During childbirth, an incision may be made in the perineum - the diamond shaped area that includes the vagina and rectum. This incision, called an episiotomy, used to be routine for vaginal delivery, particularly a first delivery. The incision was thought to reduce potential damage from a natural tear, while making repair easier, and speeding delivery. An episiotomy is no longer a routine part of childbirth in the United States and is usually done on a case by case basis.