{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T01:15:39Z","timestamp":1789780539715,"version":"4.0.1"},"reference-count":59,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,12,17]],"date-time":"2013-12-17T00:00:00Z","timestamp":1387238400000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Birth"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>To examine the episiotomy incidence and determinants and outcomes associated with its use in primary care midwifery practices.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Secondary analysis of two prospective cohort studies (<jats:italic>n<\/jats:italic>\u00a0=\u00a03,404).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The episiotomy incidence was 10.8 percent (20.9% for nulliparous and 6.3% for parous women). Episiotomy was associated with prolonged second stage of labor (adj. <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 12.09 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 6.0\u201324.2] for nulliparous and adj. <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.79 [1.7\u20134.6] for parous women) and hospital birth (adj. <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.75 [1.2\u20132.5] for parous women). Compared with episiotomy, perineal tears were associated with a lower rate of postpartum hemorrhage in parous women (adj. <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.58 [0.4\u20130.9]). Fewer women with perineal tears reported perineal discomfort (adj. <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.35 [0.2\u20130.6] for nulliparous and adj. <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.22 [0.1\u20130.3] for parous women). Among nulliparous women episiotomy was performed most frequently for prolonged second stage of labor (38.8%) and among parous women for history of episiotomy or prevention of major perineal trauma (21.1%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The incidence of episiotomy is high compared with some low\u2010risk settings in other Western countries. Episiotomy was associated with higher rates of adverse maternal outcomes. Restricted use of episiotomy is likely to be beneficial for women.<\/jats:p><\/jats:sec>","DOI":"10.1111\/birt.12060","type":"journal-article","created":{"date-parts":[[2013,12,17]],"date-time":"2013-12-17T18:52:26Z","timestamp":1387306346000},"page":"247-255","source":"Crossref","is-referenced-by-count":23,"title":["The Use of Episiotomy in a Low\u2010Risk Population in The Netherlands: A Secondary Analysis"],"prefix":"10.1111","volume":"40","author":[{"given":"A. E.","family":"Seijmonsbergen\u2010Schermers","sequence":"first","affiliation":[{"name":"Department of Midwifery Science AVAG and the EMGO Institute of Health and Care Research VU University Medical Centre Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. C.","family":"Geerts","sequence":"additional","affiliation":[{"name":"Department of Midwifery Science AVAG and the EMGO Institute of Health and Care Research VU University Medical Centre Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Prins","sequence":"additional","affiliation":[{"name":"Department of Midwifery Science AVAG and the EMGO Institute of Health and Care Research VU University Medical Centre Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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