Episiotomies still favored by private practitioners. (More Common in Whites, Privately Insured).

LOS ANGELES -- Routine episiotomies are falling out of favor in response to a growing body of evidence that they are medically unjustified, but white women, those with private insurance, and those with private practitioners are still disproportionately receiving what the popular press has called "the unkindest cut."

A number of studies focused on the controversial topic at the annual meeting of the American College of Obstetricians and Gynecologists, including an analysis of National Hospital Discharge Survey data that found a decline in the percentage of episiotomies from 56% of vaginal deliveries in 1979 to 31% in 1997.

That study, by Dr. Anne M. Weber and Leslie Meyn of Magee-Womens Hospital at the University of Pittsburgh, reported on the striking disparities in the episiotomy rate that persist in spite of the continuing overall decline in the procedure's popularity.

They reported, for instance, that 48% of white women received an episiotomy between 1979 and 1997, compared with 31% of black women.

Nearly half of women with private insurance had an episiotomy, compared with 35% with government insurance. Slightly younger women were also more likely to have an episiotomy in the study that chronicled an overall drop in episiotomy rates, from 1.9 million in 1979 to 1.1 million in 1997.

A study by Dr. Jay Goldberg and his associates at Jefferson Medical Hospital in Philadelphia noted a "stepwise reduction" in episiotomy rates at Thomas Jefferson University Hospital, from 69.6% of vaginal births in 1983 to 19.4% in 2000.

This study paralleled Dr. Weber's findings in that black women were at considerably lower risk for an episiotomy than white women, with an odds ratio ...