consideration of warm compresses and 'hands off' to protect against episiotomy. Even more unsettling is the statement 'MPP should be used unless the woman objects', implying little consideration for autonomy and informed consent.For these reasons we are not only disappointed with the BJOG article but also with the professional stakeholder investment in the intervention, which seems to have been widely and uncritically supported, with some support even being somewhat evangelical, despite the limited evidence in favour.