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Risk factors and midwife-reported reasons for episiotomy in women undergoing normal vaginal delivery

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

In Singapore, a developed Asian nation, a relatively high proportion of women undergo episiotomy. We assess risk factors and midwife-reported reasons for episiotomy among women undergoing normal vaginal deliveries (NVDs) conducted by midwives and ascertain the association between episiotomy and degree of perineal tear.

Methods

Participants included 77 midwives from a high-volume delivery unit in Singapore. The study had three sequential phases: (1) medical record review of women undergoing NVDs conducted by midwives over a 1-month period to document the proportion with episiotomy; (2) focus group discussions with midwives to form a checklist of reasons for episiotomy; (3) checklist-based documentation of midwife-reported reasons for episiotomy and data collection on maternal, neonatal, practice and midwife factors, and degree of perineal tear among women undergoing NVDs conducted by midwives over a 2-month period. Risk factors for episiotomy were assessed through logistic regression.

Results

Primiparity, advanced maternal age, Indian ethnicity, higher birth weight and older midwife age were associated with episiotomy. The most common midwife-reported reason for episiotomy among primiparous women was primiparity (55.1 %), and among multiparous women was fetal distress (20.0 %) and poor maternal effort (20.0 %). All women with episiotomy sustained at least a second-degree perineal tear versus 27.1 % among women without episiotomy.

Conclusion

Most midwife-reported reasons for episiotomy were not congruent with international practice guidelines. Women without episiotomy have lesser tears than those with episiotomy. Practice protocols and educational programs are needed to change episiotomy practice.

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Acknowledgments

We would like to express our gratitude to the sisters, staff nurses and midwives at KKH delivery suite and to colleagues Chee Wai and Chen-Hsin for their helpful comments on this paper. We appreciate the support of SingHealth/Duke-NUS Academic Medicine Research Institute Singapore and the assistance of Taara Madhavan (Associate in Clinical Sciences, Duke-NUS Graduate Medical School, Singapore) and Chandima Arambepola (Research Assistant, Duke-NUS Graduate Medical School, Singapore) in editing this manuscript.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Duke-NUS Graduate Medical School, 8 College Road Singapore, Singapore, 169857, Singapore

    Lin Chieh Wu & Thiam Chye Tan

  2. Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore

    Rahul Malhotra & Truls Østbye

  3. Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore

    John Carson Allen Jr. & Desiree Lie

  4. Duke Global Health Institute, Durham, NC, USA

    Truls Østbye

  5. Department of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, Singapore, Singapore

    Thiam Chye Tan

Authors
  1. Lin Chieh Wu
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  2. Rahul Malhotra
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  3. John Carson Allen Jr.
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  4. Desiree Lie
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  5. Thiam Chye Tan
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  6. Truls Østbye
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Correspondence to Lin Chieh Wu.

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Wu, L.C., Malhotra, R., Allen, J.C. et al. Risk factors and midwife-reported reasons for episiotomy in women undergoing normal vaginal delivery. Arch Gynecol Obstet 288, 1249–1256 (2013). https://doi.org/10.1007/s00404-013-2897-6

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  • DOI: https://doi.org/10.1007/s00404-013-2897-6

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