Episiotomy rates differ depending on practitioner.

Even though current evidence suggests restricted use of episiotomies, obstetricians in private practice are much more likely than their academic counterparts to perform them. Many recent studies have shown that episiotomy is associated with increased rates of severe lacerations, more pain, and slower return to sexual function.

Researchers at the University of Pittsburgh Health Sciences Center studied trends in episiotomy use at their facility since 1995. They compared episiotomy rates by residents and faculty to private practitioners. Nearly 28,000 women were studied. Overall, the rate of episiotomy declined from 59.7 percent in 1995 to 45.0 percent in 2000, the last year with completed data. The average rate of episiotomy was 17.7 percent among 38 residents and faculty practitioners, versus 67.1 percent among the 141 private practitioners.

Researchers considered maternal age, race, infant birth weight, nulliparity, and history of cesarean section. They estimate that private practice physicians were seven times more likely than academic practitioners to perform an episiotomy. This disparity may be related to the period in which doctors were trained.

--Obstetrics and Gynecology, January, 2004