Nine in every 10 primiparous women who gave birth spontaneously in hospitals in Latin America between 1995 and 1998 had an episiotomy. This figure was similar in public and private hospitals, primary care and referral hospitals, and deliveries attended by doctors or midwives. If a rate of 92% is applied to the 2.35 million primiparous women giving birth spontaneously in Latin American hospitals per year, this means that 2.17 million primiparous women per year receive an episiotomy.
The results were obtained from a database in which routine data are collected, and therefore have some potential limitations. The rates might have been affected by different outcome definitions among hospitals, but in maternity health services, episiotomy has a unique definition. In view of the high rates, it is possible that episiotomy rates are over-reported by recording perineal tears as episiotomies. But this is unlikely in the perinatal information system, because outcomes are marked separately in the data collection form. The rate of missing values in this dataset was below 1%.
Seventy one per cent of hospitals in the database were located in Argentina and Uruguay. The results might therefore represent standards of care in hospitals in those two countries rather than elsewhere. The similarities between hospitals in rates of episiotomy are, however, unlikely to be indicative of bias in hospital selection but of a common standard practice in the use of the procedure in most of Latin America's hospitals.
This situation is inadmissible in the light of the current evidence. The challenge now is to design and test an original intervention directed to women and caregivers to change the use of episiotomy in Latin American hospitals.