I agree with Rachel that they do have their place - births that require instruments (forceps and vacuums) need the room the get the gear in there, so quite often a cut is made to get them in. Also if you look like you are going to tear badly or in the wrong spot, it can be better than letting you tear naturally. An Epi also cuts throught the muscle, which is why they take longer to heal and feel quite sore afterwards.

One school of thought is that when you tear, you only tear as much as you need to get the baby out and with an epi you may be cut more than you needed to be.

Having good birth management helps immensely, with the birth of the baby not being rushed and letting the baby take it's own time to be born and hence not creating a strain on the perineum as the area has time to stretch to accommodate the baby coming out.

I think that most hospitals don't rountinely do them as a matter of course, but use their judgement at the time to see if one is required.

I personally think that it is better to tear, the healing time was much faster and less uncomfortable.