Episiotomy practice and perineal outcomes in low risk vaginal deliveries: comparing a hospital attached birth center and delivery suite in Beirut, Lebanon.

Background: Episiotomy is considered a protective intervention when used selectively rather than routinely. Although current obstetric practice no longer recommends routine episiotomy, data on its use remain limited, particularly in Lebanon.Objective: This study evaluated the prevalence, predictors, and maternal outcomes of episiotomy in low-risk vaginal deliveries and compared its use between a hospital-attached birth center (BC) and a delivery suite (DS).Methods: A retrospective observational study was conducted using data from Rafik Hariri University Hospital (RHUH) BC and DS between January 2024 and September 2025. A total of 333 patients were included. Data were analyzed using SPSS v23. Binary logistic regression identified predictors of episiotomy, while associations with maternal outcomes were assessed using risk ratios and number needed to treat.Results: The episiotomy rate was 28.5%, with no significant difference between BC and DS. Rates were higher among primiparous women. Episiotomy was associated with lower rates of perineal injury overall (NNT = 4 for both parity groups). Among primiparous women, those without episiotomy had significantly higher rates of paraurethral injury (41.2 vs 12.3%, p = 0.011) and first-degree tears (35.3 vs 11.0%). On multivariate logistic regression, independent predictors of episiotomy included primiparity (aOR = 39.18, 95%, CI 18.42-83.33), private patient status (aOR = 21.72, 95%, CI 3.33-141.64), older age (aOR = 0.93, 95% CI: 0.86-0.99), and greater cervical dilation at admission (aOR = 0.74, 95% CI: 0.60-0.91).Conclusion: Episiotomy use varies by case and remains common in low-risk pregnancies, especially among primiparous women. Predictive and preventive factors associated with its use were identified.