I am not saying this is the case for all women but I definitely think this is something to consider given so many of us are fearful about birth - someone made a comment about a watermelon out of something the size of a lemon. Doesn't paint a nice picture. So try to picture a walnut going through a toilet seat and give it your best shot. But many women do have an episiotomy when it is not required. Hear examples all the time of the scissors being suggested or gotten out and the baby is born fine or even shoots out quickly - another thing to do with fear called the 'ejection reflex' has a place too in the birth room... there is just not one answer for everything, or one problem, I like to start with the least interventive, first.