Population Based Study of Episiotomy

Objectives: To estimate episiotomy rate in a rural population and to find out if higher episiotomy rate is associated with place of delivery and category of health care provider. Design: Population based cross sectional study Setting: Rural population near Chennai. Sample: Included 442 mothers who had vaginal delivery between August 2004 and July 2005. Methods: Cluster sampling was used to select the study sample. Information about episiotomy during last child birth and other details were obtained by personal interview and from available medical records. Results: Overall episiotomy rate was 67% (95% CI 62.6 – 71.4). For women whose delivery was conducted by doctors the episiotomy rate was 77.4% and conducted by nurses it was 53.1%. Episiotomy rate was very high (91.8%) when delivery was conducted in private medical college hospitals and the rates were lower when conducted in secondary and primary level institutions. Adjusted odds ratio for episiotomy was 38 when doctors conducted delivery compared to trained birth attendants and 8.9 when delivery was conducted at private medical college hospitals compared to primary health centres. Conclusion Episiotomy rate in the study population is high. Probably similar high rates are found in other parts of India. The probability of episiotomy is very high when doctors conducted the delivery and when place of delivery is private medical college hospital. Evidence based restrictive practice of episiotomy to less than 30% should be adopted by all, particularly in tertiary care teaching hospitals which should serve as role models.