For decades, episiotomies, surgical cuts made during childbirth to widen the vaginal opening, were performed as a matter of routine in U.S. hospitals. Many women never questioned them. Some were never even asked. But behind this once-common practice lies a deeper story, one about gender, power, and the medicalization of birth.

What Is an Episiotomy, and Why Was It So Common?

In the 1950s-70s, doctors performed episiotomies in more than half of all vaginal births in the U.S. An episiotomy involves cutting the perineum (the area between the vagina and anus) during delivery. In the past, experts believed they would prevent tearing and make childbirth faster and safer. However, the latest studies show letting the perineum tear naturally is preferred for healing. Research shows episiotomies can worsen tearing, increase pain during recovery, cause sexual dysfunction, and lead to infections. In 2006, the American College of Obstetricians and Gynecologists officially discouraged the routine use of episiotomy. Today, experts agree they should only be used in rare situations. 

So, how did they become so common in the first place?

The Medicalization of Birth

Until the 19th century, most births were attended by women, midwives who relied on hands-on knowledge, community support, and non-invasive care. In the 1800s, hospitals started offering obstetric services, particularly for women with complications or who desired pain relief during childbirth. Male physicians began to assert authority over childbirth. The shift away from midwives was not purely scientific but reflected broader patriarchal trends that devalued women’s experiential knowledge in favor of institutional, male-dominated science.

and Anesthesia and medical advancements during the early 1900s made hospital births more appealing to many. By the 1940s, over 50% of U.S. births were happening in hospitals. 

With this shift came new tools, procedures, and control, often at the expense of women’s comfort and autonomy. Episiotomies were seen as efficient, being faster and easier for doctors to stitch up than natural tears. But that efficiency came with a cost: less control, more pain, and sometimes permanent damage for birthing people.

Sexism in the Delivery Room

In many cases, episiotomies were done without consent or explanation. Feminist scholars have long pointed out how male-dominated obstetrics prioritized physician authority over patient choice. In the words of scholar Robbie Davis-Floyd, birth became something “done to women” rather than “done by them.”

Studies have even shown that male OB-GYNs were more likely to perform episiotomies than their female counterparts. That trend reflects a deeper issue: the legacy of paternalism in medicine and the ongoing need to center patient voices.

Centering Patient-Centered Care

Since the 1980s, a growing number of researchers, activists, and patients have spoken out against routine episiotomies. Thanks to their efforts, the rate of episiotomies in the U.S. has dropped from 60% to around 3.4%. Today, informed consent and evidence-based care are becoming the norm.

Still, not all hospitals or providers follow best practices. Some people, especially younger or marginalized patients, still experience procedures without proper explanation or choice. That’s why continuing to question outdated norms, advocating for bodily autonomy, and supporting consented birth care is so important.

The story of the episiotomy is a reminder that medicine isn’t just about biology; it’s also about culture, power, and history. When we examine who makes decisions, whose voices are heard, and whose bodies are on the table, we can start building a more just and ethical healthcare system.