ABSTRACT: A review of the medical literature shows that episiotomy is done in about two-thirds of births in the US, and routinely in many settings, especially in primiparas. While episiotomy can be clinically justified in specific circumstances such as impending laceration of the perineum, the literature does not support its routine use, since it is associated with significant risks of pain and infection, and the benefits claimed for routine episiotomy have not been subjected to randomized controlled trials.