From The Official Lamaze Guide: Giving Birth with Confidence.

What to Know

• Research provides no evidence that an episiotomy reduces the risk of perineal injury, improves perineal healing, prevents birth injury to babies, or reduces the risk of future incontinence. Rather, the evidence shows that routine or liberal use of episiotomy is likely to be ineffective or harmful.
• The WHO recommends eliminating routine or liberal episiotomy.

You may need an episiotomy if:

• You or your baby is in distress.
• Your baby is very large or in an unusual position.  

How to Avoid Unnecessary Use:

• Ask potential caregivers their thoughts about episiotomy and choose your caregiver carefully.
• Push in upright positions that let your perineum stretch gently as your baby descends.
• Change positions often while you’re pushing.
• Push spontaneously, according to your body’s signals, not in a directed way.
• Remember that your body knows how to give birth.
• Be patient with your body.

What you can do if you have an episiotomy:

• After birth, start doing Kegel exercises as soon as possible to help heal and strengthen your perineal muscles.
• After birth, take warm baths to increase circulation and decrease pain and apply ice to reduce swelling.