There is little clinical evidence to suggest that episiotomies should be carried out routinely, yet over 200,000 of these operations are performed every year in the UK and over 1.5 million in the US. This book focuses on the process of innovation and change in the use of this controversial procedure by tracing the evolution of the liberal or routine use of episiotomy in the UK and US. It discusses the influence of professional and institutional pressure on bringing about change, and highlights the importance of the recent backlash by midwives and women's groups to reduce the number of times the procedure is used. The book should be a useful text for all those involved in effecting change within midwifery practice and management.