Severe perineal trauma is rising, but let us not overreact.

Severe perineal trauma (SPT) experienced during childbirth is a serious morbidity for women, impacting on short and long-term physical and psychological wellbeing (Signorello et al., 2001; Macarthur and Macarthur, 2004; Priddis et al., 2013; H. Priddis et al., 2014). SPT is defined as a third degree tear, which involves injury to the perineum involving the anal sphincter complex; or a fourth degree tear, which involves injury to the perineum involving the external, internal and epithelium of the anal sphincter (Royal College Obstetricians and Gynaecologists, 2007). It does appear that severe perineal trauma is rising in several developing nations; including Australia (Kettle and Tohill, 2008; Baghestan et al., 2012; Dahlen et al., 2013) (Fig. 1) and this should be a concern to health practitioners. It is important that thoughtful, appropriate and co-ordinated multidisciplinary action is taken and that this action is based on high level evidence, and most importantly is acceptable to women. Overreacting, or reacting without a full understanding of the problem at hand should never be acceptable in today’s enlightened, evidence based health care environment. Consideration of possible unintended consequences and acceptability to women is most important when making major changes in clinical practice.