Episiotomy practice in six Palestinian hospitals: a population-based cohort study among singleton vaginal births

OBJECTIVE: To explore the rates, characteristics and indications for episiotomy among women delivering vaginally for the first time, as well as parous women. STUDY DESIGN: A prospective, population-based birth cohort study. SETTING: Obstetric departments in six Palestinian government hospitals. PARTICIPANTS: All women with singleton vaginal births (n=29 165) from 1 March 2015 until 1 March 2016. METHODS: All women were divided into two groups: first vaginal birth group (n=9108), including primiparous women and women with their first vaginal birth after one caesarean section, and the parous group (n=20 057). Each group was analysed separately. Data were presented as numbers and percentages or range. Differences in rates were assessed by the p values of χ(2) test, or Fisher’s exact test if there are cell counts less than 5. MAIN OUTCOME MEASURES: Episiotomy rates and indications among women of singleton births. RESULTS: The overall episiotomy rate was 28.7%: 78.8% for women with first vaginal birth (range 56.6%–86.0%) and 5.9% for parous women (range 1.0%–9.5%). The most common indications for episiotomy were ‘primiparity’ in the first vaginal birth group (69.9%) and ‘protecting the perineum’ in the parous group (59.5%). The least common indications were prolonged second stage (1.5%) and fetal distress (6.9%), respectively. CONCLUSION: In Palestine, the majority of women who delivered vaginally for the first time had an episiotomy. Education of birth attendants, clinical audits, educational interventions and adherence to the updated guidelines may help to decrease the routine overuse of episiotomy.