In 1984, we proposed to study the need for episiotomy in the first North American randomized controlled trial on this subject. Getting funded and published proved to be difficult since we were questioning not only established views on episiotomy but also conventional beliefs about birth. During the 10-year process from conceptualization to publishing, we were confronted with the paradigm of birth as a pathological state and episiotomy as of trivial consequence. Although many of the reviewers of our study found the topic to be of little importance and some disputed its scientific merit, others saw the study as both important and well conceived. The tension between these views and the place of episiotomy in a wider context of maternity care forms the subject of this paper.