Role of Obstetric Violence and Patient Choice: Factors Associated With Episiotomy

In the United States, 1 in 6 women reports obstetric violence in the form of physical and verbal abuse, coercion, and lack of informed consent. Despite recommendations against routine episiotomy, its use in the United States remains notable and varies considerably. This study aimed to analyze the various forms of obstetric violence associated with undergoing an episiotomy and having a choice in undergoing an episiotomy.

Data from the cross-sectional Listening to Mothers in California survey were analyzed using weighted sample. Logistic regression models were conducted to compute adjusted odds ratios (aORs) and 95% CIs for undergoing episiotomy and having a choice in it.

Overall, 21% of the respondents reported undergoing an episiotomy, and 75% of them reported not having a choice in undergoing this procedure. After adjusting for covariates, feeling pressured to induce labor (aOR, 1.31; 95% CI, 1.28-1.35) and to use an epidural analgesia (aOR, 1.82; 95% CI, 1.77-1.88) increased the odds of undergoing an episiotomy. Having a midwife during childbirth significantly reduced the odds of an episiotomy. Respondents who indicated being handled roughly by health care providers were 95% less likely to have a choice in receiving an episiotomy (aOR, 0.05; 95% CI, 0.04-0.06).

This is the first study to examine other forms of obstetric violence as correlates of episiotomy and having a choice in it. Standardized institutional measures against obstetric violence, patients' ability to make autonomous decisions through informed consent, and engaging midwives could decrease medically unnecessary labor procedures and associated complications.