ABSTRACT: Episiotomy, the unkindest cut of all, persists despite clinical practice guidelines recommending its restrictive use. The purpose of this paper was to compile international statistics on the use of this practice and examine whether current guidance on the restrictive use of episiotomy was being followed. Methods: We searched government websites and the Internet, contacted colleagues for references, and checked the references of retrieved citations. Results: Statistics from around the world revealed overall high rates of episiotomy with a decreasing trend in some countries. Considerable variation occurs in the use of the operation by country, within countries, and even within the same professional provider group. Conclusions: Greater efforts are needed than currently in place to reduce the episiotomy rate, particularly in the developing world.