Abstract
Background
Eastern African immigrants from countries affected by female genital mutilation have
resettled in many developed countries, including Australia. Although possibly at risk
of perineal trauma and episiotomy, research investigating their perineal status post-migration
is sparse.
Aim
To investigate variations in episiotomy use and incidence of severe perineal tear
for women born in Eritrea, Ethiopia, Somalia and Sudan compared with Australian-born
women.
Methods
A population-based study of 203,206 Australian-born and 3502 Eastern African immigrant
women admitted as public patients, with singleton vaginal births between 1999 and
2007, was conducted using the Victorian Perinatal Data Collection. Descriptive and
multivariable logistic regression analysis adjusting for confounders selected a priori, were performed to compute incidence and adjusted odds ratios.
Findings
Overall, 30.5% Eastern African immigrants had episiotomy compared to 17.2% Australian-born
women. Severe perineal trauma occurred in 2.1% of Eastern African immigrants and 1.6%
of Australian-born women. While the odds of severe perineal trauma was significantly
elevated only during non-instrumental vaginal births for Eastern African immigrants
{ORadj1.56 95%CI(1.17, 2.12)}; that of episiotomy was increased during both non-instrumental
{ORadj4.47 95%CI(4.10, 4.88)} and instrumental {ORadj2.51 95%CI(1.91, 3.29)} vaginal births.
Conclusions
Overall, Eastern African immigrant women experienced elevated odds of episiotomy and
severe perineal tear. Health care providers need to be mindful of the increased risk
of severe perineal tear in these women and enhance efforts in identification and treatment
of severe perineal trauma to minimise associated short and long term morbidity. Strategies
to reduce unneeded episiotomy and ways of enhancing perineal safety are also needed.
Keywords
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Article info
Publication history
Published online: November 23, 2016
Accepted:
November 13,
2016
Received in revised form:
October 31,
2016
Received:
August 23,
2016
Identification
Copyright
Crown Copyright © 2016 Published by Elsevier Ltd on behalf of Australian College of Midwives. All rights reserved.
