Advertisement

Episiotomy and its role in the incidence of perineal lacerations in a maternity center and a tertiary hospital obstetric service

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      This study examines the use of episiotomy and the frequency of perineal lacerations in a primary care maternity center staffed by certified nurse-midwives (Booth Maternity Center) and a tertiary care teaching hospital where deliveries were performed by physicians (Thomas Jefferson University Hospital). The study sample (1262 women) was a stratified random selection of singleton live births in 1977 and 1978 at Booth Maternity Center and Thomas Jefferson University Hospital, with the demographic characteristics of women at Booth Maternity Center used as the sampling frame. Data were abstracted from medical records. Clinical and demographic factors that might be associated with the likelihood of having an episiotomy or experiencing a perineal laceration were examined using logistic regression. After controlling for other significant factors, women at Thomas Jefferson University Hospital were twice as likely to have an episiotomy as women at Booth Maternity Center. Use of an episiotomy was associated with a decrease in perineal lacerations of first- or second-degree, but a fourfold increase in the incidence of third-degree lacerations. (Am J Obstet Gynecol 1989;160:1047-52.)

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Pritchard JA MacDonald PC Gant NF Williams' obstetrics.17th ed. AppletonCentury-Crofts, Norwalk, Connecticut1985: 347-351
        • Thacker SB
        • Banta HD
        Benefits and risks of episiotomy: an interpretive review of the English language literature, 1860-1980.
        Obstet Gvnecol Surv. 1983; 36: 322-338
        • Dunne K
        Characteristics associated with perineal condition in an alternative birth center.
        J Nurse Midwifery. 1984; 29: 29-33
        • Baruffi G
        • Dellinger Jr, WS
        • Strobino DM
        • Rudolf A
        • Timmons RY
        • Ross A
        A study of pregnancy outcomes in a maternity center and a tertiary care hospital.
        Am J Public Health. 1984; 74: 973-978
        • Gass MS
        • Dunn C
        • Stys SJ
        Effect of episiotomy on the frequency of vaginal outlet lacerations.
        J Reprod Med. 1986; 31: 240-244
        • Cleary PD
        • Angel R
        The analysis of relationships involving dichotomous dependent variables.
        J Health Soc Behav. 1984; 25: 334-338
        • Thorp Jr, JM
        • Bowes Jr, WA
        • Brame RG
        • Cefalo R
        Selected use of midline episiotomy: effect on perineal trauma.
        Obstet Gynecol. 1987; 70: 260-262
        • Enkin MW
        • Hunter DJ
        • Snell L
        Editorial: Episiotomy: effects of a research protocol on clinical practice.
        Birth. 1984; 11: 145-146
        • Mayes F
        • Oakley D
        • Wranesh B
        • Springer M
        • Krumlauf J
        • Crosby R
        A retrospective comparison of certified nurse-midwife and physician management of low risk births: a pilot study.
        J Nurse Midwifery. 1987; 32: 216-221
        • Reynolds JL
        • Yudkin PL
        Changes in the management of labor: 2. Perineal management.
        Can Med Assoc J. 1987; 136: 1045-1049
        • Sleep J
        • Grant A
        • Garcia J
        • Elbourne D
        • Spencer J
        • Chalmers I
        West Berkshire perineal management trial.
        Br Med J. 1984; 289: 587-590
        • Harrison RE Brennan M
        • North PM
        • Reed JV
        • Wickham EA
        Is routine episiotomy necessary?.
        Br Med J. 1984; 288: 1971-1975
        • Buekens P
        • Lagasse R
        • Dramaix M
        • Wollast E
        Episiotomy and third degree tears.
        Br J Obstet Gynaecol. 1985; 92: 820-823