Births: episiotomies drop 39% in public hospitals

A study by the Faculty of Medicine of the University of Porto (FMUP) reveals that the practice of episiotomies or incisions performed during childbirth decreased between 2013 and 2022 in Portugal, falling from 60% to 21% in national public hospitals.

"The study shows that, for some years now, there has been a consistent cultural and practical shift among professionals, in line with international recommendations that advocate the restrictive and individualized use of this procedure," reads the summary of the study, which dates back to May and was published in the scientific journal International Journal of Gynecology and Obstetrics.

Episiotomies are incisions made during childbirth, in the vaginal area and toward the perineum. This procedure aims to widen the vaginal opening and facilitate the baby's exit during vaginal delivery, but the routine use of episiotomies is not recommended by health organizations.

According to FMUP, the data contained in the study now released was collected from all public hospitals nationwide and "analyzed rigorously, transparently, and consistently, taking into account data from various official databases, potentially helping to clarify one of the most discussed topics in obstetric health in recent times."

The results reveal that, between 2013 and 2022, the episiotomy rate in uninstrumented vaginal deliveries fell from 63% to 21% in Portuguese public hospitals. However, this reduction impacted the woman's recovery and future, such as perineal lacerations affecting the anal sphincter. "This data is essential, as it demonstrates that the decision to resort to episiotomy must seriously weigh risks and benefits," the summary reads.

The use of routine episiotomies has been questioned since the 1980s, but became much more contested in 2010, after it became public that this technique was used in more than 70% of all vaginal births performed in Portugal.

More recently, the public debate reached the Assembly of the Republic through a petition on obstetric practices considered inhumane , which resulted in the publication, in March 2025, of a law that penalizes hospitals and health professionals who perform unjustified episiotomies (law no. 33/2025).

There are no known objective universal criteria for defining when an episiotomy should be performed. Typically, the decision is made spur-of-the-moment, often under enormous pressure and in emergency situations.

In Portugal, there has been a set of recommendations since 2023 that restrict episiotomies, meaning that they should only be performed when there is a need to shorten the birth , namely when there are signs of fetal distress or when there are signs of an imminent complicated perineal laceration.

In the study now published, the FMUP research team takes the opportunity to advocate for the training and education of professionals who provide childbirth assistance, considering it "essential to ensure that all women receive safe, individualized, and truly respectful care."

In this regard, a source at FMUP told Lusa that the institution has made "a significant investment in the training of medical students, interns, obstetricians, and even specialist nurses, who receive training dedicated to childbirth assistance and perineal protection techniques at the institution's Medical Simulation Center." "Cumulatively, the Faculty also invests in research in this area," he added.

The study was carried out by Mariana Bandeira, Cristina Costa-Santos, Fernando Lopes, João Bernardes and Ana Reynolds, all from FMUP, and involved the Alto Minho Local Health Unit and RISE-Health.