If a woman does not have an episiotomy, she is likely to have a small tear, but with rare exceptions the tear will be at worse, no worse than a routine episiotomy. Episiotomies do not prevent urinary incontinence or improve sexual satisfaction. Episiotomies are not easier to repair than tears. Episiotomies do not heal better than tears. Episiotomies do not prevent birth injuries or fetal brain damage.
Episiotomies increase blood loss.
As with any other surgical procedure, episiotomies may lead to infection, including fatal infections. Epidurals increase the need for episiotomy. They also increase the probability of instrumental delivery. Instrumental delivery increases both the odds of episiotomy and deep tears. The prone position during delivery increases the need for episiotomy, probably because the perineum is tightly stretched.