Midline versus mediolateral episiotomy

We still don't know which cut is better or how beneficial the procedure is

First described by a Scottish midwife in the 1740s, episiotomy was not used widely until the middle of the 20th century.1 Prominent obstetricians in the United States argued that childbirth was a “decidedly pathological process” and that a small incision would speed labour, decrease trauma, and allow the perineum to be restored to nearly virginal condition after proper suturing.2 3 This became standard practice in the United States and to a lesser degree in Europe throughout most of the century. The type of incision varied: in the United States, for example, midline episiotomy was preferred, in the United Kingdom the mediolateral procedure was standard. What is the evidence that routine episiotomy is beneficial or that one incision is better than another?

The first systematic review of this procedure was published in 1983.4 The evidence at that time—three studies with control groups and no randomised controlled trials—concluded that “little research has been done to test the benefit of the procedure, and no published study could be considered adequate in its design and execution to determine whether hypothesized benefits do in fact …