How did episiotomy rates change from 2007 to 2014? Population-based study in France

Abstract

BackgroundSince the 2000s, selective episiotomy has been systematically recommended worldwide. In France, the recommended episiotomy rate in vaginal deliveries is less than 30%. The aims of this study were to describe the evolution of episiotomy rates between 2007 and 2014, especially for vaginal deliveries without instrumental assistance and to assess individual characteristics and birth environment factors associated with episiotomy.MethodsThis population-based study included all hospital discharge abstracts for all deliveries in France from 2007 to 2014. The use of episiotomy in vaginal deliveries was identified by one code in the French Common Classification of Medical Procedures. The episiotomy rate per department and its evolution is described from 2007 to 2014. A mixed model was used to assess associations with episiotomy for non-operative vaginal deliveries and the risk factors related to the women’s characteristics and the birth environment.ResultsThere were approximately 540,000 non-operative vaginal deliveries per year, in the study period. The national episiotomy rate for vaginal deliveries overall significantly decreased from 26.7% in 2007 to 19.9% in 2014. For non-operative deliveries, this rate fell from 21.1% to 14.1%. For the latter, the use of episiotomy was significantly associated with breech vaginal delivery (aOR = 1.27 [1.23–1.30]), epidural analgesia (aOR = 1.45 [1.43–1.47]), non-reassuring fetal heart rate (aOR = 1.47 [1.47–1.49]), and giving birth for the first time (aOR = 3.85 [3.84–4.00]).ConclusionsThe episiotomy rate decreased throughout France, for vaginal deliveries overall and for non-operative vaginal deliveries. This decrease is probably due to proactive changes in practices to restrict the number of episiotomies, which should be performed only if beneficial to the mother and the infant.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1747-8) contains supplementary material, which is available to authorized users.

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“…A study on variation across 13 regions in Canada, including 8,244 women, found varying episiotomy rates of between 5% to 24% [34]. A variation of between 1% and 34% was found for episiotomy rates in non-instrumental births across many regions in France, in a study including national data [35].…”

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“…22 The population-based analysis in France reveals that overall, the national episiotomy rate for vaginal deliveries decreased considerably from 26.7% in 2007 to 19.9% in 2014. 23 The total episiotomy incidence decreased from 20.3% in 2002 to 9.4% in 2011 in the United States. 24 In one European study, episiotomy rates ranged from 3.7% in Denmark to 75% in Cyprus.…”

Factors associated with the performance of episiotomy

“…The World Health Organization (WHO) recommends that the rate of episiotomy in an institution does not exceed 10% (4) . There is a variation in these indices according to the country studied: for example, in France, it was performed in 19.9% of births (5) . In Colombia and Spain, the rate was 30.48% and 50%, respectively (6)(7) .…”