If an episiotomy is performed there are arguments for and against the type of episiotomy that can be given, being either a midline or a mediolateral. This relates to the angle at which the cut is made. The type of episiotomy used will usually depend on the caregiver's preferences. The trend in America is for midlines, in UK and Europe it is a mediolateral. As with everything in Australia we have a mixture being used.
At present these arguments have not been adequately supported by good research studies but they may give you an insight into why your caregiver may prefer one method to the other.
The midline episiotomy involves cutting through less muscle tissue and following the natural line of the perineum that a tear would take if it occurred. This can mean they are easier to repair, involve less blood loss, heal better, and have less scarring and possibly less pain in the early weeks after the birth.
The disadvantages can be that performing a midline episiotomy increases the chances of the cut extending through to the anus and causing a 3rd or 4th degree tear. In one study the incidence was shown to be as high as 24% extending in this way.
A mediolateral episiotomy involves cutting into more muscle tissue and does not follow the natural way a woman would tear. This can mean they are harder to repair, have increased bleeding, the cut may not heal as well, it may produce more scarring, and possibly more pain in the weeks following the birth.
The advantage of a mediolateral episiotomy is that it is less likely to extend to a 3rd or 4th degree tear.
Updated June 2008