Episiotomy in the United States: has anything changed?

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Surgical Outcomes

Background:

• Episiotomy, a surgical incision, was historically common during childbirth.
• Clinical practice guidelines have evolved to discourage routine episiotomy.
• Understanding current episiotomy rates is crucial for assessing maternal and infant outcomes.

Purpose of the Study:

• To analyze trends in episiotomy rates in the United States.
• To evaluate changes in related obstetric outcomes following shifts in clinical practice.
• To assess the impact of changing episiotomy practices on anal sphincter lacerations and delivery modes.

Main Methods:

• Utilized the National Hospital Discharge Survey (NHDS) data from 1979 to 2004.
• Calculated age-adjusted rates for various delivery types and outcomes.
• Employed regression analysis to identify trends in episiotomy usage.

Main Results:

• Episiotomy rates dropped from 60.9% in 1979 to 24.5% in 2004.
• Anal sphincter lacerations decreased with spontaneous vaginal delivery but increased with operative vaginal delivery.
• Operative vaginal delivery rates declined, while cesarean delivery rates significantly increased.

Conclusions:

• The decline in routine episiotomy aligns with recommendations against liberal usage.
• Reduced episiotomy likely contributed to lower rates of anal sphincter lacerations in spontaneous vaginal births.
• The rise in cesarean deliveries may reflect a shift towards surgical intervention for complex births.