Obstetric Interventions Among Native and Migrant Women: The (Over)use of Episiotomy in Portugal

Elsa Lorthe; Milton Severo; Sousan Hamwi; Teresa Rodrigues; Cristina Teixeira; Henrique Barros

doi:10.3389/ijph.2024.1606296

Obstetric Interventions Among Native and Migrant Women: The (Over)use of Episiotomy in Portugal

Int J Public Health. 2024 Mar 21:69:1606296. doi: 10.3389/ijph.2024.1606296. eCollection 2024.

Authors

Elsa Lorthe^{1

2

3}, Milton Severo^{1

2

4}, Sousan Hamwi^{1

2}, Teresa Rodrigues^{1

2

5}, Cristina Teixeira^{1

2

6}, Henrique Barros^{1

2

4}

Affiliations

¹ EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
² Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal.
³ Unit of Population Epidemiology, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
⁴ Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
⁵ Department of Gynecology and Obstetrics, Centro Hospitalar Universitário São João, Porto, Portugal.
⁶ Polytechnic Institute of Bragança, Bragança, Portugal.

Abstract

Objective: Episiotomy, defined as the incision of the perineum to enlarge the vaginal opening during childbirth, is one of the most commonly performed surgical interventions in the world. We aimed to determine if migrant status is associated with episiotomy, and if individual characteristics mediate this association. Methods: We analyzed data from the Bambino study, a national, prospective cohort of migrant and native women giving birth at a public hospital in mainland Portugal between 2017 and 2019. We included all women with vaginal delivery. The association between migrant status and episiotomy was assessed using multivariable multilevel random-effect logistic regression models. We used path analysis to quantify the direct, indirect and total effects of migrant status on episiotomy. Results: Among 3,583 women with spontaneous delivery, migrant parturients had decreased odds of episiotomy, especially those born in Africa, compared to native Portuguese women. Conversely, with instrumental delivery, migrant women had higher odds of episiotomy. Disparities in episiotomy were largely explained by maternity units' factors, and little by maternal and fetal characteristics. Conclusion: Our results suggest non-medically justified differential episiotomy use during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use in a country with a high frequency of medical interventions during delivery.

Keywords: differential care; episiotomy; healthcare inequities; migrant; obstetric interventions; perinatal health; reproductive health.

MeSH terms

Delivery, Obstetric
Episiotomy* / methods
Female
Humans
Portugal
Pregnancy
Prospective Studies
Transients and Migrants*

Grants and funding

The Bambino project was funded by FEDER funds through the Operational Programme for Competitiveness and Internationalisation (POCI-01-0145-FEDER-016874), and by national funds of FCT—Fundação para a Ciência e Tecnologia (Ref. FCT PTDC/DTPSAP/6384/2014) under the scope of the project “Perinatal Health in Migrants Barriers, Incentives and Outcomes” and the Research Unit of Epidemiology (EPIUnit)—Institute of Public Health of the University of Porto (POCI-01-0145-FEDER-006862; Ref. UID/DTP/04750/2013). This grant included external peer review for scientific quality. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.