The presence of grade 3 female genital mutilation (FGM) with obstruction of the vaginal introitus following infibulation requires staff appropriately trained in defibulation. Best practice consists of antenatal identification of women with FGM and the offer of defibulation before the onset of labor, supported by appropriate counseling. When a woman presents in labor, defibulation should be undertaken only when the tissues are stretched as the fetal head descends. Defibulation should be performed before evaluating the need for episiotomy, which may not be required. The practice of “double episiotomy” is damaging and should be avoided.