The recent paper by Kalis et al.1 on types of episiotomy, although interesting, misses the point. It is the type of perineum that is important. A long perineum will almost certainly tear but is ideal for a midline episiotomy, with all its perceived advantages. However, whereas a short perineum may not tear, it indicates a high risk for anal sphincter damage, and in my view mandates an episiotomy. Those who only perform midline episiotomies (e.g. many obstetricians in the USA), only perform mediolateral episiotomies (e.g. many obstetricians in the UK and Ireland), never perform episiotomies (e.g. many midwives), or always perform an episiotomy (e.g. some obstetricians), are all wrong. It is one of the few remaining areas in the specialty where the ‘art of obstetrics’ can be thoughtfully applied.