January 15, 2015 — The percentage of vaginal deliveries in the U.S. involving an episiotomy dropped from 17% in 2006 to less than 12% in 2012, a study published Tuesday in the Journal of the American Medical Association had found, according to HealthDay/U.S. News & World Report (Mozes, HealthDay/U.S. News & World Report, 1/13).
An episiotomy is an incision in the perineum to widen the vagina during childbirth (Pappas, Live Science, 1/13). According to the study's authors, episiotomies were performed during about 25% of all vaginal births as recently as 10 years ago. However, the procedure's prevalence has been declining since the 1990s because of concerns about its risks and benefits, according to HealthDay/U.S. News & World Report.
For the study, Alexander Friedman and other researchers from the Columbia University College of Physicians and Surgeons looked at data on more than 2.2 million U.S. women who had vaginal deliveries between 2006 and 2012 at 510 facilities (HealthDay/U.S. News & World Report, 1/13).
The data were taken from an insurance database and excluded deliveries that involved fetal distress, fetal heartbeat abnormalities or shoulder dystocia because such occurrences could warrant an episiotomy, according to MedPage Today's "The Gupta Guide."
The researchers found that 14.4% of the women had an episiotomy between 2006 and 2012, with the overall prevalence of the procedure declining by nearly 32% over that time frame (Brown, "The Gupta Guide," MedPage Today, 1/13).
The researchers noted that some hospitals performed considerably more episiotomies than others during the study period, suggesting that "nonmedical factors are related" to the procedure's use. Specifically, episiotomies were performed in more than 34% of deliveries at the 10% of hospitals that performed the procedure most frequently, while it was used for only 2.5% of deliveries in the 10% of hospitals that used it the least (HealthDay/U.S. News & World Report, 1/13).
Further, the study found that white women, at 15.7%, were nearly two times more likely to undergo an episiotomy than black women, at 7.9%. In addition, women with private health plans underwent the procedure 17.2% of the time, compared with women with Medicaid coverage, who underwent the procedure 11.2% of the time ("The Gupta Guide," MedPage Today, 1/13).