In a prospective study, pelvic floor muscle strength was investigated pre- and post partum in 87 women with uncomplicated pregnancies. Those vaginally delivered were 71 primiparas, while 16 underwent an elective cesarean section. The objective was to evaluate the effect of the delivery procedure on the pelvic floor muscle strength with the aid of vaginal cones. In the group of women with vaginal delivery three subgroups were identified: episiotomy, spontaneous laceration and intact perineum. Pelvic floor muscle strength was weakest in the episiotomy subgroup, the difference in values between this subgroup and each of the other subgroups and the elective cesarean section group being significant. No significant difference was evident between the spontaneous lacerations and intact perineum subgroups.

Stress urinary incontinence is the most common form of female incontinence. The purpose with this study was to describe consequences of episiotomy and spontaneous tears on urinary incontinence after the delivery. A postal questionnaire was sent to 205 women who had participated in an earlier study concerning episiotomy and spontaneous tears during delivery. They were contacted four years post-partum. One hundred and eighty-five women (90%) responded and there was no difference in the response rate between the group with episiotomy and in the group with spontaneous tears. Urinary incontinence symptoms were found in 65 women (36%). This frequency was similar in both groups. The study does not confirm the protective value of episiotomy on urinary incontinence.

While episiotomy is a common operation during delivery little is known of its benefits compared with spontaneous tears. This study was designed to evaluate and compare episiotomies and spontaneous tears. The sample comprised 205 primiparas, 157 with episiotomies and 48 with spontaneous tears. Women with episiotomies expressed more discomfort, perineal complications were more pronounced and prolonged, and fewer were able to participate in the post-partum exercises. Furthermore, delayed healing was recorded for the episiotomy group and more analgesia was used post-partum by women with episiotomies.

Objective To study changes in the use of episiotomy since 1989, controlling for variables such as severe tears, epidural anaesthesia, duration of the second stage of labour, instrumental deliveries, birthweight and maternal position at delivery. Design Retrospective study. Data were obtained from original birth records and questionnaires. Setting Huddinge University Hospital and all labour wards (n= 62) in Sweden. Population 10,661 women who were delivered vaginally (4575 nulliparae, 6086 multiparae) between 1992 and 1994, and 3366 nulliparae delivered in all Swedish hospitals during the month of March 1995. Main outcome measures Episiotomy rates, severe tears and instrumental deliveries. Results The rate of episiotomy was 1 % and of severe tears 0.6% among multiparae delivered vaginally (including instrumental deliveries) at Huddinge University Hospital between 1992 and 1994. The rate of episiotomy was 6.6% and of severe tears 2.3% among nulliparae. Vacuum extraction and epidural anaesthesia were more commonly associated with episiotomy. Factors significantly associated with severe tears were infant birthweight ≥ 4000 g, vacuum extraction and episiotomy. In all Swedish labour wards in 1995 the mean incidence of episiotomy in nulliparae was 24.5%, a significant decrease from 33.7% in 1989. Wide variations occurred between hospitals (4%‐50%). Conclusion The use of episiotomy was much reduced at Huddinge University Hospital, with a consistently low rate of severe tears. This supports the growing evidence for individualised and restrictive use of episiotomy at childbirth.