A

Because the cut is directed away from the anal sphincter, a mediolateral episiotomy is much less likely than a midline episiotomy to extend into the external anal sphincter or rectum, whereas it is actually associated with more blood loss and more difficult repair. Studies have shown a significantly lower rate of anal sphincter injury with mediolateral compared with midline incisions [Coats, 1980, PMID 7387941; de Leeuw, 2008, PMID 17999693].