Skip to main content
NCBI home page
The BMJ logoLink to The BMJ
. 1994 Nov 12;309(6964):1255–1258. doi: 10.1136/bmj.309.6964.1255

Methods and consequences of changes in use of episiotomy.

T B Henriksen 1, K M Bek 1, M Hedegaard 1, N J Secher 1
PMCID: PMC2541821  PMID: 7888844

Abstract

OBJECTIVES--To evaluate the use of feedback by graphical profiles of rates of episiotomy and the impact on clinical practice and perineal state after spontaneous vaginal deliveries assisted by midwives with different attitudes towards episiotomy. DESIGN--Observation period in labour ward followed by feedback to midwives about their own and other midwives' use of episiotomies. The periods before and after the intervention were compared. SUBJECTS--All women (n = 3919) delivering during the two periods who had been assisted by one of 30 midwives; each midwife supervised at least 20 deliveries during each period. MAIN OUTCOME MEASURES--Overall rates of episiotomies and indications, incidence of intact perineums, perineal lacerations, and tears of anal sphincter. RESULTS--The overall rate of episiotomy during the observation period was 37.1% (615). During the second period the rate was 6.6% lower (95% confidence interval 3.6% to 9.6%), corresponding to a relative decrease of 17.8% (10.1% to 24.7%). Higher rates of episiotomy during the observation period were associated with larger reductions in the second period. The decrease could be explained by less use of episiotomy in deliveries with rigid perineum or impending perineal tear. Compared with the observation period, in the second period 3.2% more women (0.3% to 6.3%) had an intact perineum after delivery and 3.4% (0.4% to 6.2%) experienced perineal tears. The overall incidence of tears of the anal sphincter remained unchanged. Women had a slightly reduced incidence of tears of the anal sphincter, however, if they were delivered by midwives who reduced a medium or high initial rate of episiotomy and a tendency towards an increased incidence of tears if they were assisted by midwives who reduced low initial rates (around 20%) of episiotomy. CONCLUSIONS--Changes in the use of episiotomy induced by awareness of clinical practice among midwives seem to increase the incidence of parturients with intact perineum without a concomitant rise in tears of the anal sphincter. To avoid the increase of such tears these changes should probably be restricted to midwives with rates of episiotomies above 30%.

Full text

PDF
1255

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Buekens P., Boutsen M., Kittel F., Vandenbussche P., Dramaix M. Does awareness of rates of obstetric interventions change practice? BMJ. 1993 Mar 6;306(6878):623–623. doi: 10.1136/bmj.306.6878.623. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Buekens P., Lagasse R., Dramaix M., Wollast E. Episiotomy and third-degree tears. Br J Obstet Gynaecol. 1985 Aug;92(8):820–823. doi: 10.1111/j.1471-0528.1985.tb03052.x. [DOI] [PubMed] [Google Scholar]
  3. Gleicher N. Cesarean section rates in the United States. The short-term failure of the National Consensus Development Conference in 1980. JAMA. 1984 Dec 21;252(23):3273–3276. [PubMed] [Google Scholar]
  4. Harrison R. F., Brennan M., North P. M., Reed J. V., Wickham E. A. Is routine episiotomy necessary? Br Med J (Clin Res Ed) 1984 Jun 30;288(6435):1971–1975. doi: 10.1136/bmj.288.6435.1971. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Hemminki E., Teperi J., Tuominen K. Need for and influence of feedback from the Finnish birth register to data providers. Qual Assur Health Care. 1992 Jun;4(2):133–139. [PubMed] [Google Scholar]
  6. Henriksen T. B., Bek K. M., Hedegaard M., Secher N. J. Episiotomy and perineal lesions in spontaneous vaginal deliveries. Br J Obstet Gynaecol. 1992 Dec;99(12):950–954. doi: 10.1111/j.1471-0528.1992.tb13695.x. [DOI] [PubMed] [Google Scholar]
  7. Lomas J., Anderson G. M., Domnick-Pierre K., Vayda E., Enkin M. W., Hannah W. J. Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians. N Engl J Med. 1989 Nov 9;321(19):1306–1311. doi: 10.1056/NEJM198911093211906. [DOI] [PubMed] [Google Scholar]
  8. MANTEL N., HAENSZEL W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959 Apr;22(4):719–748. [PubMed] [Google Scholar]
  9. Mugford M., Banfield P., O'Hanlon M. Effects of feedback of information on clinical practice: a review. BMJ. 1991 Aug 17;303(6799):398–402. doi: 10.1136/bmj.303.6799.398. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Myers S. A., Gleicher N. A successful program to lower cesarean-section rates. N Engl J Med. 1988 Dec 8;319(23):1511–1516. doi: 10.1056/NEJM198812083192304. [DOI] [PubMed] [Google Scholar]
  11. Shiono P., Klebanoff M. A., Carey J. C. Midline episiotomies: more harm than good? Obstet Gynecol. 1990 May;75(5):765–770. [PubMed] [Google Scholar]
  12. Sleep J., Grant A., Garcia J., Elbourne D., Spencer J., Chalmers I. West Berkshire perineal management trial. Br Med J (Clin Res Ed) 1984 Sep 8;289(6445):587–590. doi: 10.1136/bmj.289.6445.587. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Sleep J., Grant A. West Berkshire perineal management trial: three year follow up. Br Med J (Clin Res Ed) 1987 Sep 26;295(6601):749–751. doi: 10.1136/bmj.295.6601.749. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Szczepura A., Mugford M., Stilwell J. A. Information for managers in hospitals: representing maternity unit statistics graphically. Br Med J (Clin Res Ed) 1987 Apr 4;294(6576):875–880. doi: 10.1136/bmj.294.6576.875. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Thacker S. B., Banta H. D. Benefits and risks of episiotomy: an interpretative review of the English language literature, 1860-1980. Obstet Gynecol Surv. 1983 Jun;38(6):322–338. [PubMed] [Google Scholar]
  16. Thranov I., Kringelbach A. M., Melchior E., Olsen O., Damsgaard M. T. Postpartum symptoms. Episiotomy or tear at vaginal delivery. Acta Obstet Gynecol Scand. 1990;69(1):11–15. doi: 10.3109/00016349009021032. [DOI] [PubMed] [Google Scholar]
  17. Watt P. C., Patterson C. C., Kennedy T. L. Late mortality after vagotomy and drainage for duodenal ulcer. Br Med J (Clin Res Ed) 1984 May 5;288(6427):1335–1338. doi: 10.1136/bmj.288.6427.1335. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES