Selective versus routine use of episiotomy for vaginal birth

Cochrane systematic review (11 RCTs) comparing selective/restrictive vs routine episiotomy in women without intended instrumental delivery. A selective policy reduced severe perineal/vaginal trauma (RR 0.70, 95% CI 0.52-0.94; 5375 women, 8 RCTs; low-certainty evidence) with no clear maternal or neonatal harm. The belief that routine episiotomy prevents severe trauma is not supported by evidence.