Introduction: The well-documented advantages of restricting the practice of episiotomy rather than encouraging its routine use include less risk of posterior perineal trauma and of severe perineal trauma. So, this study aimed to compare the maternal morbidity during first vaginal birth in women with or without episiotomy. Methodology: This was a hospital based randomized controlled trial conducted in the Department of Obstetrics and Gynaecology. Nulliparous women in active stage of labour attending labour unit with singleton pregnancy with cephalic presentation at term. Multiparous women, mal-presentations and mal-positions, multifetal pregnancy, pregnancy with medical disorder, instrumental deliveries, big baby (Clinically or USG weight > 4 kg), preterm and previous perineal surgery cases were excluded. The collected data were entered in Statistical Package for Social Science (SPSS) and analysis was using Chi-Square test. P value<0.05 was considered as significant. Result: Among the 200 cases selected, 100 cases were in the Liberal (routine) episiotomy and 90 cases in Optional (restrictive) episiotomy group after randomization via computer generated table. 10% cases in the optional episiotomy group converted to episiotomy. In the current study comparison of the two groups in terms of vaginal and paraurethral tear showed that they are more common in the optional (restrictive) group. In the present study rate of episiotomy had reduced remarkably with 10% women delivering with an episiotomy in the restrictive group compared to routine episiotomy where 100% episiotomy rates were observed. On comparison of the requirement of analgesia in restrictive group, and in routine group statistically significant difference was found. There was no statistically significant difference in the neonatal outcome in the two groups in our study. Conclusion: It is necessary to establish documented protocols to decide in which cases, when and how to perform episiotomy. Individualization of cases for approach of episiotomy is a need of the hour.