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. One of the best midwife's secrets for avoiding an episiotomy is a simple, liberal application of warm oil compresses or warm water compresses applied to your perineum and around your baby's head as it begins to show. A natural tear easily heals on its own. A surgical incision will take twice as long to heal and often leads to deeper and longer tears. The perineum can be compared to a piece of cloth.