ORIGINAL ARTICLE Different episiotomy techniques, postpartum perineal pain, and blood loss: an observational study Kathrine Fodstad & Katariina Laine & Anne Cathrine Staff Received: 7 June 2012 / Accepted: 25 September 2012 # The International Urogynecological Association 2012 Abstract Introduction and hypothesis The lateral episiotomy tech- nique has been postulated to cause more postpartum perine- al pain and blood loss compared to the midline and mediolateral episiotomy technique. The aim of the study was to explore the association with postpartum perineal pain and blood loss between different episiotomy techniques. Methods Clinical evaluation of episiotomy was performed 0–3 days after delivery on 300 participating women. Episi- otomy technique was classified by millimeter distance from the incision point to the posterior fourchette and by angle from the sagittal plane in degrees. Postpartum perineal pain was scored on a visual analogue scale (VAS) the first day after delivery. Blood loss data were collected from medical charts. Different episiotomy techniques and different episi- otomy incision point groups were compared in relation to perineal pain perception and blood loss. Results We found no difference between midline, medio- lateral, and lateral episiotomy techniques in perineal pain perception the first postpartum day (p 0 0.74) or in estimated blood loss (p 0 0.38). No differences were found in perineal pain or blood loss between midline and lateral incision points. Mediolateral angles were significantly narrower than lateral angles (p <0.005). Physicians performed longer epis- iotomies than midwives (p <0.005), but episiotomy angle did not vary between professions (p 0 0.075). Conclusions No differences in perineal pain perception the first postpartum day and no differences in estimated blood loss were found when comparing different episiotomy tech- niques or when comparing midline and lateral incision points. Keywords Episiotomy . Angle . Perineum . Postpartum pain . Blood loss . Vaginal birth Introduction Episiotomy is one of the most frequently practiced surgical procedures in obstetrics, defined as a surgical enlargement of the vaginal orifice by an incision of the perineum during the last part of the second stage of delivery [1, 2]. Episiot- omy rates around the world differ considerably [3], but the recommendation today is restrictive use, and on indication only [4, 5], although indications may be highly subjective. Several episiotomy techniques are described in the liter- ature, but only two are commonly addressed, namely, the midline and the mediolateral techniques (Fig. 1). Existing literature on lateral episiotomy is scarce, but the lateral technique seems to be a tradition in some European countries [6, 7]. The lateral episiotomy technique is defined as an incision commencing 1–2 cm lateral to the posterior fourchette, directed towards the ischial tuberosity [8–10]. Studies have also shown that lateral episiotomies are likely to be performed unintentionally [11–13]. The lateral tech- nique may therefore be a more frequently used episiotomy than earlier perceived. Parts of the preliminary data were presented by the first author at the International Urogynecological Association 2011 Annual Meeting in Lisbon, where the abstract was selected for an oral presentation of 12 min. K. Fodstad (*) : K. Laine : A. C. Staff Department of Obstetrics and Gynaecology, Oslo University Hospital, Ullevål, Postboks 4956, Nydalen, 0424 Oslo, Norway e-mail: kfodstad@ous-hf.no K. Fodstad : K. Laine : A. C. Staff Faculty of Medicine, University of Oslo, Oslo, Norway Int Urogynecol J DOI 10.1007/s00192-012-1960-3