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 lithotomy position increases the need for episiotomy, probably because the perineum is tightly stretched. The birth attendant's philosophy, technique, skill, and experience are the major determinants of perineal outcome. That Reduce the Probability of Tears Top References Cunningham FG, MacDonald PC, and Gant NF, eds. Williams Obstetrics . Birth as an American rite of passage .