Forty years of research fails to support any of the claims made for episiotomy. Episiotomy does not prevent anal tears; median episiotomy provokes them, and mediolateral episiotomy may as well. In fact, nonextending median episiotomy at the first birth predisposes to increased spontaneous tearing, including anal sphincter tears, at the next birth. Episiotomy increases the risk of anal incontinence. Episiotomy does not preserve pelvic floor strength, and mediolateral episiotomy may decrease it. Episiotomy does not hurt less or heal better; the opposite is true. Far from improving sexual functioning, episiotomy increases the likelihood of painful intercourse. Episiotomy has no effect on neonatal outcomes either. Episiotomy neither prevents nor relieves shoulder dystocia, nor does it improve neonatal outcomes with shoulder dystocia, and median episiotomy with shoulder dystocia is a disaster for the woman’s anal sphincter. Finally, women are more likely to experience anal injury with instrumental vaginal delivery when they have median episiotomies, and the jury is still out on whether mediolateral episiotomy is harmful, neutral, or protective.

Passage from chapter 15, Episiotomy: The Unkindest Cut