Evolution of Episiotomy Incidence and Obstetric Anal Sphincter Injury Over 10 Years: A Mixed‐Methods Study

ABSTRACT Objective To assess the association between the decrease in the use of episiotomy and the incidence of obstetric anal sphincter injuries (OASIS) over a 10‐year period and understand their reasons by interviewing obstetricians and midwives. Design Mixed‐methods study. Setting A tertiary university public maternity hospital, Paris, France. Population All patients who delivered vaginally between January 2012 and December 2021 in the maternity hospital and 20 interviews with obstetrician‐gynaecologists and midwives. Methods Quantitative data analysis using a multivariate logistic regression model, stratifying on the mode of delivery. Semi‐structured interview with 20 obstetricians and midwives, with an interview guide. Main Outcome Measures Obstetric anal sphincter injuries. Results The quantitative study of 37 942 women (16.1% of whom had an episiotomy and 1.4% OASIS) shows that, the incidence of episiotomy decreased from 25% to 7.6% over this 10‐year period. Allow on the known risk factors for OASIS, we demonstrate that its incidence rose (adjusted odds ratio 1.35, 95% confidence interval 1.09–1.67) for the years in which the episiotomy incidence fell below 10% for the overall population. The interviews showed professionals' apparent awareness that the decreased incidence in episiotomy (achieved by changes in departmental policy, redefining its benefit/risk balance and acquiring new skills to manage the expulsion phase) could lead to an increased incidence of OASIS. Conclusions Decreasing the episiotomy incidence appears to be associated with a rising incidence of OASIS. The optimal incidence of episiotomy remains controversial in the literature and among professionals.