Vaginal delivery care, episiotomy performance and examination of severe perineal tears: Cross-sectional study in 43 public hospitals

Introduction: In recent years work has been done in the public health system in Catalonia in order to achieve consensus in promoting a model of normal childbirth care. This study aims to ascertain the proportion of singleton, full-term vaginal non-instrumental births attended in public hospitals for which an episiotomy was performed and the incidence of severe perineal tears. Methodology: Descriptive cross-sectional study of all singleton births between 37 and 41 completed weeks of gestation attended in public hospitals (2013-2014). Births were grouped into two groups “deliveries with episiotomy” and “deliveries without episiotomy”. Hospitals were grouped by level of complexity (I to III – according to the Catalonia health department classification). The relationship between qualitative variables was analysed using a chi-square test and the T-student test was used for quantitative variables; a pvalue equal to or lower than 0.005 was considered significant. Results: Data were collected from 53770 births. The total percentage of perineal tears was 35.7% and the total of severe tears was 0.8%. No significant differences in the mean proportion of severe perineal tears among different types of hospitals or between the two groups. The regression analysis shows that the birth weight of the newborn is the only variable that increases the risk of experiencing a severe perineal tear. Conclusion:No significant difference was demonstrated in Catalonia in the incidence of severe perineal tears in singleton full-term vaginal non-instrumental births with and without episiotomies