As part of the regional health project 2018-2022the Ile-de-France Regional Health Agency undertook to reflect on the relevance of perinatal care and to better communicate with families, in particular to reduce maternal and infant morbidity and mortality. It is with this in mind that the ARS just launched a site (childbirth.sante-idf.fr) in collaboration with gynecologists-obstetricians and midwives as well as the Interassociative Collective around birth (CIANE). This site aims to inform future parents in Ile-de-France on the number of annual deliveries in 78 maternity hospitals in the region, with the rate of caesareans, epidurals or episiotomies.
1 in 5 women give birth by caesarean section
In 2020, nearly 167,800 deliveries were recorded in Ile-de-France. Of which :
- 77.1% of vaginal deliveries (79.5% in metropolitan France)
- 82.2% deliveries under epidural (80.2% in mainland France)
- 22.9% of deliveries by caesarean section (20.5% in metropolitan France)
The regional percentage of use of epidurals is not indicated, but it ranges from 0.5% at the Maternité des Lilas to 15% at the CH Marne-la-Vallée Coulommiers.
Cesareans and episiotomy: recommendations from the College of Obstetricians
According to the national perinatal survey published in 2016, an episiotomy is performed in 2 out of 10 deliveries (20% of cases). Episiotomy is this medical procedure, performed in case of vaginal delivery, which consists of incising part of the muscles of the perineum in order to facilitate the passage of the baby and reduce the risk of obstetric tears.
Yes, but here it is: episiotomy is not a trivial medical procedure. In addition to the risk of postpartum hemorrhage and possible perineal pain, an American study published in April 2017 showed that women who underwent an episiotomy were also more likely than others to develop psychological disorders after childbirth. This is why in 2018, the National College of French Gynecologists and Obstetricians (CNGOF) issued new recommendations to prevent postnatal perineal symptoms.
“There is no recognized benefit to the practice of episiotomy in normal childbirth: there is no evidence to indicate an episiotomy in the event of breech presentation (or) twin pregnancy” specify the specialists who add, for the benefit of their colleagues: “it is recommended (…) to obtain the woman’s agreement before performing an episiotomy”.
On the other hand, in the event of a difficult delivery, an episiotomy will remain recommended: “instrumental extraction, especially with a forceps, is associated with a risk of serious tearing which can extend to the anal sphincter. However, studies suggest, with however, a low level of proof that episiotomy could have a preventive action”, explains Professor Xavier Fritel, one of the authors of the recommendations.
Sources:
- Obstetric practices in Ile-de-FranceRegional Health Agency, June 2021
- Prevention and perineal protection in obstetricsNational College of French Gynecologists and Obstetricians, 2018
Read also :
- New birth centers planned in France
- The right steps to take good care of your episiotomy
- WHO wants to fight against the epidemic of cesarean sections