Routine episiotomy prevents severe tearing, protects the pelvic floor, and improves childbirth outcomes.

An episiotomy is a surgical cut in the perineum, the tissue between the vaginal opening and the anus. It was introduced as a controlled incision that could replace an unpredictable natural tear. The logic was persuasive: a clean incision might heal better, prevent severe perineal injury, protect the pelvic floor, and speed delivery.

During the twentieth century, the procedure became routine in many hospitals even though those preventive benefits had not been established by strong trials.

Comparative studies reversed the assumption. Routine episiotomy did not reliably prevent severe tearing or later pelvic-floor problems and could itself increase pain, blood loss, healing difficulty, and extension into more serious injury.

A restrictive strategy—using episiotomy only when there is a specific indication—produced better overall outcomes for most spontaneous vaginal births and became the recommended approach.

Episiotomy has not disappeared. It can still be appropriate in selected assisted or urgent deliveries or when clinicians judge that enlarging the vaginal opening is necessary.

The overturned claim is the population-wide preventive rule: routinely cutting the perineum does not protect mothers better than selective use.