Hi I am usually quite a silent participant but felt an urge to comment on this topic.  I have been a midwife for 15years and still am working in hospital settings with high risk women and women that choose to birth in a hospital.  The rate of episiotomy can be high in hospital settings but I have had to perform 8 in all this time and all for severe fetal distress and I feel that if all of my pregnant women that I cared for were low risk pregnancy and natural healthy labour then this would yield a different result.  Sometimes I keep a closer eye on previous history of 3rd & 4th degree tears who have done no perineal massage antenatally. hope this helps Jenni

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