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Factors such as physician attitudes and the patient's socioeconomic status may influence the decision to perform an episiotomy, the incision made in a woman's perineum to enlarge her vaginal opening for childbirth. For example, white women and women with private health insurance were at higher risk for episiotomy than non-whites and women without private insurance. Dr. Hueston suggests that providers may be more interventional with women they perceive as expecting perfect outcomes and are more likely to file malpractice suits.