Episiotomy is performed in over half of the hospital-based deliveries in the US, despite the dearth of scientific data demonstrating its usefulness in uncomplicated cases. After roughly 70 years of widespread use in the US, the first randomized clinical trial of episiotomy conducted in North America (and the first worldwide involving median episiotomy) found no evidence for better outcomes in deliveries assigned to "liberal" than those assigned to "restricted" use of episiotomy. These results lend support to the many health professionals and lay persons calling for further reduction in the use of this procedure.