Risk factors and midwife-reported reasons for episiotomy in women undergoing normal vaginal delivery

• Published in: Archives of gynecology and obstetrics Vol. 288; no. 6; pp. 1249 - 1256
• Main Authors: Wu, Lin Chieh, Malhotra, Rahul, Allen, John Carson, Lie, Desiree, Tan, Thiam Chye, Østbye, Truls
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2013; Springer Nature B.V
• Subjects: Adult; Birth Weight; Endocrinology; Episiotomy - statistics & numerical data; Female; Focus Groups; Gynecology; Health risk assessment; Human Genetics; Humans; Logistic Models; Maternal Age; Maternal-Fetal Medicine; Medicine; Medicine & Public Health; Midwifery; Multivariate Analysis; Nurse Midwives - psychology; Obstetric Labor Complications; Obstetrics/Perinatology/Midwifery; Parity; Perineum - surgery; Practice Patterns, Nurses' - statistics & numerical data; Pregnancy; Pregnancy Outcome; Prevalence; Retrospective Studies; Risk Factors; Singapore - epidemiology; Singapore; Checklist; Episiotomy; Guideline; Singapore; Midwife
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-013-2897-6

Purpose In Singapore, a developed Asian nation, a relatively high proportion of women undergo episiotomy. We assess risk factors and midwife-reported reasons for episiotomy among women undergoing normal vaginal deliveries (NVDs) conducted by midwives and ascertain the association between episiotomy and degree of perineal tear. Methods Participants included 77 midwives from a high-volume delivery unit in Singapore. The study had three sequential phases: (1) medical record review of women undergoing NVDs conducted by midwives over a 1-month period to document the proportion with episiotomy; (2) focus group discussions with midwives to form a checklist of reasons for episiotomy; (3) checklist-based documentation of midwife-reported reasons for episiotomy and data collection on maternal, neonatal, practice and midwife factors, and degree of perineal tear among women undergoing NVDs conducted by midwives over a 2-month period. Risk factors for episiotomy were assessed through logistic regression. Results Primiparity, advanced maternal age, Indian ethnicity, higher birth weight and older midwife age were associated with episiotomy. The most common midwife-reported reason for episiotomy among primiparous women was primiparity (55.1 %), and among multiparous women was fetal distress (20.0 %) and poor maternal effort (20.0 %). All women with episiotomy sustained at least a second-degree perineal tear versus 27.1 % among women without episiotomy. Conclusion Most midwife-reported reasons for episiotomy were not congruent with international practice guidelines. Women without episiotomy have lesser tears than those with episiotomy. Practice protocols and educational programs are needed to change episiotomy practice.