Provider contribution to an episiotomy risk model

Antonella Cromi, Matteo Bonzini, Stefano Uccella, Maurizio Serati, Giorgio Bogani, Nadia Pozzo, Fabio Ghezzi

Research output: Contribution to journalArticlepeer-review


Objective: The extent to which the observed variation in episiotomy rates can be attributed to individual practitioners is not known. We sought to analyze the contribution of the attending midwife to a risk model for episiotomy.Study design: We prospectively collected data on 736 consecutive vaginal deliveries in nulliparas at a tertiary maternity hospital. The study measures the impact of the attending midwife on the decision to perform an episiotomy, controlling for a host of patient and clinical characteristics. Midwife effect is evaluated in terms of its overall contribution to the explanatory power of logistic regression model.Results: The overall rate of episiotomy in primiparas was 40.6%. Individual midwife episiotomy rate ranged from 5.6% to 73.9% (p <0.0001). After controlling for confounding factors with logistic regression, maternal age ≥35 years (OR 1.61, 95%CI: 1.02-2.52), vacuum extraction (OR 26.88, 95%CI: 2.57-280.7), fundal pressure (OR 62.90, 95%CI: 18.39-214.98), second-stage duration (OR 2.24, 95%CI: 1.53-3.28), and the individual midwife were all associated with episiotomy use. The midwife attending the birth and fundal pressure provided the greatest explanatory power of the model.Conclusions: The attending provider adds a significant independent effect to the episiotomy risk model. This has implications for both practice and research in this clinical area.

Original languageEnglish
Pages (from-to)2201-2206
Number of pages6
JournalJournal of Maternal-Fetal and Neonatal Medicine
Issue number18
Publication statusPublished - Dec 12 2015


  • Clinician
  • episiotomy
  • genital tract trauma
  • midwife
  • provider
  • risk model

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynaecology


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