:Adult; D004841:Episiotomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007748:Labor Stage, Second; D016015:Logistic Models; D008880:Midwifery; D015999:Multivariate Analysis; D009426:Netherlands; D007744:Obstetric Labor Complications / Q000517:prevention & control / Q000601:surgery*; D010502:Perineum / Q000293:injuries; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D012307:Risk Factors; D016896:Treatment Outcome
keywords: episiotomy; indications; maternal outcomes