Episiotomy, a surgical incision of the perineum, is performed during vaginal delivery to facilitate childbirth and prevent maternal and neonatal complications. Despite its historical routine use, evidence has highlighted its potential to cause pain, sexual dysfunction, and long-term health consequences, leading to recommendations for restricted and selective application. Current obstetric practice reserves episiotomy for cases with imminent perineal injury or fetal compromise. Maternal factors such as age, parity, booking status, and gestational age, along with fetal characteristics including presentation, position, and weight, influence the risk of perineal trauma. Additional contributors include unskilled birth attendance, suboptimal delivery positions, inadequate instruments, and delivery setting, all of which may increase maternal morbidity. Mild perineal tears may have minimal impact, but severe injuries, particularly anal sphincter damage, are associated with significant morbidity and indicate poor quality of care. At our institution, perineal and fetal head protection is routinely practiced during crowning, with episiotomy reserved for imminent tears, performed as a medio-lateral incision of approximately 3 cm. This study examines maternal and neonatal factors associated with episiotomy and perineal trauma over a three-year period, providing insight into childbirth outcomes and quality of care.