Background: Episiotomy is a surgical procedure that can result in postpartum hemorrhage, perineal pain, and dyspareunia. Moreover, episiotomy is not totally protective against severe perineal lacerations or maternal and neonatal morbidity; thus, its benefit in reducing the occurrence of severe perineal tears has to be investigated. Objectives: We aimed to assess the pros and cons of a policy of selective episiotomy (only if needed) compared with a policy of routine episiotomy (part of routine management) for vaginal births. Methodology: Nulliparous women in the active phase of labor with gestational age 37-41 and a single viable fetus with vertex presentation attending the Obstetrics and Gynecology Emergency Department, Kasr Al Aini Cairo University Hospital were included. One hundred and twenty laboring women were divided into 2 groups. Group A: Conducting routine episiotomy and Group B: Conducting selective episiotomy. Results: There was no significant difference between the groups regarding the incidence of perineal tears and obstetrical anal sphincter injuries (OASIS). Conclusion: In comparison to conventional episiotomy, selective episiotomy is equally risky for severe perineal/vaginal trauma. In Egypt, obstetric and tertiary care establishments may recommend selective episiotomy. Regarding the volume of intrapartum blood loss, selective episiotomy is superior to routine episiotomy.