Episiotomy and perineal trauma during childbirth

A study was conducted to assess the frequency of episiotomy and spontaneous tears in 807 primiparas during singleton births. The incidence of episiotomy was 50%, spontaneous tears 22% and intact perineum 28%. A significantly lower frequency of episiotomy ( P < 0.001) as well as epidural anaesthesia ( P < 0.001) was found among immigrant women. There were no indications registered for 58% of the episiotomies. The non‐episiotomy group experienced more clitoris/labia tears ( P < 0.01). On the other hand there was a tendency towards an increased risk for second and third degree tears, 4.2% in the episiotomy group compared to 1.7% in the non‐episiotomy group ( P = 0.06). Haemorrhage (> 600 ml) was more frequent in the episiotomy group than in the non‐episiotomy group ( P < 0.001). We conclude that there is little support for the claim that episiotomy prevents tears in normal deliveries, and that the rationale for the practice of episiotomy is in need of reappraisal.