EPISIOTOMY COUNTS - TRENDS AND PREVALENCE IN CANADA, 1981 1982 TO 1993/1994/

Background: The purpose of this study was to produce a minimum estimat e of the prevalence of episiotomy use in Canada, and to investigate th e trend in its use between 1981/1982 and 1993/1994. Method: A retrospe ctive population case series study was conducted wing hospital dischar ge abstracts. Outcome measures were the count of episiotomies performe d during a 12-month period and the episiotomy rate per 100 vaginal bir ths. Results: For more than a decade, official statistics have signifi cantly underreported episiotomy use by as much as 50 percent. In 1993/ 1994 at least 37.7 percent of women giving birth vaginally in Canada a re known to have received an episiotomy. Between 1981/1982 and 1993/19 94 its prevalence declined 29.1 percent, with the greatest decline occ urring during the 1990s. This decline did not result from changes in p arity in the population. The decrease in episiotomy use during this 13 -year period is more than twice that found in the United States (a dec line of only 13.6%). Conclusions: The reporting of official statistics on obstetric procedures in Canada should be modified to include all k nown cases of episiotomy. The observed downward trend in the rate of t his procedure is encouraging,and is in the direction of evidence-based recommendations advocating its restrictive use.