Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries.

Episiotomy use has decreased due to the lack of evidence on its protective effects from maternal obstetric anal sphincter injuries. Indications for episiotomy vary considerably and there are a great variety of factors associated with its use. The aim of this article is to describe the episiotomy rate in France between 2013 and 2017 and the factors associated with its use in non-operative vaginal deliveries. In this retrospective population-based cohort study, we included vaginal deliveries performed in French hospitals (N = 584) and for which parity was coded. The variable of interest was the rate of episiotomy, particularly for non-operative vaginal deliveries. Trends in the episiotomy rates were studied using the Cochran-Armitage test. Hierarchical logistic regression was used to identify variables associated with episiotomy according to maternal age and parity. Between 2013 and 2017, French episiotomy rates fell from 21.6 to 14.3% for all vaginal deliveries (p < 0.01), and from 15.5 to 9.3% (p < 0.01) for all non-operative vaginal deliveries. Among non-operative vaginal deliveries, epidural analgesia, non-reassuring fetal heart rate, meconium in the amniotic fluid, shoulder dystocia, and newborn weight (≥ 4,000 g) were risk factors for episiotomy, both for nulliparous and multiparous women. On the contrary, prematurity reduced the risk of its use. For nulliparous women, breech presentation was also a risk factor for episiotomy, and for multiparous women, scarred uterus and multiple pregnancies were risk factors. In France, despite a reduction in episiotomy use over the last few years, the factors associated with episiotomy have not changed and are similar to the literature. This suggests that the decrease in episiotomies in France is an overall tendency which is probably related to improved care strategies that have been relayed by hospital teams and perinatal networks.

Factors related to episiotomy practice: an evidence-based medicine systematic review.

Episiotomy practice is influenced by many factors studied in the scientific literature. Evidence-based medicine has isolated many factors that are linked to episiotomy practice, thus creating a need to group all these factors to create a relevant and useful database for scientific research. Based on the PRISMA methodology, the authors conducted a systematic literature review with the aim of covering this very need. Using 12 French and English combinations of relevant keywords, 15 databases containing publications published between 2008 and 2018 were evaluated. A total of 63 articles were identified, grouped and categorised into four main themes in the results section: (1) Individual and clinical factors related to the mother, (2) individual and clinical factors related to the child, (3) technical factors, and (4) organisation of health care and professional factors (institutional, organisational, personal and professional factors). These factors are then presented in terms of their impact on the practice of episiotomy. Then the future implications of this study on scientific research and clinical practice are discussed.

Socio-historical evolution of the episiotomy practice: A literature review.

Episiotomy is an enlargement of the vaginal orifice made by a surgical incision of the perineum. This review aimed to provide a socio-historical retrospective on the practice or episiotomy. Using the criteria from the PRISMA guidelines, the authors conducted a literature review, browsing twenty databases and several papers available in the gray literature. Sixty-four articles, seven reports, and fifteen books were selected. Through this study, four eras with different approaches to episiotomy practice could be identified: 1792-1920, 1920-1980, 1980-1996, and 1996-2018. This review shows that institutionalization and medicalization of birth lead to a systematic practice of episiotomy in many westernized countries until 1996. Lay questioning and evidence-based medicine may have reversed this trend into a restrictive practice. After making an inventory of the factors associated with the evolution of change in the rate of episiotomies, the review finally revealed that evolution of the practice of episiotomy has also been influenced by ideological, political, and social factors.

The evolution of birth medicalisation: A systematic review.

First described at the beginning of the 1970s, the concept of birth medicalisation has experienced a theoretical and ideological evolution influenced by the lines of research that have been associated with it. This evolution has given rise to different schools of thought concerning medicalisation, but also various methodologies used in different scientific fields. It seems relevant to propose a global synthesis of the various lines of thought related to birth medicalisation. To do this, the authors conducted a systematic literature review based on the PRISMA method. With a total of 38 occurrences in French and English, the authors scrutinised 17 databases with a publication period between 1995 and 2018. A total of 112 documents (107 articles, 3 book chapters, 2 books) has been identified, grouped and categorised into five main themes in the results section (1) the theoretical evolution of the concept of medicalisation, (2) factors related to the birth medicalisation, (3) the impact of the birth medicalisation, (4) the humanisation of birth and (5) experiences related to childbirth. A reasoned synthesis of the literature is therefore carried out in each part and then discussed according to the selected lines of research that require development in order to guarantee the best possible accompaniment to women who give birth.

Statistical trends of episiotomy around the world: Comparative systematic review of changing practices.

The authors' purpose for this article is to identify, review and interpret all publications about the episiotomy rates worldwide. Based on the criteria from the PRISMA guidelines, twenty databases were scrutinized. All studies which include national statistics related to episiotomy were selected, as well as studies presenting estimated data. Sixty-one papers were selected with publication dates between 1995 and 2016. A static and dynamic analysis of all the results was carried out. The assumption for the decline in the number of episiotomies is discussed and confirmed, recalling that nowadays high rates of episiotomy remain in less industrialized countries and East Asia. Finally, our analysis aims to investigate the potential determinants which influence apparent statistical disparities.