Pelvic floor damage.

Birth attendants must keep up to date with the recommendations made in good clinical studies, and incorporate these into their practice. There is no justification for routine, liberal use of episiotomy, and when performed it must be a mediolateral incision, not midline. The indications for episiotomy are fetal distress, prolonged active second stage of labour and if severe perineal damage is thought to be imminent. Further study of the effect of overstretching tissues is required, to establish if episiotomy would protect against prolapse. Perineal trauma should be repaired by an experienced member of staff, with a polyglycolic acid suture, preferably using a continuous subcuticular technique. It is possible that women who are particularly at risk of pelvic floor damage, such as those who have already experienced postpartum anorectal incontinence, should be offered an elective caesarean section.