Abstract Background: Obstetric anal sphincter rupture (OASR) is a severe complication in vaginal delivery, and is shown to be the strongest predicator of later anal incontinence. The rate of OASR in Norway increased from the 1960s until 2000. This trend evoked a national focus on how to decrease the rate of OASR, and especially how to perform perineum support during labour as a technique to prevent OASR. Objective: To review the documentation of today s clinical use of perineum support and episiotomy during vaginal delivery in Norway and how these techniques have an impact on the rate of OASR. Moreover to examine if there are any differences in attitude between doctors and midwifes concerning how these techniques can prevent OASR. Material and methods: The work is based on publications provided by our supervisor and a non-systematic search in PubMed and McMasterPlus. We also participated in and used selected results from two ongoing research studies at Forskningssenteret for fødselshjelp og kvinnesykdommer at Oslo Universitetssykehus (OUS, Kvinne- og barneklinikken, Ullevål). Results: Today s clinical use of perineum support reflects the results of research in this field, and the recommendations of using perineum support provided to the labour units. There is today a hands-on delivery policy, that both midwives and doctors seem to acknowledge as a way of preventing OASR. The use of episiotomy is less established in Norwegian labour units, possibly reflecting that researchers still disagree on how episiotomy can prevent OASR. There are reports supporting that an episiotomy truly angled as a mediolateral episiotomy can prevent OASR. Our study indicate that doctors have a more favorable attitude towards episiotomy than midwifes. Conclusion: Both perineum support and episiotomy are likely to prevent OASR during vaginal delivery. However, the episiotomy needs to be performed with a certain angle, and more research remains before we can fully conclude on the preventive OASR effect in selected risk groups. Both midwives and doctors are positive to the preventive effect of perineum support. Doctors are more positive regarding the preventive effect of episiotomy compared to midwives.