The drastic reduction in the number of episiotomies in France

This is good news for French women: episiotomies now only affect 8.31% of deliveries, compared to 251% in 2010 and up to 711% in 2003, concludes a new study published in PLoS Medicine. However, care must be taken to differentiate patient profiles according to whether or not they could benefit from the practice of episiotomy, which in certain cases prevents severe obstetric lesions of the anal sphincter, points out researcher and midwife Thomas Desplanches.

In France, up to 71% episiotomies at the start of 2000

Episiotomy, which involves an incision in the perineum to make more room for the baby during delivery, has " has long been a routine practice in France", especially in the 2000s, recalls Thomas Desplanches, who co-directed this work. The idea is that by widening the baby's exit route, the risk of the perineum tearing during the pushing effort will be greatly reduced. However, a spontaneous tear can reach the anus – this is called obstetric anal sphincter injury (OASI) – and is much more complex to heal than the controlled and clean incision of an episiotomy and can have a very negative impact on quality of life.

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But while in 2003 in France, 71% of women experiencing their first birth underwent an episiotomy, the learned society of obstetricians and gynecologists (CNGOF) questioned their relevance. In 2004, it published recommendations calling for a restricted practice of episiotomy. 71 %, this means that episiotomy was extremely frequent and therefore often not justified given the insufficient level of scientific evidence concerning its protective effect against serious obstetric injuries (LOSA) and the potentially negative consequences of this procedure", comments Thomas Desplanches.

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Between 2010 and 2021, three times fewer episiotomies were performed

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Perinatal professionals and patients, whose concerns are increasingly audible against the backdrop of the debate on obstetric violence, can indeed rejoice in a drastic decrease in the number of episiotomies performed in the country. To the point that they only concerned 26% of deliveries in 2010, 20% in 2016, and 8.3% in 2021! Figures obtained thanks to the valuable data from the ENP, the National Perinatal Survey, which has been collecting data on French perinatal health since 1995. We have reached the World Health Organization's target of not exceeding 10%", comments Thomas Desplanches with satisfaction.

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Episiotomies should be avoided in some cases, and potentially reinstated in others

The challenge now is to know according to which criteria and on which patients episiotomies remain relevant. Our study shows that nulliparous women (who do not yet have children, editor's note) with a newborn in cephalic presentation (by the head, as opposed to breech presentation, editor's note) and whose delivery requires the use of instruments such as spatulas undergo half as many episiotomies, but have a risk of OASI multiplied by three“, from 2.6% in 2010 to 9.6% in 2021, warns Thomas Desplanches.

For this particular group of women, the restriction on the practice of episiotomies was potentially too drastic. These figures should raise the question of the place of episiotomy in these subgroups particularly at risk of OASI.. » On the other hand, other subgroups have shown encouraging results. In nulliparous women, delivery without instruments and with cephalic presentation no longer requires episiotomy in only 9% of cases (compared to 35% in 2010) while maintaining a very low risk of OASI of approximately 1%. In this group, perhaps we should go even further in the restriction, the question deserves to be asked" concludes Thomas Desplanches.