When to Consider Episiotomy at Vaginal Birth?

After the recommendation that episiotomy only be used when necessary to improve maternal or neonatal birth outcomes, U.S. episiotomy rates fell from 20% in 2002 to 9% in 2011 (Jt Comm J Qual Patient Saf 2017 Jan; 43:41). Canadian investigators studied the relation between episiotomy at vaginal birth and obstetric anal sphincter injury in >2,500,000 term singleton vaginal births. Analysis was adjusted for maternal age, labor induction, prolonged second stage, epidural anesthesia, infant birth weight, and delivery year. In Canada, mediolateral episiotomy is more common than median episiotomy (90% vs.10%).

Among women with spontaneous vaginal deliveries, incidence of obstetric anal sphincter injury was higher with episiotomy than without episio…