Episiotomy’s prevalence and its associated factors before and after the Brazilian Obstetrics Violence Law

Author(s): Jan Pawel Andrade Pachnicki, M.D., Ph.D, Bruno Damasceno da Silva, Isadora Goetten Santos da Silva

Objective:

Understanding episiotomy’s prevalence before and after the implementation of Obstetrics Violence Law, in order to demonstrate the procedure’s role in preventing perineal lacerations and its influences on neonatal outcomes.

Methods:

The sample of this retrospective cross-sectional study consists in 5,412 patients undergoing vaginal delivery from 2016 to 2022 in a hospital located at the metropolitan region of Curitiba – PR. Data such as age, parity, episiotomy, perineal laceration, use of forceps and/or vacuum extractor, Apgar score were gathered, with the quantitative variables described by mean, standard deviation, median, minimum and maximum, and categorical variables by frequency and percentage. To assess the association between two categorical variables it was used the Chi-square test and Fisher’s exact test. Comparison between two odds ratio (OR) was performed using the Breslow-Day test and for the common estimate of two OR the Mantel-Haenzel approach. The Mann Whitney non-parametric test was used to compare cases with and without episiotomy, as to the Apgar values. Values of p<0.05 indicated statistical significance.

Results:

2,065 were primiparous and 3,347 were multiparous. The average age was 24.4 years-old. There was a reduction in the number of episiotomies after the brazilian law from 19.32% to 16.53% (p=0.011). There is a higher prevalence of episiotomies in primiparous patients OR=4.91 (95%CI: 4.26-5.65) and p<0.001 for both periods. Not performing episiotomy was seen to be a risk factor for perineal laceration OR=7.44 (95%CI: 5.60-9.88), p<0.001. In instrumented childbirth, episiotomy proved to be protective in both primiparous OR=0.098 95%CI (0.030 – 0.322), p<0.001 and multiparous patients OR=0.154 95%CI (0.031 – 0.759), p=0.04. Episiotomy was not related to better neonatal outcomes.

Conclusions:

There was a significant reduction in the prevalence of episiotomies after the Obstetric Violence Law. In addition, it was observed that a practice aimed at selective episiotomy seems to play an important role in preventing perineal lacerations.