{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:06:04Z","timestamp":1785409564374,"version":"3.56.0"},"reference-count":33,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Based on current evidence, the World Health Organization (WHO) recommends a restrictive approach to episiotomy, rather than routine performance, with a rate of between 5% and 10%. This study aimed to ascertain the rate and conformity to the restrictive patterns of episiotomy among women delivering at Mthatha Regional Hospital (MRH).\nMethods:\u00a0A cross-sectional analytical study was conducted with 400 participants at MRH between January and June 2022. Demographic and obstetric data were collected and analysed using SPSS software. Continuous data were analysed using the student\u2019s\u00a0t-test for normally distributed data and the Wilcoxon\u2013Mann\u2013Whitney\u00a0U-test for skewed data, categorical data with the chi-square and Fisher\u2019s tests, and logistic regression for the independent predictors of episiotomy. A\u00a0p-value &lt; 0.05 was considered significant.\nResults:\u00a0The rate of episiotomy was 19% (74\/400). The indications for episiotomy were macrosomia (8.1%), foetal distress during the second stage of labour (5.4%), delayed second stage of labour (5.4%), prolonged second stage (5.4%), previous C\/S x2 in labour (2.7%), forceps delivery (2.7%) and tight perineum (1.3%); 74% (55\/74) was undocumented. The factors associated with episiotomy were maternal age &lt; 20 years (odds ratio [OR] 5.5, confidence interval [CI] 3.2\u20139.5) and primigravid status (OR 10.2, CI 5.2 \u2013 19),\u00a0p\u00a0&lt; 0.05. The rate of third-degree perineal tears among women without episiotomy was 0.3%. There were no fourth-degree tears.\nConclusion:\u00a0The practice of episiotomy at MRH exceeds the recommendation by the WHO. Young maternal age and primigravid women were risk factors for episiotomy.\nContribution:\u00a0The low incidence of third- and fourth-degree tears among women without episiotomy reaffirms the advantages of a restrictive approach to the practice of episiotomy.<\/jats:p>","DOI":"10.4102\/jcmsa.v4i1.242","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:53:53Z","timestamp":1771232033000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Restrictive approach to episiotomy and the risk of third- and fourth-grade perineal tears: An analytical cross-sectional study at a rural tertiary hospital in South Africa"],"prefix":"10.4102","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0880-2470","authenticated-orcid":false,"given":"Masibonge","family":"Ndlela","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02svzjn28","id-type":"ROR","asserted-by":"publisher"}],"name":"Walter Sisulu University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8393-1198","authenticated-orcid":false,"given":"Charles","family":"Businge","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02svzjn28","id-type":"ROR","asserted-by":"publisher"}],"name":"Walter Sisulu University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"ref0","unstructured":"Worku SA, Mitku YM, Getahun SA. Episiotomy practice and its associated factor among women who gave birth at public health institutions of Akaki Kality in Addis Ababa, Ethiopia. Clin Mother Child Health. 2019;16(2):1\u20136."},{"key":"ref1","unstructured":"Brody SA. The Osler medal essay. The life and times of Sir Fielding Ould: Man-midwife and master physician. Bull Hist Med. 1978;52(2):228\u2013250."},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Schoon PG. A guest editorial: Episiotomy: Yea or nay. Obstet Gynecol Surv. 2001;56(11):667\u2013669. https:\/\/doi.org\/10.1097\/00006254-200111000-00001","DOI":"10.1097\/00006254-200111000-00001"},{"key":"ref3","unstructured":"Cronje HS, Cilliers JBF, Pretorius MS. Clinical obstetrics: A South African perspective. Pretoria: Van Schaik; 2016."},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Woolley RJ. Benefits and risks of episiotomy: A review of the English-language literature since 1980. Part II. Obstet Gynecol Surv. 1995;50(11):821\u2013835. https:\/\/doi.org\/10.1097\/00006254-199511000-00021","DOI":"10.1097\/00006254-199511000-00021"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Ononuju CN, Ogu RN, Nyengidiki TK, Onwubuariri MI, Amadi SC, Ezeaku EC. Review of episiotomy and the effect of its risk factors on postepisiotomy complications at the University of Port Harcourt Teaching Hospital. Niger Med J. 2020;61(2):96\u2013101. https:\/\/doi.org\/10.4103\/nmj.NMJ_121_19","DOI":"10.4103\/nmj.NMJ_121_19"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"G\u00fcn \u0130, Do\u011fan B, \u00d6zdamar \u00d6. Long- and short-term complications of episiotomy. Turk J Obstet Gynecol. 2016;13(3):144\u2013148. https:\/\/doi.org\/10.4274\/tjod.00087","DOI":"10.4274\/tjod.00087"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev. 2009(1):Cd000081. https:\/\/doi.org\/10.1002\/14651858.CD000081.pub2","DOI":"10.1002\/14651858.CD000081.pub2"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Venus D, S R, Prajwal SD. Comparison of use of restrictive episiotomy versus routine episiotomy in primigravidae undergoing vaginal birth at a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol. 2017;6:1770\u20131776. https:\/\/doi.org\/10.18203\/2320-1770.ijrcog20171501","DOI":"10.18203\/2320-1770.ijrcog20171501"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Rasouli M, Keramat A, Khosravi A, Mohabatpour Z. Prevalence and factors associated with episiotomy in Shahroud City, Northeast of Iran. Int J Women\u2019s Health Reprod Sci. 2016;4(3):125\u2013129. https:\/\/doi.org\/10.15296\/ijwhr.2016.29","DOI":"10.15296\/ijwhr.2016.29"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Woldegeorgis BZ, Obsa MS, Tolu LB, Bogino EA, Boda TI, Alemu HB. Episiotomy practice and its associated factors in Africa: A systematic review and meta-analysis. Front Med (Lausanne). 2022;9:905174. https:\/\/doi.org\/10.3389\/fmed.2022.905174","DOI":"10.3389\/fmed.2022.905174"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Beyene F, Nigussie AA, Limenih SK, Tesfu AA, Wudineh KG. Factors associated with episiotomy practices in Bahirdar City, Ethiopia: A cross-sectional study. Risk Manag Healthc Policy. 2020;13:2281\u20132289. https:\/\/doi.org\/10.2147\/RMHP.S277657","DOI":"10.2147\/RMHP.S277657"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Ballesteros-Meseguer C, Carrillo-Garc\u00eda C, Meseguer-de-Pedro M, Canteras-Jordana M, Mart\u00ednez-Roche ME. Episiotomy and its relationship to various clinical variables that influence its performance. Rev Lat Am Enfermagem. 2016;24:e2793. https:\/\/doi.org\/10.1590\/1518-8345.0334.2686","DOI":"10.1590\/1518-8345.0334.2686"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Maphanga CM, Naidoo TD. The perception and knowledge about episiotomy: A cross-sectional survey involving healthcare workers in a low- and middle-income country. Afr J Prim Health Care Fam Med. 2021;13(1):e1\u2013e6. https:\/\/doi.org\/10.4102\/phcfm.v13i1.2424","DOI":"10.4102\/phcfm.v13i1.2424"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Sangkomkamhang U, Kongwattanakul K, Kietpeerakool C, et al. Restrictive versus routine episiotomy among Southeast Asian term pregnancies: A multicentre randomised controlled trial. BJOG. 2020;127(3):397\u2013403. https:\/\/doi.org\/10.1111\/1471-0528.15982","DOI":"10.1111\/1471-0528.15982"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev. 2017;2(2):Cd000081. https:\/\/doi.org\/10.1002\/14651858.CD000081.pub3","DOI":"10.1002\/14651858.CD000081.pub3"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Melo I, Katz L, Coutinho I, Amorim MM. Selective episiotomy vs. implementation of a non episiotomy protocol: A randomized clinical trial. Reprod Health. 2014;11:66. https:\/\/doi.org\/10.1186\/1742-4755-11-66","DOI":"10.1186\/1742-4755-11-66"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Woretaw E, Teshome M, Alene M. Episiotomy practice and associated factors among mothers who gave birth at public health facilities in Metema district, northwest Ethiopia. Reproductive Health. 2021;18(1):142. https:\/\/doi.org\/10.1186\/s12978-021-01194-9","DOI":"10.1186\/s12978-021-01194-9"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Tex-Jack D, Eleke C. Perspectives of skilled birth attendants and pregnant women regarding episiotomy: A quantitative approach. Afr Health Sci. 2021;21(3):1355\u20131361. https:\/\/doi.org\/10.4314\/ahs.v21i3.47","DOI":"10.4314\/ahs.v21i3.47"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"B\u0105czek G, Rychlewicz S, Sys D, Rzo\u0144ca P, Teliga-Czajkowska J. Episiotomy for medical indications during vaginal birth-retrospective analysis of risk factors determining the performance of this procedure. J Clin Med. 2022;11(15): 4334. https:\/\/doi.org\/10.3390\/jcm11154334","DOI":"10.3390\/jcm11154334"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Soleimanzadeh Mousavi SH, Miri M, Farzaneh F. Episiotomy and its complications. Zahedan J Res Med Sci. 2021;23(2):e104127. https:\/\/doi.org\/10.5812\/zjrms.104127","DOI":"10.5812\/zjrms.104127"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Cesar JA, Marmitt LP, Mendoza-Sassi RA. Episiotomy in Southern Brazil: Prevalence, trend, and associated factors. Rev Saude Publica. 2022;56:26. https:\/\/doi.org\/10.11606\/s1518-8787.2022056003908","DOI":"10.11606\/s1518-8787.2022056003908"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Owa O, Eniowo A, Ilesanmi O. Factors associated with episiotomy among parturients delivering in a tertiary care centre in Nigeria. Int J Res Med Sci. 2015;3:836. https:\/\/doi.org\/10.5455\/2320-6012.ijrms20150403","DOI":"10.5455\/2320-6012.ijrms20150403"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Urge Y, Sisay T, Chala G, Mengistu A, Yehualashet S, Worku N. Prevalence of episiotomy and its associated factors in University of Gondar comprehensive specialized referral hospital: A retrospective study from Ethiopia. Am J Life Sci. 2020;8(1):9\u201313. https:\/\/doi.org\/10.11648\/j.ajls.20200801.12","DOI":"10.11648\/j.ajls.20200801.12"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Deyaso ZF, Chekole TT, Bedada RG, Molla W, Uddo EB, Mamo TT. Prevalence of episiotomy practice and factors associated with it in Ethiopia, systematic review and meta-analysis. Womens Health (Lond). 2022;18:17455057221091659. https:\/\/doi.org\/10.1177\/17455057221091659","DOI":"10.1177\/17455057221091659"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"H\u00e9man LM, Van der Linden PJ, Stigter RH. Attitude of maternity staff regarding episiotomies in an African rural hospital with high HIV prevalence: A descriptive qualitative study. Am J Trop Med Hyg. 2014;90(5):976\u2013979. https:\/\/doi.org\/10.4269\/ajtmh.13-0395","DOI":"10.4269\/ajtmh.13-0395"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Tsehay AK. Factors associated with HIV-positive sero-status among exposed infants attending care at health facilities in Bahir Dar administration, Ethiopia: Evidence from medical records. Cogent Med. 2019;6(1):1623754. https:\/\/doi.org\/10.1080\/2331205X.2019.1623754","DOI":"10.1080\/2331205X.2019.1623754"},{"key":"ref27","unstructured":"NDoH. Guideline for vertical transmission prevention of communicable infections. Pretoria: National Department of Health; 2023."},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Chilaka VN, Konje JC. HIV in pregnancy \u2013 An update. Eur J Obstet Gynecol Reprod Biol. 2021;256:484\u2013491. https:\/\/doi.org\/10.1016\/j.ejogrb.2020.11.034","DOI":"10.1016\/j.ejogrb.2020.11.034"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Inyang-Etoh EC, Umoiyoho A. The practice of episiotomy in a university teaching hospital in Nigeria: How satisfactory? Int J Med Biomed Res. 2012;1:68\u201372. https:\/\/doi.org\/10.14194\/ijmbr.1111","DOI":"10.14194\/ijmbr.1111"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Akhtar U, Rattani S, Meghani R, Zuberi NF. Maternal care providers\u2019 perspectives of selective vs routine episiotomy. J Asian Midwives. 2024;11(2):66\u201380. https:\/\/doi.org\/10.71071\/JAM\/v11i2.1.15th","DOI":"10.71071\/JAM\/v11i2.1.15th"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Simmelink R, Moll E, Verhoeven C. The influence of the attending midwife on the occurrence of episiotomy: A retrospective cohort study. Midwifery. 2023;125:103773. https:\/\/doi.org\/10.1016\/j.midw.2023.103773","DOI":"10.1016\/j.midw.2023.103773"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Khan NB, Anjum N, Hoodbhoy Z, Khoso R. Episiotomy and its complications: A cross sectional study in secondary care hospital. J Pak Med Assoc. 2020;70(11):2036\u20132038. https:\/\/doi.org\/10.1001\/jama.2020.18731","DOI":"10.5455\/JPMA.290331"}],"container-title":["Journal of the Colleges of Medicine of South Africa"],"original-title":[],"link":[{"URL":"https:\/\/jcmsa.org.za\/index.php\/jcmsa\/article\/view\/242\/911","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:53:57Z","timestamp":1771232037000},"score":1,"resource":{"primary":{"URL":"https:\/\/jcmsa.org.za\/index.php\/jcmsa\/article\/view\/242"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,17]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.4102\/jcmsa.v4i1.242","relation":{},"ISSN":["3105-4331","2960-110X"],"issn-type":[{"value":"3105-4331","type":"print"},{"value":"2960-110X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,17]]},"article-number":"a242"}}