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A significant decrease in the prevalence of episiotomy in France from 2010 to 2021 has not been linked to an increase in obstetric anal sphincter injury (OASI), according to a recent study published online on January 14 in PLOS Medicine.
The study, led by Raphaele Houlbracq from Université Paris Cité, assessed trends in episiotomy and OASI prevalence using data from the National Perinatal Surveys conducted in 2010, 2016, and 2021, covering 29,750 women who had vaginal deliveries. Researchers observed a substantial reduction in the use of episiotomy, from 25.8% in 2010 to 20.1% in 2016, and a dramatic drop to 8.3% in 2021, reflecting an adjusted risk ratio of 0.33. This trend was consistent across various groups, with reductions as high as 94% in women with multiple pregnancies.
Despite this decrease in episiotomy use, the overall prevalence of OASI between 2010 (0.7%) and 2021 (1.0%) did not show a statistically significant increase. Notably, only nulliparous women with a term cephalic singleton undergoing spatula delivery experienced a significant rise in OASI.
The findings challenge the assumption that a reduction in episiotomy would necessarily lead to higher rates of OASI. The researchers suggest that the results and other recent studies highlight the need to reconsider restrictive episiotomy policies, particularly for instrumental deliveries in nulliparous women.
As the study continues to spark discussions in the field of obstetrics, experts advocate for more targeted approaches to prevent perineal injury during childbirth without compromising maternal health.
For more details, see the full study: Raphaele Houlbracq et al, Episiotomies and Obstetric Anal Sphincter Injuries Following a Restrictive Episiotomy Policy in France: An Analysis of the 2010, 2016, and 2021 National Perinatal Surveys, PLOS Medicine (2025). DOI: 10.1371/journal.pmed.1004501.
