The 2006-07 NHS Maternity Statistics for England were published in September, and it is very interesting to look beyond the highlighted 'key facts and summary' and delve into the details and numbers contained in specific tables.
For example, the key facts state that 13% of women had an episiotomy, but this does not mean that there is a 13% chance of having an episiotomy during a planned vaginal delivery (PVD). In fact, the percentage risk is much higher. Take a look at Table 16. It states that "The highest proportion of Episiotomies were carried out for Instrumental deliveries. For spontaneous deliveries the highest proportion were carried out in the London Strategic Health Authority (31.9%) and the lowest proportion in the South East Coast Strategic Health Authority (20.5%)." So at least 1 in 5 women have an episiotomy with a PVD.
Why are these numbers so much higher?
Because the 13% figure is the number of times episiotomies occur in ALL deliveries, including cesarean deliveries. Since the rate of occurrence is "0.0%" during an elective cesarean and ""0.3%" during an emergency cesarean, you can see how this helps bring the overall total down to 13.3%.
So what is the risk of having an episiotomy with a planned vaginal delivery (PVD)?
Table 16 separates PVD into a number of different outcome categories, and while a woman can never predict which outcome will be her personal experience, this is what we know about episiotomy occurrence (and therefore likelihood) in England:
With a spontaneous vertex delivery, 7.8% of women had an episiotomy. For other types of spontaneous deliveries, 16.1% of women had an episiotomy. With a low forceps delivery, 84.8% of women had an episiotomy, and for other types of forceps deliveries, 82.5% of women had an episiotomy. With a ventouse delivery, 63.6% of women had an episiotomy. For breech deliveries, and breech extraction, 23.4% and 17.7% of women had an episiotomy respectively.
So with a PVD outcome of forceps, 4 out of every 5 women have an episiotomy.
Why is this an elective cesarean 'benefit'?
Because medical studies have cited the negative repercussions of episiotomies; in particular, the risk of severe perineal trauma and its related long-term health issues. Many medical professionals believe that episiotomies were overused in the past and have sought to reduce their incidence (see Table 15 to witness falling rates over the years). Clearly, women don't decide to have a planned cesarean 'only' to avoid an episiotomy, but its avoidance is certainly a legitimate factor in their risk-benefit analysis. You can read a list of medical studies on episiotomy here.