In plain words
A mediolateral episiotomy is a cut made during birth. It starts at the back of the vaginal opening and goes out and to the side, away from the rectum. Providers may use it when the baby needs more room, or when a tear is likely to be worse. It is done after numbing medicine. The angled cut is meant to lower the chance of a deeper tear into the rectum. Healing takes a few weeks, and the stitches dissolve. Many births now do not need one. Ask your provider how often they use it, and what they would do instead.
The deeper version
A mediolateral episiotomy is an incision of the posterior fourchette and directed at about 45 to 60 degrees from the midline, intended to reduce the risk of compared with a midline incision, at the cost of more blood loss and a possible extension toward the sphincter. The UK OASI Care Bundle evaluation (BJOG, 2021) included mediolateral episiotomy at 60 degrees when indicated, alongside antenatal information, manual perineal protection, and warm compresses, across 16 units, and reported a fall in OASI rates. A Cochrane review of (Carroli and Mignini, 2009) did not support routine use, and found less severe perineal trauma with restrictive use. Current practice favors selective use. The controversy is whether a mediolateral cut meaningfully reduces sphincter injury outside study settings.
Where it comes up
- Perineal massage, tearing, and episiotomyGetting Ready for Birth
- Vacuum and forceps birthsBirth and the First Days
- Healing a tear or stitchesPostpartum: Your Body
- Pushing and positions for birthGetting Ready for Birth
What mothers here say about mediolateral episiotomy
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Sources
- BJOG — Evaluation of the UK OASI Care Bundle in 16 units (2021)
- Carroli G and Mignini L — Episiotomy for vaginal birth, Cochrane Database of Systematic Reviews (2009)