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Approximately 40 percent of all vaginal deliveries in the U.S. include an episiotomy. A study examined episiotomy in the country from 1980 to 1998, when the trend toward avoiding the routine use of the procedure was strong. Data were obtained from the National Hospital Discharge Survey, which is conducted annually and based on a nationally representative sample of discharges from short-stay non-federal hospitals. During the 18-year period, the episiotomy rate in the U.S. dropped by 3 percent. Rates decreased for all age and racial groups investigated, in all four geographic regions, and for all sources of payment. Significant differences remained between groups in 1998, …