Picked up off the Medscape RSS feed:
Epidural Analgesia and Severe Perineal Laceration in a Community-based Obstetric Practice. Perineal trauma during vaginal delivery can have serious consequences. Long-term adverse effects of severe perineal laceration include chronic fecal incontinence, dyspareunia, perineal pain, and rectovaginal fistula.
Journal of the American Board of Family Practice [Medscape Family Medicine Headlines]
It's a good article, and provides us with more reasons NOT to support knee-jerk epidurals for our laboring patients. In my residency .. it felt like we NEVER did epidurals … (though I think it was actually about 20% of the time). Since my residency, I've noticed that about 70% of our patients receive them. I'm not sure what accounts for the difference.