Though discouraged by experts, episiotomy rates still high: How hospitals are responding

Despite falling out of favor with experts, episiotomies are still being performed at much higher than recommended rates in certain hospitals, according to a California Healthline report. However, some organizations are making efforts to lower the number of procedures performed.

Episiotomy, an obstetric procedure that involves cutting muscular area between the vagina and the anus, has only been recommended for restrictive use due to the risks of the procedure and unclear benefits of routine use, a 2015 report in JAMA notes. In 2006, the American Congress of Obstetricians and Gynecologists made a recommendation against routine episiotomy,and, in 2008, the National Quality Forum also supported limiting routine episiotomy, citing quality and patient safety.

Still, the 2015 report found that within the cohort of 2.3 million women who were hospitalized for a vaginal delivery in 510 hospitals from 2006 to 2012, 325,193 women underwent episiotomy. The report does note, however, that there was a decline in rates of episiotomy between 2006 and 2012, from 17.3 percent to 11.6 percent.

However, the procedure is still very common at some hospitals. For instance, at Whittier (Calif.) Hospital Medical Center and Beverly Hospital in Los Angeles, episiotomies are performed in more than 60 percent of vaginal births, according to California Healthline.

One physician at Dignity Health's California Hospital Medical Center in Los Angeles posited physicians continue to perform episiotomies for three main reasons: They don't know best practices, it's what they've always done, or they want to speed up deliveries.

Oakland, Calif.-based Kaiser Permanente has seen huge reductions in use of the procedure since the managed care organization made intentional efforts to address overuse, the report states. Those efforts included looked at rates at the hospital level, then at the physician level, according to Kaiser Permanente in Northern California. That data was then sent to the individual hospitals, and physicians at each hospital who rarely performed episiotomies educated their colleagues about the appropriate use and risks, the organization told California Healthline. Northern California Kaiser hospitals now have an average episiotomy rate of about 3 percent, according to Kaiser.

Additionally, the California Maternal Quality Care Collaborative at Stanford (Calif.) University said the organization is spearheading efforts to provide physicians and hospitals with data on certain childbirth practices to show them how they compare with other healthcare providers statewide, California Healthline reports. After partnering with the March of Dimes to educate providers about the dangers of elective delivery prior to 39 weeks, that practice had dropped off rapidly within three years, Elliott Main, MD, medical director of the CaliforniaMaternal Quality Care Collaborative, told California Healthline.


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