“…Depending on the study, the mediolateral episiotomy has been found to lower the incidence of OASI in spontaneous vaginal deliveries. 19 Other studies, however, have found that episiotomies were not protective against severe perineal lacerations, 8,9,20 and can actually increase the risk of third-degree and fourth-degree perineal tears in women who are multiparous. 20 This is potentially due to the difficulty in correctly estimating the episiotomy angles in patients, as perineal distension occurs at crowning of the fetal head.…”