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Birth. 2013 Dec;40(4):247-55. doi: 10.1111/birt.12060.

The use of episiotomy in a low-risk population in the Netherlands: a secondary analysis.

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Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.



To examine the episiotomy incidence and determinants and outcomes associated with its use in primary care midwifery practices.


Secondary analysis of two prospective cohort studies (n = 3,404).


The episiotomy incidence was 10.8 percent (20.9% for nulliparous and 6.3% for parous women). Episiotomy was associated with prolonged second stage of labor (adj. OR 12.09 [95% CI 6.0-24.2] for nulliparous and adj. OR 2.79 [1.7-4.6] for parous women) and hospital birth (adj. OR 1.75 [1.2-2.5] for parous women). Compared with episiotomy, perineal tears were associated with a lower rate of postpartum hemorrhage in parous women (adj. OR 0.58 [0.4-0.9]). Fewer women with perineal tears reported perineal discomfort (adj. OR 0.35 [0.2-0.6] for nulliparous and adj. OR 0.22 [0.1-0.3] for parous women). Among nulliparous women episiotomy was performed most frequently for prolonged second stage of labor (38.8%) and among parous women for history of episiotomy or prevention of major perineal trauma (21.1%).


The incidence of episiotomy is high compared with some low-risk settings in other Western countries. Episiotomy was associated with higher rates of adverse maternal outcomes. Restricted use of episiotomy is likely to be beneficial for women.


episiotomy; indications; maternal outcomes

[Indexed for MEDLINE]

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