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

BACKGROUND: To examine the episiotomy incidence and determinants and outcomes associated with its use in primary care midwifery practices. METHODS: Secondary analysis of two prospective cohort studies (n = 3,404). RESULTS: 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%). CONCLUSIONS: 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.

Periconceptional smoking: an exploratory study of determinants of change in smoking behavior among women in the fertile age range.

How can women who are not yet pregnant be motivated to stop smoking before they become pregnant? Epidemiological studies have suggested that periconceptional smoking and smoking during the first trimester of the pregnancy may lead to congenital abnormalities. To motivate women to stop smoking before pregnancy, more insight is needed into the differences between 'smoking' women who want to have children and those who do not. A sample of 931 women (65% response rate) aged 15-45 years returned a questionnaire with questions about their smoking behavior, wish to have children, risk perceptions, attitude to smoking, personal efficacy and stage of readiness to change. In spite of some positive outcomes (e.g. negative attitude to smoking, relatively high risk perceptions of the relationship between congenital anomalies and smoking), one cannot automatically assume that these women will stop smoking before they get pregnant. (1) Beliefs, attitude and readiness to change were not well integrated and grounded cognitively. (2) Women who smoked were pessimistic about their ability to quit. Future campaigns need to 'invite' women to associate and to integrate risk information about the relationship between smoking and congenital abnormalities with other cognitions (attitude, intention). It is also important to instruct women in how to stop smoking and to remain non-smokers.