Methods	Generation method of randomization not established. Concealment of allocation by opaque, sequentially numbered envelopes
Participants	1050 women enrolled at30to 34 weeks’ gestation, from which 703 were randomized. Randomization took place if the women were at least 37 weeks’ gestation, medical conditions developing late in pregnancy, fetal distress, caesarean deliveries and planned forceps. Parity 0, 1 or 2. Between the ages of 18 and 40 years. Single fetus. English or French spoken. Medical or obstetrical low risk determined by the physician
Interventions	“Try to avoid an episiotomy”: the restricted episiotomy instruction “Try to avoid a tear”: the liberal episiotomy instruction.
Outcomes	Perineal trauma including first, second, third and fourth degree and sulcus tears. Perineal pain at 1, 2, 10 days. Dyspareunia. Urinary incontinence and perineal bulging. Time on resumption and pain of sexual activity. Pelvic floor function. Admission to special care baby unit
Notes	Midline episiotomies. Epsiotomy rates were 43.8% for restricted group and 65% for the routine group
Risk of bias
Bias	Authors’ judgement	Support for judgement
Allocation concealment (selection bias)	Low risk	A - Adequate