Severe Perineal Laceration and Episiotomy Among Asian American, Native Hawaiian, and Pacific Islander Ethnicities in California, 2007-2018
Creators: name: Chidyausiku, Tracy
name: Bane, Shalmali
name: Main, Elliott
name: Carmichael, Suzan
Publisher: name: Stanford Digital Repository
Year: 2023
Subjects: subject: AANHPI
subject: Episiotomy
subject: Severe Perineal Laceration
subject: Asian American Native Hawaiian Pacific Islander

description: Background: Asian individuals have an increased risk for episiotomy and severe perineal lacerations during vaginal delivery. The Asian population in the US is diverse yet very few studies disaggregate Asian American, Native Hawaiian, and Pacific Islander (AANHPI) ethnic groups. Objective: This study investigated the variability of risk for episiotomy and severe perineal laceration among 16 disaggregated AANHPI groups, compared to Non-Hispanic White (NH White) individuals, and assessed whether maternal social, maternal health-related, and delivery-related factors explained the variability in risk. Study Design: Birth and fetal death certificate files linked to hospital discharge records were used to identify nulliparous, term, singleton, vertex vaginal deliveries among individuals who self-identified as AANHPI or Non-Hispanic White. Modified Poisson regression models were used to examine risks of episiotomy and severe perineal laceration among AANHPI subgroups compared with Non-Hispanic Whites. A sequential adjustment approach was utilized to assess if maternal social, maternal health-related, and delivery-related factors explain the variability of risk for the outcomes. Results: Among the 568,229 individuals in this study cohort, prevalence of episiotomy was 15.7% (N=89,105) and prevalence of severe perineal laceration was 6.8% (N=38,619). Prevalence of episiotomy ranged from 11% in Other Pacific Islander individuals to 26% in Vietnamese individuals. Prevalence of severe perineal laceration ranged from 3% in Guamanian individuals to 16% in Indian individuals. In a fully adjusted model, 7 of the AANHPI subgroups had a RR > 1.0 for episiotomy and 14 of the AANHPI subgroups had a RR > 1.0 for severe perineal laceration, compared to NH White individuals. After adjustment, Vietnamese individuals were at highest risk of episiotomy (adjusted relative risk 1.75 [95% CI 1.70, 1.80]), and Indian individuals were at highest risk of severe perineal laceration (adjusted relative risk 2.11 [95% CI 2.03, 2.18]). The greatest changes in relative risks for both episiotomy and severe perineal lacerations occurred when adding maternal social factors into the models. Conclusion: Social factors, in contrast to maternal health and clinical factors including episiotomy, had higher impact in the variability of risk of the outcomes among the AANHPI population. This study adds to the growing evidence of the diversity and disparity in health outcomes among AANHPI subgroups. the impact of social factors, including those not assessed in this study, on the risk of the outcomes among AANHPI ethnic groups merits further investigation. Study findings can also help inform health interventions, such as provider discussions with patients, tailored to AANHPI subgroups for preventive measures against severe perineal lacerations and routine episiotomy.