Compares restrictive vs routine episiotomy, midline and mediolateral. Restrictive use reduces posterior perineal trauma, suturing and complications with no difference in pain or severe trauma and an increase in anterior trauma.

RCOG Green Top Guideline: Perineal Repair No.23
http://www.rcog.org.uk/guidelines.asp?PageID=106&GuidelineID=15
Evidence based review which includes suture material, method of repair, operator experience and risk management.

Kettle C, Johanson RB.
Absorbable synthetic versus catgut suture material for perineal repair (Cochrane Review).
In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software, Abstract.

Absorbable synthetic suture material resulted in less short term pain, analgesia usage and dehiscence with no change in long term pain or dysparunia. However absorption time was longer and it needed removal more often than catgut.

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