title: Episiotomy and severe perineal trauma among Eastern African immigrant women giving birth in public maternity care: A population based study in Victoria, Australia.
abstract: BACKGROUND
  Eastern African immigrants from countries affected by female genital mutilation have resettled in many developed countries, including Australia. Although possibly at risk of perineal trauma and episiotomy, research investigating their perineal status post-migration is sparse.
  
  
  OBJECTIVE
  To investigate variations in episiotomy use and incidence of severe perineal tear for women born in Eritrea, Ethiopia, Somalia and Sudan compared with Australian-born women.
  
  
  METHODS
  A population-based study of 203,206 Australian-born and 3502 Eastern African immigrant women admitted as public patients, with singleton vaginal births between 1999 and 2007, was conducted using the Victorian Perinatal Data Collection. Descriptive and multivariable logistic regression analysis adjusting for confounders selected a priori, were performed to compute incidence and adjusted odds ratios.
  
  
  RESULTS
  Overall, 30.5% Eastern African immigrants had episiotomy compared to 17.2% Australian-born women. Severe perineal trauma occurred in 2.1% of Eastern African immigrants and 1.6% of Australian-born women. While the odds of severe perineal trauma was significantly elevated only during non-instrumental vaginal births for Eastern African immigrants {ORadj1.56 95%CI(1.17, 2.12)}; that of episiotomy was increased during both non-instrumental {ORadj4.47 95%CI(4.10, 4.88)} and instrumental {ORadj2.51 95%CI(1.91, 3.29)} vaginal births.
  
  
  CONCLUSIONS
  Overall, Eastern African immigrant women experienced elevated odds of episiotomy and severe perineal tear. Health care providers need to be mindful of the increased risk of severe perineal tear in these women and enhance efforts in identification and treatment of severe perineal trauma to minimise associated short and long term morbidity. Strategies to reduce unneeded episiotomy and ways of enhancing perineal safety are also needed.
authors.affiliation: The Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000, Australia. Electronic address: fbelihu@students.latrobe.edu.au.
authors.forename: Fetene B
authors.initials: FB
authors.lastname: Belihu
authors.affiliation: The Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000, Australia. Electronic address: R.Small@latrobe.edu.au.
authors.forename: Rhonda
authors.initials: R
authors.lastname: Small
authors.affiliation: The Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000, Australia; Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia. Electronic address: mary-ann.davey@monash.edu.
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davey
mesh_terms: D000328:Adult; D001315:Australia; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D004841:Episiotomy / Q000706:statistics & numerical data*; D019017:Eritrea; D005260:Female; D006771:Hospitals, Maternity / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D022125:Lacerations / Q000209:etiology*; D007744:Obstetric Labor Complications / Q000209:etiology*; D016017:Odds Ratio; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D011633:Public Facilities / Q000706:statistics & numerical data*; D012307:Risk Factors; D012998:Somalia; D013397:Sudan; D014739:Victoria
keywords: Episiotomy; Eritrea; Ethiopia; Somalia; Sudan