The intensity with which physicians adhere to the belief that episiotomy benefits women is well illustrated by the behavior of many of the participating physicians in this trial. Many were unwilling or unable to reduce their episiotomy rate according to protocol. It reinforces beliefs about the inherent defectiveness and untrustworthiness of the female body and the dangers this poses to women and babies. If a baby were to have its head caught in a door very lightly, but enough to cause cerebral hemorrhage, we would say that it is decidedly pathologic, but when a baby's head is crushed against a tight pelvic floor, and a hemorrhage in the brain kills it, we call this normal. While few modern obstetricians are willing to go as far as DeLee, these beliefs about women still pervade obstetrics, and they fuel episotomy.
Episiotomy serves another purpose.
Davis-Floyd observes that surgery holds the highest value in the hierarchy of Western medicine, and obstetrics is a surgical specialty. In short, routine episiotomy has a ritual function but serves no medical purpose. If any reader believes otherwise, I challenge him or her to find a credible study done in the past 15 years that supports those beliefs. Mediolateral episiotomies are the opposite. Because of these differences, I will note which type was performed after the abstract citation.