This retrospective study examines whether parturient preference to deliver without a routine episiotomy is viable. One hundred sixty-two women who delivered in an alternative birth center with the aid of nurse-midwives were studied. The incidence of episiotomies was 38%; 33% of the population delivered over intact perineums. First-degree lacerations were experienced by 21% of the population and second-degree lacerations by 8% of the women. Primiparous women with second stages lasting longer than 50 min who required anesthesia most often required an episiotomy. Neither the women who delivered without an episiotomy nor their infants appeared to suffer from the experience.