More women in developing countries are delivering their babies in hospitals. In Latin America institutional births account for 70% of all deliveries; in Africa, 36%; and in developing countries overall some 40%.1 What is becoming apparent is that in some countries virtually all the women delivering in hospital will be surgically cut. If they miss out on a caesarean section they will have an episiotomy. For example, Brazil has caesarean section rates of greater than 30%, and Argentina has episiotomy rates of greater than 80% for vaginal births. Questions about high caesarean sections rates have been raised in the past, but unnecessary episiotomies have not been widely debated.Obstetricians in the tropics continue to instruct health staff to apply a policy of “avoid …