a. A median episiotomy is the most common and generally the least painful. Occasionally there may be an extension through the rectal sphincter (third-degree laceration) or even into the anal canal (fourth-degree laceration).

b. With a mediolateral episiotomy, third-degree lacerations may occur but fourth-degree lacerations may be avoided. The blood loss is greater, repair is more difficult and painful, and there is usually more pain during healing.