Changes in the management of labour: 2. Perineal management.

An analysis of 24,439 deliveries between 1980 and 1984 in a large British obstetric unit showed a striking decline in the rate of episiotomy. The rates of first- and second-degree perineal tears increased during the study period, but overall there was a significant rise in the proportion of women who gave birth with an intact perineum (p less than 0.001). There was no increase in the rate of third-degree tears or of other perineal complications. Delivery with an intact perineum was more likely among younger women, those with a short second stage of labour and those with a small baby (p less than 0.001). These findings confirm the short-term safety of lowering episiotomy rates and should be helpful to all obstetric professionals in reducing unnecessary perineal morbidity among childbearing women.